Journal of Manual & Manipulative Therapy最新文献

{"title":"Inter-rater reliability of Mechanical Diagnosis and Therapy (MDT) in evaluating and classifying chronic pelvic pain syndrome.","authors":"Di Wu, Catherine Bednarczyk, Adriana RamonFigueroa, Helen Zhu, Meridith Geer, Richard Rosedale, Shawn M Robbins","doi":"10.1080/10669817.2025.2475456","DOIUrl":"https://doi.org/10.1080/10669817.2025.2475456","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pelvic pain syndrome (CPPS) involves complex interactions between the musculoskeletal system, nervous system, and psychosocial factors. A major challenge in managing CPPS is the lack of reliable assessment and classification systems. The Mechanical Diagnosis and Therapy (MDT) is a widely used and reliable classification system for assessing and managing painful musculoskeletal conditions affecting the spine and extremities. This study's primary objective was to assess the inter-rater reliability of the MDT assessment in diagnosing CPPS using clinical vignettes. Secondary objectives included determining the prevalence of MDT classification categories.</p><p><strong>Methods: </strong>Five MDT clinicians classified clinical vignettes into three categories: 1) Spinal Derangement, 2) Pelvic Floor Contractile Dysfunction, or 3) MDT OTHER subgroups. The vignettes were developed from the McKenzie Pelvic Pain Assessment Form. Inter-rater reliability among clinicians was calculated using the Fleiss kappa statistic with 95% confidence intervals, and Cohen's kappa examined reliability between pairs of raters.</p><p><strong>Results: </strong>A total of 76 vignettes were developed (40 females and 36 males). Good inter-rater reliability was found among clinicians (Fleiss kappa = 0.616, 95% CI = 0.598-0.633, <i>p</i> < 0.001). Inter-rater reliability was higher when classifying female vignettes (Fleiss kappa = 0.658, 95% CI = 0.634, 0.682) than male vignettes (Fleiss kappa = 0.546, 95% CI = 0.519, 0.573). The most common classification was Spinal Derangement (57%), followed by MDT OTHER subgroups (26%) and Pelvic Floor Contractile Dysfunction (17%).</p><p><strong>Conclusions: </strong>The study indicates good inter-rater reliability among MDT clinicians in classifying pelvic pain syndrome. However, clinical vignettes may not fully capture the complexities of real participant interactions, potentially inflating agreement. Future studies should incorporate direct observation of real participant encounters alongside clinical vignettes to improve validity.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-8"},"PeriodicalIF":1.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the impact of interactive versus traditional e-learning on physiotherapists' knowledge, attitudes, and clinical decision-making in low back pain management: a randomized controlled trial.","authors":"Antoine Fourré, Jef Michielsen, Laurence Ris, Ben Darlow, Rob Vanderstraeten, Hilde Bastiaens, Christophe Demoulin, Nathalie Roussel","doi":"10.1080/10669817.2025.2476670","DOIUrl":"10.1080/10669817.2025.2476670","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the recommendations to use a bio-psycho-social framework, many physiotherapists still manage their patients mainly from a biomedical point of view. The purpose of this study is to analyze the impact of two different e-learning interventions on knowledge, attitudes, and clinical decision-making of physiotherapists managing low back pain (LBP) to increase guideline-consistent care.</p><p><strong>Methods: </strong>Physiotherapists were allocated (1/1) either to an experimental or a traditional e-learning intervention. Baseline and post-intervention assessment included the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), and a clinical vignette. Participants had 2 weeks to complete the post-intervention assessment. Statistics were processed using ANCOVA and Fisher's t-tests.</p><p><strong>Results: </strong>Four hundred nineteen physiotherapists were included in the analysis. Mean scores of HC-PAIRS, Back-PAQ, and NPQ significantly improved post-intervention in both groups. There was a significant effect of the intervention type (experimental versus traditional) on the scores of HC-PAIRS (<i>p</i> < .001; η²_p = .243) and Back-PAQ (<i>p</i> < .001; η²_p = .135) but not on NPQ scores. Return to work, recommendations assessed with the clinical vignette were significantly more guideline-consistent in the experimental group (<i>p</i> < .001) post-intervention.</p><p><strong>Conclusion: </strong>An interactive e-learning intervention which includes concrete clinical examples and focused on patient's reassurance, self-management, and importance of screening psycho-social factors had more impact than a traditional e-learning intervention to enhance physiotherapists' knowledge, attitudes, and clinical decision-making regarding LBP.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-14"},"PeriodicalIF":1.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information needs for people with neck pain seeking physiotherapy neck manipulation or mobilization: an exploratory study.","authors":"Michelle Lumasag, Anita Gross, Derek Clewley, Pasqualina Santaguida","doi":"10.1080/10669817.2025.2472374","DOIUrl":"https://doi.org/10.1080/10669817.2025.2472374","url":null,"abstract":"<p><strong>Objective: </strong>To explore the foundational needs for a decision aid on receiving physiotherapy neck manipulation and mobilization from a broad age spectrum.</p><p><strong>Method: </strong>An e-survey was conducted from January to 30 April 2024, targeted child/infant-parent dyads, adolescents, adults, and adult-caretaker dyads with neck pain who received physiotherapy treatment in Canada and the United States. The survey method captured knowledge and attitudes to manual therapy, treatment expectations (10 items from the Treatment Expectation Questionnaire (TEX-Q), decision conflict (Decisional Conflict Scale (DCS)) and participant demographics. Descriptive analyses were used to assess responses.</p><p><strong>Results: </strong>Out of 146 participants who started the survey, 48 adults (mean age 48) completed it fully. Due to low response rates, the survey lacked insights into adolescent, child/infant-parent, or adult-caretaker dyads. Most respondents were familiar with mobilization (86%) and manipulation (82%). Mobilization was preferred (67%) and viewed more favorably compared to manipulation (7%), which was seen as riskier. Stroke was identified as the top risk/adverse event for techniques and was more commonly associated with manipulation (52%) than mobilization (25%). Other perceived risks included soreness, pain, headache, stiffness, tenderness, dizziness, and fatigue, reported more often for mobilization (57%) than manipulation (41%). The TEX-Q showed that respondents' treatment expectations were largely met, indicating positive expectations. Additionally, low scores on the DCS subscales and total scores (mean 16.26, SD 21.00) reflected minimal decisional conflict among respondents.</p><p><strong>Conclusion: </strong>The study found that adults with neck pain who received physiotherapy involving neck manipulation or mobilization were well informed about the benefits, risks, and potential major and minor adverse events of their treatment. Their expectations for treatment were generally positive, and they experienced minimal decisional conflict. To further support shared decision-making, we recommend adding a qualitative component, such as structured interviews or focus groups with inter-professional child/infant-parent dyads, to help clinicians improve patient counseling and decision-making guidance.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-8"},"PeriodicalIF":1.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of lumbar segmental motion using ultrasound imaging following common joint mobilization techniques.","authors":"Nathan J Savage, Katelyn George, Evante Gibson, Kayleigh Taylor","doi":"10.1080/10669817.2025.2470464","DOIUrl":"10.1080/10669817.2025.2470464","url":null,"abstract":"<p><strong>Objectives: </strong>Spinal mobility is clinically important in managing mechanical low back pain. Manual methods are commonly used for diagnosis and treatment in orthopedic practice. This study quantified changes in sagittal plane lumbar segmental motion using ultrasound imaging (USI) following common joint mobilization techniques in asymptomatic individuals. Additionally, tibial H-reflexes and sagittal plane trunk motion in standing were evaluated for association with lumbar segmental motion.Participants aged ≤ 30 or ≥ 50 years were recruited from among students, faculty, and affiliates of the Department of Physical Therapy at Winston-Salem State University and randomized to receive L4 central posterior-to-anterior (CPA) mobilization or left lumbar rotation mobilization interventions. Joint laxity was assessed using the Beighton score, and standing sagittal plane trunk motion was measured using the fingertip-to-floor method. Lumbar segmental motion was evaluated using USI in neutral, extension, and flexion positions at baseline, immediately following joint mobilization, and following 5 minutes of prone resting. Tibial H-reflexes were measured at baseline, immediately following joint mobilization, and in real-time during CPA mobilization. The primary outcome was lumbar segmental motion analyzed by position, mobilization group, sex, age category, and Beighton risk.</p><p><strong>Results: </strong>Repeated measures ANOVA revealed significant increases in L4/5 flexion (<i>p</i> = .01, ƞ²=.21) and combined flexion and extension (<i>p</i> = .03, ƞ²=.15). These changes persisted following 5 minutes of prone resting, regardless of mobilization technique. Significant interactions between segmental motion, sex, and/or Beighton risk were observed.</p><p><strong>Discussion/conclusion: </strong>Significant increases were observed in L4/5 flexion immediately following joint mobilization regardless of mobilization group, with significant statistical interactions observed between segmental motion, sex, and/or Beighton risk. This is the first investigation to demonstrate the value of USI for quantifying lumbar segmental motion following joint mobilization. Quantifying lumbar segmental motion helps clarify the underlying mechanisms of manual therapy. Future studies should include patients with low back pain.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-13"},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of integrated neuromuscular inhibition technique on subjects with neck pain and forward head posture: a randomized controlled trial.","authors":"Rania Reffat Ali, Somaya Nady Mohamed Elsayed, Ragia Mohamed Kamel, Ebtisam Mohamed Fahmy, Hend Ahmed Hamdy","doi":"10.1080/10669817.2025.2476662","DOIUrl":"https://doi.org/10.1080/10669817.2025.2476662","url":null,"abstract":"<p><strong>Objective: </strong>Forward head posture (FHP) and neck pain are common musculoskeletal complaints. This study aimed to evaluate the effect of the Integrated Neuromuscular Inhibition Technique (INIT) on the range of motion (ROM) and craniovertebral angle (CVA) in individuals with FHP and neck pain.</p><p><strong>Methods: </strong>A total of 40 physical therapy participants (26 females and 14 males), aged 18 to 23 years (mean age: 20 ± 1.71 years), participated in this study. They were randomized into two groups: Group A received conventional therapy combined with Integrated Neuromuscular Inhibition Technique (INIT) targeting the upper trapezius and suboccipital muscles, while Group B received conventional therapy consisting of strengthening and stretching exercises only. The treatment was administered three times per week for one month.Photographic sessions were conducted using a mobile phone. A Realme 7 Pro camera and CorelDRAW software were employed to analyze the craniovertebral angle (CVA). A pressure algometer was used to measure the pressure pain threshold (PPT), while a visual analogue scale (VAS) was utilized to assess pain severity. Additionally, a clinometer application on an Android device was used to evaluate cervical range of motion (ROM).</p><p><strong>Results: </strong>Both groups demonstrated significant improvements in craniovertebral angle (CVA) and visual analogue scale (VAS) scores, with Group A showing a 16.12% improvement in CVA and a 75.61% reduction in VAS, compared to a 7.20% improvement in CVA and a 57.14% reduction in VAS in Group B.Group A also showed a significantly greater post-treatment increase in CVA (<i>p</i> = 0.01), cervical range of motion (ROM) for flexion (<i>p</i> = 0.002), extension (<i>p</i> = 0.005), right bending (<i>p</i> = 0.001), left bending (<i>p</i> = 0.001), right rotation (<i>p</i> = 0.001), and left rotation (<i>p</i> = 0.001). Additionally, Group A exhibited a significantly greater decrease in VAS (<i>p</i> = 0.003) compared to Group B following treatment.</p><p><strong>Conclusion: </strong>The Integrated Neuromuscular Inhibition (INI) technique, which combines ischemic compression, strain-counterstrain, and muscle energy techniques, yields superior outcomes compared to conventional therapy alone for individuals with forward head posture (FHP) and neck pain. It is particularly effective in improving craniovertebral angle (CVA), reducing pain levels, and enhancing cervical range of motion (ROM).</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-11"},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An international consensus on the etiology, risk factors, diagnosis and Management for individuals with Frozen Shoulder: a Delphi study.","authors":"Paul Salamh, Brent Stoner, Nathaniel Ruley, Huiling Zhu, Marcus Bateman, Rachel Chester, Liesbet Da Baets, Jo Gibson, Luise Hollmann, Martin Kelley, Jeremy Lewis, Philip McClure, Karen McCreesh, Michel Gcam Mertens, Lori Michener, Amee L Seitz, Filip Struyf, Joseph Zuckerman, William King","doi":"10.1080/10669817.2025.2470461","DOIUrl":"https://doi.org/10.1080/10669817.2025.2470461","url":null,"abstract":"<p><strong>Introduction: </strong>There has been an emergence of evidence in the area of frozen shoulder (FS) within the past decade related to risk factors, etiology, diagnosis, and management. It has become increasingly challenging for clinicians and researchers to stay up to date in these areas, particularly with the clinical practice guidelines that are available being few and outdated. To this end, the aim of this study was to produce an international consensus on the risk factors, etiology, diagnosis and management for individuals with FS.</p><p><strong>Methods: </strong>During phase one a steering committee was formed in order to identify experts in the area of FS, examine the current evidence related to FS and identify key areas lacking consensus. Phase two consisted of inviting experts to participate in a three-round survey with a priori consensus level set at 80%. Descriptive statistics were utilized to determine the characteristics of the expert panel, response rate, and level of consensus.</p><p><strong>Results: </strong>A total of 14 international experts responded to all three rounds of the Delphi survey with 100% response rate following round one. Consensus was reached for 101 items (57 in the first round, 37 in the second round and 7 in the third and final round). Specific to key topic areas, the following number of items reached consensus; etiology 9 items (diabetes mellitus, trauma, shoulder arthroscopy, thyroid disease, prolonged immobilization, adrenocorticotropic hormone deficiency, metabolic synderome, connective tissue disorders, and hyperlipidemia), risk factors 40 items (including biophysical factors for developing FS and biophysical and psychosocial factors influencing the Management and course of outcomes related to FS), diagnosis 19 items (4 confounding the diagnosis and 15 signs and symptoms associated with FS), Management 33 items overall and categorized into effectiveness for early and later stages of FS).</p><p><strong>Conclusion: </strong>The results of this international Delphi study help to provide a consensus on key elements to consider in clinical practice related to etiology, risk factors, diagnosis, and management for those with FS.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-12"},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point of care ultrasonography in physical therapists' clinical practice: a clinical perspective.","authors":"Lorna M Hayward, Alycia M Markowski, Bruno U K Steiner, Murry E Maitland, Maureen K Watkins, Robert C Manske, George J Beneck","doi":"10.1080/10669817.2025.2470460","DOIUrl":"https://doi.org/10.1080/10669817.2025.2470460","url":null,"abstract":"<p><p>This paper offers a contemporary, evidence-based perspective on how point of care ultrasonography imaging (POCUS) has the potential to impact orthopedic and sports physical therapists' examination and treatment. Clinical use of POCUS has increased in medicine and is emerging in physical therapist practice. Greater affordability, portability, ease of use, and evidence supporting its' diagnostic value have contributed to increased use. Modern ultrasound devices have improved resolution allowing for the differentiation of anatomical structures. Physical therapists use POCUS in clinical practice as an extension of the physical examination to confirm, refute, expand, or narrow a differential diagnosis. Doctor of Physical Therapy professional education provides entry-level student physical therapists with the foundational knowledge necessary for the clinical application of POCUS. A physical therapist's use of POCUS complements the clinical evaluation and contrasts with the approach of referring out for diagnostic imaging and waiting for results. We present current evidence for expanded use of POCUS by physical therapists in clinical practice. We advocate for using ultrasound imaging in orthopedic and sports physical therapists' practice. Integrating POCUS into physical therapist patient management, could decrease patient healthcare costs through increased diagnostic efficiency.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Straight leg raise versus knee extension angle: which structure limits the test in asymptomatic subjects?","authors":"Pierre Pesesse, Sebastien Wolfs, David Colman, Stephanie Grosdent, Marc Vanderthommen, Christophe Demoulin","doi":"10.1080/10669817.2025.2465739","DOIUrl":"https://doi.org/10.1080/10669817.2025.2465739","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine if the first onset of symptoms (discomfort) during the straight leg raise (SLR) (hip flexion with an extended knee) and the Knee Extension Angle (KEA) tests (knee extension with 90°of hip flexion) results from nervous or muscular structures in asymptomatic individuals. The secondary objective was to investigate if the gender influences the structure related to the discomfort.</p><p><strong>Methods: </strong>This cross-sectional study consisted of a single assessment session during which the structure related to participants' discomfort during the KEA and SLR was identified. For this identification, a structural differentiation (SD) was conducted during both tests using passive mobilization of the cervicothoracic spine in flexion and extension. Changes in participants' discomfort were monitored during the SD to determine whether a change or lack of change was consistent with variations in the load applied to the suspected structures either muscular or neural. If the structure related to the participants' discomfort could not be identified, two additional tests were conducted: the lateral SLR and the Slump test.</p><p><strong>Results: </strong>One hundred and seventy-eight individuals were included. Median [IQR] age was 21 years [20;23], and 57.3% were female. The structure related to participants' discomfort was similar for the SLR and the KEA (<i>p</i> = 0.451): neural for 72.5% of participants in the SLR and 75.8% in the KEA. Gender only influenced the structure identified in the KEA test, with a significantly higher rate of nerve-related discomfort in females than males and a significantly higher rate of muscle-related discomfort in males (<i>p</i> = 0.002).</p><p><strong>Conclusion: </strong>In asymptomatic individuals, the discomfort induced by the SLR and the KEA tests could be related to either muscular or neural structures. Therefore, structural differentiation is necessary to identify the structure causing the discomfort in both research and clinical practice.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From placebos and shams to high-quality control interventions in manual therapy trials to study efficacy and mechanisms.","authors":"David Hohenschurz-Schmidt, Lene Vase, Jerry Draper-Rodi","doi":"10.1080/10669817.2025.2471477","DOIUrl":"https://doi.org/10.1080/10669817.2025.2471477","url":null,"abstract":"","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-2"},"PeriodicalIF":1.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ordering of diagnostic imaging by physical therapists: a multi-center analysis of successful implementation.","authors":"Aaron Keil, Evan O Nelson, Stephen Michael Kareha, Scott Tauferner, Brian Baranyi, Kelly Clark","doi":"10.1080/10669817.2025.2465738","DOIUrl":"https://doi.org/10.1080/10669817.2025.2465738","url":null,"abstract":"<p><strong>Objective: </strong>The profession of physical therapy in the United States has evolved significantly since the American Physical Therapy Association introduced Vision 2020, advocating for consumers' direct access to physical therapy services. As the use of direct access expands, it becomes essential to examine successful models and resources, such as those that allow physical therapist referral for diagnostic imaging. This study aims to report the utilization, appropriateness, and reimbursement for diagnostic imaging referrals made by physical therapists during routine care across multiple health care organizations.</p><p><strong>Methods: </strong>This study was a retrospective observational study of patients seeking care for neuromusculoskeletal conditions at ambulatory physical therapy clinics at three healthcare organizations. Data from each organization related to physical therapist referral for diagnostic imaging was reviewed to determine utilization rate, appropriateness, and reimbursement. American College of Radiology (ACR) criteria were used to determine appropriateness of diagnostic imaging referral.</p><p><strong>Results: </strong>Seventy-five physical therapists signed 596 referrals for diagnostic imaging during 61,012 episodes of routine care. The utilization rate was 9.8 diagnostic imaging referrals per 1000 episodes of care. Ninety-one percent of the referrals were consistent with evidence based ACR guidelines and deemed appropriate. There were no instances of insurance denial when a physical therapist signed the referral for diagnostic imaging.</p><p><strong>Conclusion: </strong>Physical therapists with privileges to directly refer for diagnostic imaging did so judiciously and followed ACR guidelines when referring patients for imaging. The absence of insurance reimbursement claim denial contrasts a common concern about physical therapist referral for diagnostic imaging. Physical therapists referred for appropriate imaging studies and are unlikely to contribute to diagnostic imaging overutilization.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-8"},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}