title: Decision-making ability of physical therapists: physical therapy intervention or medical referral.
abstract: OBJECTIVE
  Opponents of direct access to physical therapy argue that physical therapists may overlook serious medical conditions. More information is needed to determine the ability of physical therapists to practice safely in direct-access environments. The purpose of this study was to describe the ability of physical therapists to make decisions about the management of patients in a direct-access environment.
  
  
  METHODS
  Of a random sample of 1,000 members of the Private Practice Section of the American Physical Therapy Association, 394 participated.
  
  
  METHODS
  A survey included 12 hypothetical case scenarios. For each case, participants determined whether they would provide intervention without referral, provide intervention and refer, or refer before intervention. The percentage of correct decisions for each group of scenarios was calculated for each participant, and participants were classified as having made correct decisions for 100% of cases or less for each group. Three sets of logistic regressions were completed to determine the characteristics of the participants in relation to the decision category.
  
  
  RESULTS
  The average percentages of correct decisions were 87%, 88%, and 79% for musculoskeletal, noncritical medical, and critical medical conditions, respectively. Of all participants, approximately 50% made correct decisions for all cases within each group. The odds of making 100% correct decisions if a physical therapist had an orthopedic specialization were 2.23 (95% confidence interval=1.35-3.71) for musculoskeletal conditions and 1.89 (95% confidence interval=1.14-3.15) for critical medical conditions.
  
  
  CONCLUSIONS
  Physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.
authors.affiliation: Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA. diane.jette@uvm.edu
authors.forename: Diane U
authors.initials: DU
authors.lastname: Jette
authors.forename: Kerry
authors.initials: K
authors.lastname: Ardleigh
authors.forename: Kellie
authors.initials: K
authors.lastname: Chandler
authors.forename: Lesley
authors.initials: L
authors.lastname: McShea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000628:therapy; D026761:Physical Therapy Specialty; D011361:Professional Competence; D012017:Referral and Consultation; D011795:Surveys and Questionnaires