Will Screening for Pathology by Physical Therapists Lower Surgical Rates?

Direct access to physical therapy services is safe and effective for patients with musculoskeletal problems, like lower back pain.

Physical therapists can screen for ominous findings, such as cancer, with a predictive accuracy that meets rates by diagnostic imaging, such as x-rays, MRI or bone scans.

"Among patients who develop epidural spinal cord compression, those who are diagnosed early, while still able to ambulate, are the most likely to remain ambulatory following treatment.

The ideal diagnostic strategy would detect the few cases of cancer among primary care patients with low back pain, while minimizing unnecessary diagnostic testing."

Physical therapist early intervention may reduce unnecessary, expensive and risky back surgeries if two conditions are met:

1. Over-diagnosis of pathology by physical therapists detected in the screening examination is not sent for unnecessary diagnostic imaging, and...
   
2. Patients attitudes and choices regarding "risk free" surgical fixes do not continue to increase.

A recent study from Norway on the effect of population screening for breast cancer in 35,408 women found that screening increased that rate of surgical mastectomies in two of the three age groups.

According to the study authors:

"The objective of mammography screening is to improve the timing of breast cancer diagnosis, thereby reducing the number of associated deaths.

A potential additional benefit often stated in invitations to screening and on websites supported by governmental screening institutions is that screening reduces
the need for mastectomies and increases the potential for breast conserving treatment."

A corollary for physical therapist screening suggests that early detection of pathology and subsequent appropriate treatment should reduce unnecessary treatments, including hospitalizations, re-hospitalizations and death.

The recent meeting of the Florida Physical Therapists in Private Practice, attended by 81 private practice physical therapists, looked at physical therapist screening to reduce healthcare costs and improve outcomes under Medicare Accountable Care Organizations.

Diagnosis by physical therapists will be an important part of America's future healthcare system.

How much the physical therapists' diagnosis improves patients' lives and reduces system costs will determine the value physical therapists bring to this future system.