Direct Access to Physical Therapy: Should Italy Move Forward?

Abstract

Direct access to physical therapy (DAPT) is the patient’s ability to self-refer to a physical therapist, without previous consultation from any other professional. This model of care has been implemented in many healthcare systems since it has demonstrated better outcomes than traditional models of care. The model of DAPT mainly focuses on the management of musculoskeletal disorders, with a huge epidemiological burden and worldwide healthcare systems workload. Among the healthcare professionals, physical therapists are one of the most accessed for managing pain and disability related to musculoskeletal disorders. Additionally, the most updated guidelines recommend DAPT as a first-line treatment because of its cost-effectiveness, safety, and patients’ satisfaction compared to other interventions. DAPT was also adopted to efficiently face the diffuse crisis of the declining number of general practitioners, reducing their caseload by directly managing patients’ musculoskeletal disorders traditionally seen by general practitioners. World Physiotherapy organization also advocates DAPT as a new approach, with physical therapy in a primary care pathway to better control healthcare expenses. Thus, it is unclear why the Italian institutions have decided to recognize new professions instead of focusing on the growth of physical therapy, a long-established and autonomous health profession. Furthermore, it is unclear why DAPT is still not fully recognized, considering the historical context and its evidence. The future is now: although still preliminary, the evidence supporting DAPT is promising. Hard skills, academic paths, scientific evidence, and the legislature argue that this paradigm shift should occur in Italy.

Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists

“…Our results showed that Italian physiotherapists were more focused on the patients’ beliefs and preferences instead of their anxiety surrounding safety, recognizing the patient-centered approach as a key feature of their practice [ 99 ]. Our results also demonstrated that working in a direct access setting and having more years of practice is associated with an increase in comfort level; that is, giving the opportunity to practice their skills increases the physiotherapists’ confidence [ 100 – 102 ]. In line with UK, USA, and the Netherlands, most respondents perceived “lack of practice/training” and “lack of clinical experience” as major barriers to performing SM for all spinal regions [ 26 – 28 ].…”

Physiotherapy Screening for Referral of a Patient with Patent Foramen Ovale Presenting with Neck Pain as Primary Complaint: A Case Report

“…Our case report illustrates the informed clinical decision-making process performed by a physiotherapist working in a direct access setting that led to triage a cardiovascular disease in a patient complaining of NP [ 75 , 76 , 77 ]. NP and head/orofacial symptoms have been already observed as the early manifestation of cardiovascular diseases (including PFO), vascular pathologies and blood flow limitations [ 8 , 64 , 65 , 78 , 79 ].…”

Assessing cardiovascular parameters and risk factors in physical therapy practice: findings from a cross-sectional national survey and implication for clinical practice

“…Clinical Practice Guidelines are paramount to implement the most updated available knowledge in clinical practice [45,46]. Additionally, as the Italian Physiotherapy Association advocates for direct access [28][29][30], Clinical Practice Guidelines knowledge is a professional responsibility [47]. Surprisingly, 60.2% reported that cardiovascular measurements are outside their scope of practice.…”

“…In Italy cardiovascular rehabilitation is included during the entry level training for physiotherapists. Italian physiotherapists are also increasingly practicing as direct access providers, which potentially makes them the first point of contact within the healthcare system [28][29][30]. Therefore, it is imperative that Italian physiotherapists understand the importance of CVD screening, and demonstrate competency impact the patient and the practitioner.…”