Identifying physical therapists’ attitudes, beliefs, and barriers toward diagnostic imaging referral: a mixed-methods study

ABSTRACT

Objective

Ten states, including the District of Columbia, have laws that currently permit physical therapists (PTs) to directly order diagnostic imaging (DI) in the United States. Military and civilian PTs order DI judiciously and appropriately demonstrating optimal patient outcomes and satisfaction when compared to other medical professionals. However, no studies have explored perceived attitudes, beliefs, and barriers to PT DI referral specific to North Dakota (ND). Therefore, the purpose of this mixed-methods study was to identify ND PTs’ attitudes, beliefs, and barriers toward DI referral.

Methods

A total of 147 participants completed an online survey with a subset of 17 participants agreeing to an interview. Frequency counts of demographic data and perceived barriers were completed. A binary logistic regression was run on demographic data. One-on-one interviews were conducted with a thematic coding process completed within a qualitative analysis.

Results

Seventy-four percent of PTs reported not currently referring for DI, although 71% felt that it would improve their patient outcomes. PTs with post-professional training (OR = 4.59), a doctorate degree (OR = 3.84), practicing in an orthopaedic or sports setting (OR = 3.55), and practicing within an urban setting of ND (OR = 3.01) were more likely to refer for DI. The main barriers identified in the survey included: (1) the logistics of performing a DI referral, (2) DI referrals only privileged to other medical providers, (3) provider/work relationship dynamics, (4) the cost of continuing education (CE), (5) and the inability to identify CE. One-on-one interviews further identified five main themes related to DI referral.

Discussion/Conclusion

Several barriers identified resulted in 74.1% of PTs not directly referring for DI, although certain characteristics (post-professional training, doctorate degree, orthopaedic/sports setting, practicing in an urban area in ND) were more likely to refer for DI. This study may help improve future adoption and implementation of DI referral in current and future states.

KEYWORDS:

• Plain film radiography
• diagnostic imaging referral
• barriers
• attitudes
• physical therapy

Acknowledgements

The authorship team would like to thank Scott Holm and the ND Board of Physical Therapy for distributing the survey to all physical therapists licensed in ND.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions statement

KK, MAS, CD, and SL all developed the final study protocol and submitted it to the university’s institutional review board. These authors designed the data in the form of the survey and interview and wrote the initial draft of the manuscript, with assistance from MRS in various sections. MRS conceived the study idea, where JH assisted MRS in analyzing the data and interpretation of quantitative and qualitative results. MRS provided feedback for drafts of the manuscript and helped supervise the project process. All authors approved of the final version.

Additional information

Funding

The authors report there is no funding associated with the work featured in the article.

Notes on contributors

Matthew R. Schumacher

Matthew R. Schumacher PT, DPT, MTC, OCS, FAAOMPT is an assistant professor and core faculty in the University of Mary Physical Therapy program in Bismarck, ND. He is a Board-Certified Orthopaedic Clinical Specialist through the American Physical Therapy Association, trained with a Manual Therapy Certification through Evidence in Motion, and a Fellow of the American Academy of Orthopaedic Manual Physical Therapy.

Kendra A. Karl

Kendra A. Karl PT, DPT graduated from the University of Mary in Bismarck, ND with her Doctor of Physical Therapy degree in 2024. She is a travel physical therapist in the United States for Big Stone Therapies. She works full-time in outpatient orthopaedic and sports medicine settings.

Mattias A. Stich

Mattias A. Stich PT, DPT, graduated from the University of Mary in Bismarck, ND with his Doctor of Physical Therapy degree in 2024. He is a Sergeant in the North Dakota Army National Guard and is currently a traveling physical therapist with a passion for the pediatric setting.

Christopher R. Dean

Christopher R. Dean PT, DPT graduated from the University of Mary in Bismarck, ND with his Doctor of Physical Therapy degree in 2024. He is currently a travel physical therapist with interests in neuro, pediatrics, and vestibular rehabilitation.

Sara R. Lawson

Sara R. Lawson PT, DPT graduated from the University of Mary in Bismarck, ND with her Doctor of Physical Therapy degree in 2024. She is currently working full-time in the orthopaedics outpatient setting and possesses an interest in vestibular and pelvic health rehabilitation.

Jason L. Hogan

Jason L. Hogan PT, MPT, DSc is an assistant professor, core faculty, and researcher in the University of Mary Physical Therapy program in Bismarck, ND. He is trained through Postural Restoration Institute and a graduate of the Doctor of Science program through the University of Oklahoma.