Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists.
Childs, John D., et al. "A description of physical therapists' knowledge in managing musculoskeletal conditions." BMC Musculoskeletal Disorders 6 (2005): 32.
Physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.
Jette, Diane U., et al. "Decision-making ability of physical therapists: physical therapy intervention or medical referral." Physical Therapy 86.12 (2006): 1619-1629.
Clinical diagnostic referral accuracy by PTs and Orthopaedic surgeons on patients with musculoskeletal injuries was significantly greater than that of General Practioners, with no difference noted between PTs and Orthopaedists
Moore, Josef H., et al. "Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers." Journal of Orthopaedic & Sports Physical Therapy 35.2 (2005): 67-71.
Direct Access without a referral:
Data from studies supported that costs to patient or insurance companies per physical therapy episode of care were less when patients saw a physical therapist directly versus through physician referral, likely due to less imaging ordered, injections performed, and medications prescribed. Pendergast et al. found the mean allowable amounts during the episode of physical therapy care were approximately $152 less for physical therapy–related costs and $102 less for non–physical therapy–related costs, amounting to over $250 less for total costs per episode of care. Mitchell and de Lissovoy found that paid claims per episode of care were $1,232 less in the direct access group for all services and drugs per episode of physical therapy care
Ojha, Heidi A., Rachel S. Snyder, and Todd E. Davenport. "Direct access compared with referred physical therapy episodes of care: a systematic review." Physical therapy 94.1 (2014): 14.
Fritz et al reported that total LBP-related expenditures in a civilian population averaged $2736.23 lower per episode in the patient group that received physical therapy within 14 days of their visit to their primary care than those in the group that received physical therapy after 14 days.
Childs et al studied a military population and found that total LBP related expenditures averaged $1202.29 lower per episode in the patient group that received early physical therapy intervention compared to delayed physical therapy.
Patients who received early physical therapist management for cervical pain demonstrated better value in decreasing disability and pain compared to patients who received delayed physical therapist management. When controlling for covariates, patients receiving early physical therapist management demonstrated a 2.27 percentage point change in disability score per 100 dollars compared to patients who received delayed physical therapist management who demonstrated a 1.22 percentage point change in Neck Disability Index (NDI) per 100 dollars spent.
Patients who received early physical therapist management also demonstrated a greater change in pain per 100 dollars compared to patients who received delayed physical therapist management. Patients who received early physical therapist management also experienced more efficiency in reducing disability and pain with physical therapist management of neck pain. The patients who received early physical therapist management achieved a 3.44 percentage point change in NDI score per visit and 0.57 point change in pain compared to a 1.81 percentage point change in NDI score and 0.42 point change in pain per visit when patients received delayed physical therapist managemen