Analysis of physicians' referrals: is further diagnosis needed?

BACKGROUND As physical therapy gradually evolves into a more autonomous profession, physicians continue to play a major role in the clinical practice of physical therapists, particularly as a source of patient referral. The analysis of physicians' referrals to physical therapy may be a practical and effective way to study the relationship between physicians and physical therapists. OBJECTIVES The objective of this study was to identify the primary reasons for physicians' referrals to an outpatient physical therapy clinic and to determine whether further diagnosis by the physical therapist is necessitated prior to treatment. METHODS Between January 1, 2001 and March 31, 2003, 544 consecutive physicians' referrals were received in a rural physical therapy outpatient clinic. Physicians' specialties, diagnosis on referral (or reason for referral, if diagnosis not provided), and prescribed orders on referral were all reviewed by the authors. RESULTS One-third (33%) of the referrals were sent to physical therapy with no medical diagnosis (non-specified referrals - NSRs), and the most common reason for the referral in this NSR category was "pain" (88%). Commonly recommended treatments accompanying the NSRs included: evaluation & treatment (60%) and routine rehabilitation protocol (24%) for the relevant joints. CONCLUSION One-third (33%) of the referrals sent to physical therapy included no medical diagnosis, with the most common reason for the referral listed as "pain." Evaluation and treatment was the most recommended treatment accompanying these non-specific referrals (almost 2/3). Physical therapists cannot properly manage patients based on a physician referred diagnosis of "pain," therefore, it is necessary for physical therapists to make further diagnoses.