Direct Access Physical Therapy Policy and Low Back or Neck Pain Disability: An Ecological Study

Author(s):

John Deep, Margaret L. Longacre* and Melissa F. Miller

Background: Low-back and neck pain are major causes of disability in the United States. Policies that increase access to physical therapy may contribute to reducing back and neck pain-related disability.

Aim: This study’s purpose was to assess the association between Direct Access Physical Therapy (DAPT) policies and disability attributable to back/neck pain.

Materials and Methods: Outcomes included 2017 state-level Disability-Adjusted Life Years (DALYs) attributable to back/neck pain, measured per 100,000 population and as a percent of state DALYs. DAPT policy was categorized as unrestricted, provisional, and restricted. Multiple linear regression analysis was used to estimate the association between level of DAPT policy and disability outcomes holding sociodemographic variables constant.

Results: 40% of states had unrestricted DAPT, 54% provisional, and 3 states restricted DAPT. In multivariate analysis, state-level policy allowing unrestricted DAPT compared to provisional was associated with lower percent of total state DALYs attributable to neck pain (p=.014). The level of DAPT policy was not associated with DALYs attributable to low back pain. Sociodemographic variables associated with disability outcomes included age, race, education, and income.

Conclusion: Results suggest that state policies with unrestricted DAPT were associated with lower neck pain disability. Data also highlight socioeconomic factors associated with neck and low-back pain. Future research is required at the individual level to ensure unrestricted DAPT is warranted. These findings provide a foundation for further investigation of direct access physical therapy policy. Exploration of direct access physical therapy policy may inform health care policy makers and support efficient health care resource distribution.