Physical therapy has gradually evolved into a profession with specialized areas of practice, including primary care, which requires considerable expertise in patient evaluation. Until recently, most physical therapy education programs contained very little if any curricular content related to diagnostic imaging . The prevailing perception was that diagnostic imaging was not useful in daily physical therapy practice. The value of integrating diagnostic imaging information into the physical therapy evaluation was not recognized or explored. Rather, the absence of diagnostic imaging instruction from physical therapy curricula appeared to reflect the traditional model of medicine as well as the physical therapist’s restricted scope of practice .
In recent decades the response of the physical therapy profession to modern patient needs has resulted in an expanded professional identity and higher professional standards. These developments have been and continue to be the catalyst for legislative changes relating to state practice acts. Laws permitting clients direct access to physical therapy have been enacted in 44 states in the United States . Physical therapists, now more than ever, may be the first healthcare professionals’ patients encounter. The potential for the physical therapist to be a primary care provider is one significant factor that has changed the profession’s perception of the importance of diagnostic imaging in the education of physical therapists. As a result, diagnostic imaging is now an integral component of many physical therapy education programs .
The APTA documents “Vision Statement 2020 ,” “Guide to Physical Therapist Practice ,” “A Normative Model of Physical Therapist Professional Education ,” and “Orthopaedic Physical Therapy Description of Specialty Practice ” all contain language supportive of physical therapists’ use of diagnostic imaging information in clinical practice.
In the United States, physical therapists practicing in the military [7,8], in private practice, in health maintenance organizations, in the Veterans Administration, and in other settings may all assume primary care roles, thus necessitating knowledge of and access to diagnostic imaging . Military therapists may now refer patients to radiology for conventional radiographs, bone scans, and Magnetic Resonance (MR) images .
Physiotherapists in Australia , New Zealand [10,11], and the United Kingdom  all have the ability to directly obtain diagnostic imaging for patients within their roles as primary care providers. Diagnostic imaging is a critical piece of the diagnostic process that assists clinicians in screening for serious pathology and in defining musculoskeletal conditions.
The physical therapists were able to reduce the number of radiological examinations by more than 50% in a population of 2,117 patients with low back pain . A study found that physical therapists’ clinical diagnostic accuracy, as compared with MRI findings, was similar to that of orthopedic surgeons and significantly greater than that of non-orthopedic providers .
Physical therapists may incorporate diagnostic imaging information into intervention planning to help them identify barriers to normal movement, to choose safe and appropriate treatment techniques, to decide where to stabilize a limb during movement following a fracture, and to make decisions about weight-bearing .
- Mc Kinnis LN. Fundamentals of Musculoskeletal imaging. 3rd Edition. Philadelphia. F.A. Davis. 2010.
- APTA: A summary of direct access language in state physical therapy practice acts.
- APTA: APTA Vision Sentence and Vision Statement for Physical Therapy. 2020.
- Rothstein JM. Guide to Physical Therapist Practice. Second Edition. Physical Therapy. 2001; 81: 9-746.
- APTA: A Normative Model of Physical Therapist Professional Education: Version 2004. APTA, Alexandria, VA. 2004.
- American Board of Physical Therapy Specialties Specialty Council on Orthopaedic Physical Therapy: Orthopaedic Physical Therapy Description of Specialty Practice. APTA, Alexandria, VA. 2002.
- Dininny P. More than a uniform: The military model of physical therapy. PT Magazine. 1995; 3: 40.
- Greathouse DG, Schreck RC, Benson CJ. The United States Army physical therapy experience: Evaluation and treatment of patients with neuromusculoskeletal disorders. Journal of Orthopedic Sports Physical Therapy. 1994; 19: 261-264.
- Australian Physiotherapy Association: Physiotherapists Diagnostic Imaging Referral Patterns, Presented to the Department of Health and Aging. Australian Physiotherapy. Association, August. 2004.
- Littlejohn F, Nahna M, Newland C, Robins S. What are the protocols for imaging referral by physiotherapists? NZ J Physiother. 2006; 34: 81.
- Scrymgeour J. Moving on: A history of the New Zealand Society of Physiotherapists, Inc. 1973–1999. Wellington. The New Zealand Society of Physiotherapists, Inc. 2000.
- The Chartered Society of Physiotherapy: Chartered physiotherapists working as extended scope practitioners. Information paper no. PA29. London. 2002.
- James JJ, Stuart RB. Expanded role for the physical therapist: Screening musculoskeletal disorders. Physical Therapy. 1975; 55: 121-131.
- Moore JH, Goss DL, Baxter RE, DeBerardino TM, Mansfield LT, Fellows DW, et al. Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers. Journal of Orthopedic Sports Physical Therapy. 2005; 35: 67.