Is a prescriptive or an open referral related to physical therapy outcomes in patients with lumbar spine-related problems?

STUDY DESIGN: Retrospective review of medical records. OBJECTIVES: To describe characteristics of patients with lumbar spine dysfunction, and to compare functional outcome and number of visits to physical therapy according to type of physician referral. BACKGROUND: The type of referral, characterized as prescriptive or open, has been associated with the perceived amount of supervision that is required for the provision of physical therapy care. The rationale for prescriptive referrals is not consistent with autonomous physical therapy practice, and may be deemed unnecessary if such referrals are associated with equivalent outcomes. METHODS AND MEASURES: Medical records of patients treated within a rehabilitation provider network between October 2002 and December 2003 were reviewed retrospectively for administrative and clinical variables. Subjects were selected if they completed the Roland Morris Questionnaire (RMQ) on admission and discharge from physical therapy care. Associations between referral type, discharge RMQ scores, and number of visits were determined using independent t tests and were further examined using stepwise multiple regression analysis. RESULTS: Ninety-six records met inclusion criteria, of which 54 (56.2%) had open referrals and 42 (43.8%) had prescriptive referrals. Type of referral was not associated with number of visits in bivariate or in multivariate analyses, Prescriptive referrals were associated with higher discharge RMQ scores, representing greater disability, in bivariate analysis (t test, P = .03); however, this association was attenuated in multivariate analyses after adjustment for physician status as primary care practitioner or specialist. CONCLUSION: Prescriptive referrals were not associated with enhanced outcomes of physical therapy care.