Legislative change to permit direct access to physical therapy services: a study of process and content issues

The purpose of this study was to examine process and content issues related to legislative change to permit direct access to physical therapy services. Data sources were survey questionnaires sent to the presidents of the 52 chapters of the American Physical Therapy Association (APTA), APTA publications, state statutes, and personal contacts. Results were based on the experiences of 35 chapters, 17 in direct-access states and 18 in non-direct-access states. The majority of direct-access states obtained their status in a single legislative campaign; the majority of non-direct-access jurisdictions attempting legislative change have been unsuccessful for 2 or more years. Over 80% of the chapters reported using legislative lobbyists. Opposing forces varied from state to state and included hospital and medical associations, physicians, chiropractors, and physical therapists. The following limitations on practice in a direct-access mode are found in the various practice acts: diagnosis requirements, eventual referral requirements, physical therapist qualifications, patient consent requirements, and practice setting restrictions.