Professional uncertainty and treatment choices by physical therapists

To determine patient, clinician, and practice setting characteristics associated with physical therapists' treatment choices in patients with knee, lumbar, and cervical impairments.

Secondary analysis of data from the Focus on Therapeutic Outcomes (FOTO) database.

Data from 132 physical therapy practices owned by five United States outpatient rehabilitation companies.

The database contained information on 5,061 patients with knee, lumbar, or cervical impairments seen in these practices in 1993 and 1994 and agreeing to participate in data collection. Our sample consisted of 2,491 patients, treated by 462 physical therapists, who had complete data on the variables of interest.

Physical therapists' treatment choices relied on factors other than the patient's clinical status when the impairment was likely to result in professional uncertainty as to diagnosis and consequences of treatments. For patients with spinal impairments, the clinical status of the patient was associated only with the choice of endurance exercises and modalities. Patient's clinical status was associated with every treatment type in patients with knee impairments. Educational level of the physical therapist, patient load, and payer were associated with a variety of treatment choices across the impairment types.

In conditions of professional uncertainty, physical therapy practice may be influenced by many idiosyncratic factors.