Physical therapists as first-contact providers for musculoskeletal disorders: comparing beliefs across chiropractors, nurse practitioners, Physical therapists, and physician assistants

OBJECTIVES: Physical therapists (PTs) are increasingly being integrated into first-contact roles for musculoskeletal disorders (MSKDs), but various barriers exist to full implementation. Several barriers may arise from the beliefs and actions of other first-contact provider (FCP) types. Understanding how these different FCP types view their capabilities compared to PTs is essential for identifying factors that may influence first-contact PT integration. This study compared the beliefs of chiropractors, nurse practitioners (NPs), PTs, and physician assistants (PAs) regarding their ability to provide care, educational preparation, and scope of practice related to first-contact care for patients with MSKDs. METHODS: Electronic cross-sectional survey. Surveys were distributed to chiropractors, NPs, PTs, and PAs in the United States. Means, standard deviations, and Pearson's correlations were reported. Multivariate analysis of variance (MANOVA) and post-hoc descriptive discriminant analyses were used to analyze results. RESULTS: Ninety-two respondents completed the survey. PTs received the highest ratings for ability to care (μ = 8.42,8.94) and educational preparation (μ = 9.03), while chiropractors received the lowest for ability to care (μ = 6.40,6.99) and educational preparation (μ = 6.53). For scope of practice, NPs and PAs were rated substantially higher than chiropractors and PTs, particularly for prescribing medication (μ = 8.30-9.51 vs 1.82-4.49). All MANOVA results were significant, with most differences being attributed to chiropractors rating their profession differently from other professions. CONCLUSION: PTs received the highest average ratings for ability to provide care and education preparation for managing patients with MSKDs as an FCP. Most differences related to the ratings of the chiropractic profession, where chiropractors rated their profession higher than others. Despite this, all FCP types generally supported each profession's ability to practice in these roles. However, most FCP types believed chiropractors and PTs should have a more limited scope of practice compared to NPs and PAs.