Geospatial Disparities in Access to Outpatient Physical and Occupational Therapy Services in Texas: Implications for Health Equity and Rehabilitation Workforce Policy

Equitable access to rehabilitation services is essential for individuals living with a disability, yet geographic disparities in outpatient rehabilitation care remain understudied. This study examined spatial accessibility to outpatient physical and occupational therapy services across Texas to identify regional inequities and inform workforce and policy planning. A descriptive cross-sectional geospatial analysis was conducted using outpatient clinic location data from the Texas Health and Human Services database (2022) and population data from the 2020 U.S. Census. Clinic addresses were verified and geocoded. Accessibility was measured using an origin-destination cost matrix to estimate the travel time to the nearest clinic, and the two-step floating catchment area (2SFCA) method to calculate an accessibility index. Spatial clustering of access was assessed using the Getis-Ord Gi* statistic to identify hot and cold spots. The analysis included 2255 outpatient rehabilitation clinics across 6896 census tracts. Travel times varied substantially, with rural areas experiencing the longest travel burdens. The 2SFCA analysis revealed pronounced disparities, with low-accessibility clusters concentrated in rural and border regions and high-accessibility clusters in urban metropolitan areas. These findings demonstrate persistent geographic disparities in outpatient rehabilitation access across Texas, suggesting the need for targeted workforce placement, transportation investment, and policy interventions to improve equitable access.