Legislative Change to Permit Direct Access to

Physical Therapy Services: A Study of Process and

Content Issues
Tamra K Taylor and Elizabeth Domholdt
PHYS THER. 1991; 71:382-389.

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Research Report

Legislative Change to Permit Direct Access

to Physical Therapy Services: A Study of
Process and Content Issues

Tarnra K Taylor
Elizabeth Domholdt

The purpose of this study was to examine process and content issues related to
legislative change to pemzit direct access to physical therapy services. Data sources
were sunfey 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, 1 7 in
direct-acc:essstates and 1 8 in non-direct-accessstates. The majority of directaccess states obtained their status in a single legislative campaign; the majority of
non-direct-accessjurisdictions attempting legislative change have been unsuccessj i ~for
l 2 or more years. Over 80% of the chapters reported using legislative lobbyists. Opposingforces varied from state to state and included hospital and medical
associations, physicians, chiropractors, and physical therapists. Thefollowing limitations on practice in a direct-access mode are found in the various practice acts:
diagnosis requirements, eventual r e a l requirements, physical therapist quai@cahons, patient consent requirements, and practice setting restrictions. [Taylor TK
Domholdt E. Legislative change to pemzit direct access to physical therapy services:
a study ofprocess and content issues. Phys Ther. 1991;71:362-389.1
Key Words: Health care; LUW and liability, general; Legislation; Physical therapy
profession; professional issues.

"Direct access" to physical therapy

services refers to evaluation and treatment of patients by physical therapists
without referral from a physician o r
other health care practitioner. As of
September 1989, 24 states have per-

mitted direct access to physical therapy s e r v i ~ e s . ~

Because the practice of physical therapy is governed by the states, changes
in legislation to permit direct access

T Taylor, MS, PT, is Staff Physical Therapist, Indiana Center for Rehabilitation Medicine Inc, 6640
Parkdale PI, Ste R, Indianapolis, IN 46254 (USA). Address all correspondence to Ms Taylor.
E Domholdt, EdD, PT, is Associate Professor and Dean, Krannert Graduate School of Physical Therapy, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227.
Ms Taylor was a student in the master's degree program, Krannert Graduate School of Physical
Therapy, when this study was completed in partial fulfillment of her degree requirements.
This study was approved by the Committee on Research Involving Human Participants, University
of Indianapolis.

This article was submitted Februay 1, 1990, and was accepted December 17, 1990.

Physical 'Cherapy /Volume 71, Number 5 /May 1991

must occur at the state level. Because

legislative processes and practice acts
governing the practice of physical
therapy are unique to each state, laws
permitting direct access have taken
many forms. Stipulations in many of
the practice acts limit the conditions
under which physical therapists may
practice directly. Anderson expressed
concern that few states have "pure"
direct access, which he defined as
"the ability to treat clients needing
physical therapy without forced outside i n t e ~ e n t i o n . "For
~ the purpose
of this article, "direct access" will refer to any situation, no matter how
limited, in which patients may obtain
physical therapy services, including
both evaluation and treatment, without referral. Despite the fact that al-

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382/ 37

most half the states have direct access,

few studies have documented the impact of, opinions about, or legislative
process related to direct access.
Four studies have examined various
aspects of physical therapy practice in
a direct-access mode. James and Stuart? in a 1975 US Army study, evaluated the feasibility of using the physical therapist as the initial "screener"
for patients with low back pain. Data
collected when physical therapists
were the initial screeners were compared with baseline data gathered
when physicians were the initial contact for the patient. Patient waiting
times, treatment times, and total care
times were measured. Quality of care
with physical therapists as the initial
contact was assessed through patient
interviews, physician interviews, and
record reviews. Results revealed that
patients with low back pain received
more expeditious treatment with the
physical therapist as the initial contact
than with the physician as the initial
contact. In addition, physical therapists reported increased job satisfaction as initial screeners. The quality of
care rendered by the physical therapists was reported to be satisfactory to
the patient, the physician, and the
physical therapist.3
Overman et a14 studied the outcomes
of firstcontact physical therapy management of patients with low back
pain in a hospital-based ambulatory
care physical therapy clinic. They
found that physical-therapist-managed
patients expressed greater satisfaction
than physician-managed patients with
several aspects of their care. In addition, functional improvement for
highly dysfunctional patients was significantly greater for the physicaltherapist-managed patients than for
the physician-managed ~ a t i e n t s . ~
Durchholz and Domholdt surveyed
physical therapists in three directaccess states to determine changes in
practice after obtaining direct access
compared with before obtaining direct access (AG Durchholz, E Domholdt; unpublished research). They
reported that 45% of the surveyed
therapists had seen patients through

direct access and that those therapists

saw only 10% of their patients
through direct access. Patient populations reported to be seen most frequently through direct access were
orthopedic, neurologic, chronic pain,
preventive care, and pediatric patients.
Dennis5 studied the incidence of
direct-access practice among private
practitioners in Victoria, Australia. She
found that approximately one third of
all patients were referred without
screening from medical practitioners.
The estimated percentage of initialcontact patients for the individual
therapists, however, ranged from 0%
to 90%.5
Reports of three studies related to
direct-access opinions were presented
at the Sixty-Fifth Annual Conference
of the American Physical Therapy Association (APTA). Durant et a16 investigated outpatient views on direct access to physical therapy in Indiana
and found that 83% of the respondents were in favor of direct access
and that 72% would utilize direct access if they were to experience the
same symptoms again. Hamouz et a17
assessed Indiana physical therapists'
attitudes toward direct access and
found that 67% of the respondents
supported direct access to physical
therapy services. LeMasters and Domholdts surveyed 200 physical therapy
students who were in their last year
of study at eight programs located
across the United States. They found
that 85% of the students believed
achieving direct access to be vital to
the development of the profession,
20% planned to concentrate their immediate job searches in direct-access
states, and 53% included practice in
states with direct access in their longterm plans.
Little formal documentation about the
process of obtaining direct access and
the content of direct-access legislation
is available. The APTA Department of
Practice has published an informational booklet about direct access.
The booklet provides an overview
about direct access and related issues,
citing a few state chapters' experiences. The APTA Department of Gov-

ernment Affairs has sponsored DirectAccess Information Shares at both the

1989 and 1990 Annual Conferences.
There has been no systematic attempt,
however, to document chapters' experiences in seeking direct access. The
purpose of this study, therefore, was
to examine legislative change to permit direct access to physical therapy
services. Consideration was given to
both the process of seeking direct
access and the content of direct-access
legislation.

Method
Four sources were used to collect
information about the process of legislative change and the content of
direct-access legislation: written surveys, publications of the APTA and its
chapters, state statutes governing the
practice of physical therapy, and personal contacts.
A questionnaire and a request for relevant documents were sent to each
APTA chapter president (N=52; 50
states, District of Columbia, and Puerto Rico) on February 14, 1989. A selfaddressed, stamped envelope was
included for the return of the questionnaire and requested documents.
Each chapter president was instructed
to complete the survey or to route
the questionnaire and request for information to an appropriate chapter
member for completion. Response
was requested by March 15, 1989. On
March 21, 1989, follow-up letters were
sent to the chapter presidents from
whom no response was received.
Two separate survey questionnaires
were used, one for chapters in nondirect-access jurisdictions (n=28) and
one for chapters in states with direct
access (n =24). Both questionnaires
consisted of predominantly openended questions because of the anticipated variability of experiences
among the chapters. The questions
were generated based on our observation that both the process of legislative change and the content of ultimate direct-access laws had been
problematic for the Indiana chapter
and for other chapters. Information
requested of both non-direct-access

Physical Therapy /Volume 71, Number 5 /May 1991

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and direct-access jurisdictions included evaluation-without-referralstatus, number of years of legislative efforts for direct access, use and
function of lobbyists, sources of opposition to direct access and methods of
demonstration of opposition, sources
of support for direct access, and
methods used to increase awareness
of and support for direct access.
Questionnaires for chapters in directaccess states also requested information regarding the date direct access
became law, significant differences
between the originally proposed bill
and the bill that passed, and source of
and reasons for the differences. Both
questionnaires provided space for
additional comments. Included with
each questionnaire was a request for
additional documents pertaining to
direct access including physical therapy practice act, legislative documents,
promotio~~al
materials, minutes of
meetings regarding direct access, and
any other pertinent documents or
information.
Additional information was gathered
from chapter publications such as
newsletters and promotional and informational mailings. State statutes
governing the practice of physical
therapy were obtained from the respondent or from the local law school
library. Personal communications with
chapter leaders were not sought systematically but were used, when available, to add depth.

Data Reduction
and Analysis
The first stage of data reduction and
analysis involved the categorization of
responses to the survey questions and
artifact data (chapter publications and
state statutes). Categories for coding
of relevant data from the questionnaires and artifacts were determined
by the primary author (TKT) after
review of all available information.
When questions arose about category
development, these questions were
discussed with the secondary author
(ED) until consensus was reached.
For example, the number of legislative attempts at direct access were
initially categorized by years. Based
Physical Therapy /Volume 71, Number

on survey responses, another category, "indirect opportunity," was necessary. Content of statutes governing
the practice of physical therapy was
categorized and coded by identification of patterns of restrictions on
direct-access practice.

Results

Table 1 . Chronological Order of

States Obtaining Direct Access

State

Year
DlrectAccess
Leglslatlon
Enacted

Years
wlth
DlrectAccess
Status

Response Rate
Nebraska

Twenty-eight chapters (16 in nondirect-access jurisdictions, 12 in directaccess states) returned the survey
questionnaires. Twenty of these chapters also supplied various state publications and materials related to direct
access. Six of the chapters in directaccess states included their state statutes with the completed questionnaire.
The state statutes of the remaining
6 direct-access states were obtained
from the local law school library. Personal communication via telephone
yielded one response from the legislative committee chairperson of a nondirect-access jurisdiction's chapter that
had not returned the survey questionnaire. Personal communications at the
APTA-sponsored Direct-Access Information Shares yielded information
from an additional 6 chapters (1 in a
non-direct-access jurisdiction, 5 in
direct-access states). Thus, overall, 35
(67%) of the 52 chapters were represented in this study. Of the 24 chapters
in direct-access states, 17 (70%) were
represented. Of the 28 chapters in
non-direct-access jurisdictions, 18
(64%) were represented. Because of
the varied sources of information, the
number of chapters represented in
each subsection of the "Results" section also varied; the number of chapters represented is indcated in each
subsection.

Process
Length of time with direct access
(n= 17). The chronological order in
which states obtained direct access
and the number of years of directaccess status are presented in Table 1.
Seventy-five percent of all the states
with direct access have had such status 5 years or less.

California
Maryland
Arizona
Massachusetts
West Virginia
Nevada
North Carolina
Utah
Alaska
South Dakota
Idaho
Kentucky
Montana
Colorado
Iowa
Illinois
Minnesota
New
Hampshire
Vermont
Washington
New Mexico
North Dakota
Wisconsin

1989

SD
Range

Patterns of legislative attempts

(n=32). Five of the 18 chapters in
non-direct-access jurisdictions (ie, Hawaii, Mississippi, New Jersey, Pennsylvania, and Virginia) have made no outright attempts to obtain direct access.
These 5 chapters, however, reported
being in various stages of planning for
introduction of direct-access legislation. Statutes in Hawaii, Mississippi,
New Jersey, and Pennsylvania permit
physical therapy evaluation, but not
treatment, without referral.

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Three direct-access states obtained

direct-access status without overt legislative attempts via indirect opportunities for legislative change to permit
direct access. In Nebraska, for example, the original practice act was
drafted with no stipulation for referral. "Sunset legislation" review was
used in Massachusetts as an opportunity to obtain direct access. Sunset
legislation is legislation that includes a
date on which the legislation expires.
For the legislation to remain in effect,
it must be reviewed and the date extended for another period of time.9
During the review of sunset legislation pertaining to the practice of physical therapy in that state, the Massachusetts chapter of the APTA
successfully pursued a change that
allowed direct access. The Vermont
chapter reported that chiropractors
proposed legislation to amend the
physical therapy practice act to include chiropractors as referring practitioners. The Vermont chapter used
this opportunity to compromise with
the chiropractors to gain direct access.
The revised chiropractor bill was enacted, and Vermont obtained direct
access, with little financial burden to
the state chapter.
The remaining chapters have made
formal legislative attempts for changes
to permit direct access. Table 2 shows
that the majority of chapters in states
with direct access obtained this status
with a single successful legislative attempt. A majority of chapters in jurisdictions without direct access have
made unsuccessful legislative attempts
for 2 years or greater.

Geographic distribution. The Figure illustrates that there does not appear to be a geographical trend related to the order of obtaining direct
access. It should be noted, however,
that North Carolina is the only southe m state with direct access.
Evaluation-without-referral status
(n=22). Ten of the 18 non-directaccess jurisdictions represented in this
study permit physical therapy evaluation without referral. The average
number of years with such status
among these states is 5.4 years. Of

Table 2. Patterns of Legislative Attempts for Direct Access to Physical Therapy

Services in Non-Direct-Access and Direct-AccessJurisdictions
Efforts to
Galn Dlrect
Access

r 2 Years

2 Years

1 Year

Unsuccessful

District of Columbia
Georgia
Indiana
Michigan
Ohio
Oregon
Texas

Rhode Island

Kansas
Louisiana
Tennessee
Wyoming

Successfula

Wisconsin

Utah

California
Colorado
Idaho
Maryland
Nevada
New Hampshire
North Dakota
South Dakota

"Includes number of years of unsuccessful attern1~ s if, applicable.

12 direct-access states, only 4 permitted evaluation without referral prior

to obtaining direct access. The number of years of physical therapy evaluation without referral prior to the passage of direct access ranged from 3 to
17 years, with an average of 10.8 years
(Tab. 3).

Use of legislative lobbyists

(n=24). The majority of state chapters
represented in this smdy used legislative lobbyists in their efforts. Ten
(83%) of 12 chapters in non-directaccess jurisdictions that have sponsored legislative campaigns for direct
access reported using a lobbyist. Wyoming's chapter, which has mounted
one unsuccessful direct-access attempt, reported that a lobbyist is not
needed because of the chapter's ability to mount mass grass-roots efforts.
Ten (83%) of 12 chapters in directaccess states reported using a lobbyist
in their efforts. In Nebraska and Vermont, the special circumstances surrounding the acquisition of direct access did not require the services of
legislative lobbyists. Six chapters in
direct-access states emphasized the
important role the legislative lobbyist
played in their success.

Methods to increase support for

direct access (n=29). State chapters
reported using numerous methods to
increase awareness of, and support
for, direct access, including letterwriting campaigns, distribution of
printed materials and brochures, political campaign donations, one-onone negotiatio~iwith opposing parties, and one-on-one contact of
legislators by physical therapists and
lobbyists. Legislator contact during
physical-therapy-sponsored events has
included fitness screenings of state
legislators at the state capitol and legislative luncheons. In addition, chapters reported using physical therapist
and patient testimonials during legislative hearings. Two chapters communicated the importance of having
well-planned and organized testimonials during legislative hearings.

Sources of support for direct

access (n=29). The degree of support for direct access varied from
state to state. Individuals in favor of
increased autonomy for physical therapy have included physical therapists,
dentists, family practitioners, and patients. One state chapter reported the
support of state legislators with prior
exposure to physical therapy services.

Physical Therapy /Volume 71, Number 5 /May 1991

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Figure. Map of United States depicting states with direct access to physical therapy seruices and states with evaluation-without-referral status only.

...................
.,..,...,..........,...,...*....

Direct Access
Evaluation Without Referral

DIRECT ACCESS AND PHYSICAL THERAPY

EVALUATION WITHOUT REFERRAL

Table 3. Evaluation-WithoutReferral Status of Non-Direct-Access and

Direct-AccessJurisdictions
No. of Years
of Evaluatlon
Without
Referral

Non-DlrectAccess
Jurlsdlctlon

Georgia
Hawaii
Kansas

Louisiana

Michigan

Mississippi

10

Pennsylvania

14

Tennessee
Texas
Wyoming

District of Columbia

6.45

SD

3.61

Range

2-14

Dlrect-Access
State

Colorado

No. of Years of
Evaluatlon Wlthout
Referral Prior to
DlrectAccess Status

North Dakota

10

South Dakota

17

Vermont

13

SD
Range

5.91
3-17

associations, physicians, and chiropractors were identified as sources of

opposition to direct access to physical
therapy services. Five chapters reported that physical therapists openly
voiced opposition to direct access
during legislative hearings. As the
sources of opposition varied, so did
the reasons for opposition. Some physicians and medical associations suggested that the education of physical
therapists is not sufficient to permit
physical therapists to be the initial
contacts for entry into the health care
system. In addition, some physicians
suggested that, because physical therapists are trained to assess musculoskeletal dysfunction and not to
make medical diagnoses, serious
medical problems may be missed if
physicians are not the initial contact
for entry into the health care system.
In one state, a physician, who received a degree in physical therapy in
the 1950s, testified that physical therapists are not qualified to be firstcontact health care providers because
of insufficient education. Hospital associations expressed the concern that,
with increased autonomy, physical
therapists would pursue private practice, resulting in a shortage of physical
therapists in hospital departments.
Chapters reported that opposition was
demonstrated via verbal testimony
during legislative hearings, legislative
lobbying, and financial donations to
key political campaigns. Chapters reported defusing potential opposition
through education, negotiation, and
compromise.
Content

Five chapters reported that patients

openly supported direct access and
were willing to make testimonials
regarding their positive experiences
with physical therapy. Groups and
organizations supporting direct access
have included state physical therapy
associations, home health associations,
insurance companies, and extended
care facilities. Interestingly, sources of
support in some states were sources
of opposition in other states.
Sources of opposition to direct
access (n=29). Hospital associations, insurance companies, medical

Because the practice of physical therapy is governed at the state level,

practice acts are unique to each state.
Variations in practice acts exist in
both non-direct-access and directaccess jurisdictions. Many of the variations found in direct-access legislation
do not permit the practice of physical
therapy in a "pure" direct-access
mode.2 Chapters reported that, in
some instances, such stipulations
were the result of compromising with
opposing parties. Others indicated
that such stipulations were included
in an attempt to defuse anticipated

opposition. Stipulations found in

direct-access legislation can be placed
into five general categories: (1) diagnosis, (2) referral requirements and
relationships, (3) physical therapist
qualifications, (4) patient consent, and
(5) type of practice setting and patient
population.
The first category involves stipulations
related to diagnosis. Laws in California, Illinois, and New Mexico require
patients seeking physical therapy without a referral to have a current o r
initial diagnosis.10 In Wisconsin, a
written referral is not required when
a physical therapist provides s e ~ c e s
to an individual for a previously diagnosed medical condition. The diagnosing practitioner, however, must be
informed that physical therapy services are being initiated.11
The second category of stipulations
relates to referral requirements and
relationships. Laws in Minnesotalo and
New Hampshire12stipulate that, when
treating a patient without a referral
for a period greater than 30 days, a
consultation with, or referral to, a
physician is required. Vermont law
requires that physical therapy patienttreatment plans be developed in consultation with, and periodically reviewed by, a physician.13
In New Hampshire,12Colorado,l* and
North Dakota,l5 the law stipulates that
failure to refer a patient to another
health care practitioner when a patient's problem is outside the scope
of physical therapy is grounds for the
suspension of a license to practice
physical therapy. Maryland law stipulates that, when patients are seen
based on referral, practice must be
consistent with the referral made.16
The third general category of stipulations placed on the practice of physical therapy in a direct-access mode
involves physical therapist qualifications. In Minnesota, state law requires
physical therapists to have worked as
licensed physical therapists for 1 year
to be permitted to practice physical

Physical Therapy /Volume 71, Number 5 /May 1991

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therapy in a direct-access mode."J In

New Hampshire, to be eligible to
practice physical therapy in a directaccess mode, a therapist must have
2 years of experience as a licensed
physical he rapist, be engaged in continuing education as set by the licensing board, submit references from
two physicians with whom the therapist has a working relationship, and
interview with the physical therapy
advisory committee. If the requirements are met, the physical therapist
is designated as a "physical therapist
11" and is permitted to practice physical therapy in a direct-access mode. A
physical therapist I1 is distinguished
from a "physical therapist I," who is
permitted to practice physical therapy
only under the referral of a person
licensed to practice medicine, dentistry, podiatry, or chiropractic.12 As of
February 1, 1991, 52 therapists (out of
a total of 648 therapists) in New
Hampshire have obtained licensure as
physical therapist 11s (Jean Bond, New
Hampshire State Licensing Board; personal cornmunication).
The fourth general category of stipulations relates to patient consent.
Direct-access legislation that was enacted by the legislature in Rhode Island, but vetoed by the governor, included the stipulation that the
physical therapist explain the scope
and limitations of the practice of physical therapy to a patient seeking physical therapy without a referral. The
patient then must sign a consent form
prior to c:valuation and treatment by
the physical therapist."
The final category of stipulations
placed on physical therapy practice in
a direct-access mode relates to type of
practice setting and patient population. Wisconsin's direct-access law
stipulates that
referral is not required when a physical therapist provides senices: in
schools to children with exceptional
educational needs.. . ; as part of a
home health agency; to a patient in a
nursing home pursuant to the patient's
plan of care; related to athletic activities, conditioning or injury prevention;
to an individual for a previously diag-

nosed medical condition after informing the diagnosing practitioner."Q1)

care o r marketplace influences. The

impact of direct-access legislation
could be studied from the perspective
of patient outcomes with direct-access
practice, physical therapist willingness
to use the direct-access mode for patient treatment, o r physician-therapist
interaction in direct-access practice.

Discussion and Concluslons

Because the qualitative nature of our
research does not lend itself to concise conclusions, our discussion and
conclusions will be interwoven. First,
the limitations of the research will be
addressed; second, suggestions for
further research will be given; and
third, three major conclusions will be
made.

There were two major limitations to

this study. First, not all chapters provided information for this study. Nonrandom factors may have influenced
which chapters responded to the request for information. For example, a
majority of the chapters in states with
direct access represented in this study
obtained direct access during the first
attempt at legislative change. Perhaps
the chapters that did not respond to
the request for information had
longer, more complicated experiences that would have been more
difficult to describe.
The second limitation was the potential for bias in the analysis of data.
This is an inherent concern in any
qualitative study. The information
given generally represented one person's view of direct access in his o r
her state; the interpretation of that
information represented the two investigators' interpretations of the data.
We believe that bias was adequately
controlled through the use of several
sources of information to corroborate
one another and through the use of
two investigators who challenged
each other's conclusions until consensus was reached.

Further Research
Direct-access research could proceed
in many different directions. The legislative process could be researched
further through an in-depth study of
opposition to direct access. The process could be viewed from the framework of medical dominance of health

Malor Concluslons
Because the practice acts and political
environments are unique to each
state, it is not realistic to recommend
a plan of action for all chapters seeking direct access. Chapters pursuing
legislative change to permit direct
access, however, may wish to consider the following points, based on
the results of this study:
I . The majority of the chapters in this
study that obtained direct access did
so either during theJirstyear of attempting change or via an indirect
oppotlunityfor change.

Several chapters in this study found

themselves making repeated, unsuccessful attempts at obtaining direct
access. Those who have done so
might consider deferring their efforts
for legislative change to pursue 1 o r
more years of in-depth planning and
research. During this hiatus, emphasis
could be placed on educating the
public, the opposing groups and organizations, and the legislators, who
ultimately determine the outcome of
the legislation. In addition, chapters
might be alert to other possibilities
and opportunities for pursuing legislative change such as sunset legislation review or other amendments to
the practice act.
2. The majority of states with direct

access did not have physical therapy

eualuation without referral prior to
obtaining direct access. Those states
that did had the evaluation-withoutreferral status for a relatively long
time prior to obtaining direct access.
We believe that some chapters have
perhaps pursued direct access too
soon after obtaining evaluation without referral. Eight of the 12 states
listed under "unsuccessful attempts"

Physical Therapy /Volume 71, Number 5 /May 1991

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in Table 2 already had evaluation

without referral at the time of the survey. The remaining states, with neither evaluation nor treatment without
referral, need to consider whether
achieving evaluation without referral
only will jeopardize future attempts to
achieve direct access.

3. Stipulations placed on direct access

limit the professional autonomy that
pbysical therapists hope to achieve
through direct access.
These stipulations that limit direct
access are
the
cornpromise to gain passage of any type of
direct-access legislation. The main
categories of stipulations were prior
diagnosis requirements, eventual physician referral requirements, physical
therapist qualifications, patient consent requirements, and practice setting restrictions on direct-access practice. In our view, chapters considering

compromises to their direct-access

legislation need to consider whether
the original goal of the legislation can
still be met with the proposed stipulations. Even with the most stringent
stipulations, direct access does offer
the consumer an alternate entry point
into the health care delivery system.
References
1 Pickard NW. New Mexico, North Dakota approve direct access to physical therapy. Progress Repotl of the American Physical Therapy
Asociation. 1989;18(6):10.
2 Anderson L 1989 American Physical Therapy
Association Board of Directors and Officers
elections. Progress Repotl of the American
Physcal Therapy Association. 1989;18(3): 19.
3 James JJ- Stuart RB. Expanded role for the
physical therapist: screening musculoskeletal
disorders. Phys Ther. 1975;55:121-131.
4 Overman SS, Larson JW, Dickstein DA, et al.
Physical therapy care for low back pain: monitored program of first-contact nonphysician
care, Phys
1988;68:199-207,

ria. Australian Journal of Physiotherapy.

1987;30:181-191.
6 Durant TL,Lord LJ, Domholdt E. Outpatient
views on direct access to physical therapy in
Indiana. Phys Ther. 1989;69:85W357.
7 Hamouz L, Barron A, Porter RE. Indiana
physical ~herapists'attitudes toward direct access legislation. Phys %r. 1989;69:393. Abstract.
8 LeMasters A, Domholdt E. Direct access
opinions of physical therapy students. Phys
Ther. 1989;69:392. Abstract.
9 Safire WL. Sajire's Political Dictionary. New
York, NY: Random House Inc; 1978:705-706.
10 Direct-Access Information Share. Sixty-Fifth
Annual Conference of the American Physical
Therapy Association; June 11-15, 1989; Nashville, Tenn.
11 Pickard NW. FT' direct access for Wisconsin
is law; Rhode Islanders must wait 'ti1 next year.
Progress Report of the American Physical Therapy Association. 1989;18(8):1-2.
12 NH Rev Stat Ann ch 328-A (1989).
13 Vt Stat ch 38.
14 Colo Rev Stat ch 12, article 41 (1989).
ND Cert Code ch 43-26 (1989),
16 Md Health Occ Code Ann title 13 (1989).

Dennis JK, Decisions made by physiotherapists: a study of private practitioners in Victo-

The Chartered Society of Physiotherapy will be holding its Annual Congress on the
above dates in the Pavilion Theatre, Winter Gardens, Blackpool. Delegates are expected from throughout the WK. In addition to the Conference, there will be a trade and
charity exhibition, Specific Interest Group stands, and a poster display.
Posters are invited from physiotherapists who have completed research or who have
a particular project that they would like to display. Posters are also welcome from
Specific Interest Groups on their areas of work. Posters will be on display in the
exhibition and catering area. Display space will be 1 m wide by 2 m tall per poster.
If you are interested in taking poster space, please contact the Events Organizer at the
CSP: Jane Morrison, Events Organizer, 14 Bedford Row, London WClR 4ED; Tel:
071-242-1941;FAX:071-831-4509.

44 1389

Physical TherapyIVolume 71, Number 5 /May 1991

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Legislative Change to Permit Direct Access to

Physical Therapy Services: A Study of Process and
Content Issues
Tamra K Taylor and Elizabeth Domholdt
PHYS THER. 1991; 71:382-389.

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