Demographics of Physical Therapy Practice: Implications for Education

Journal of Physical Therapy Education, Fall 2004 by Hicks, Ramona, Cook, Paige, Dulas, Tracy, Clem, Janelle

Background and Purpose. Setting academic priorities for physical therapist professional (entry-level) education is challenging because of the diversity of clinical practice, of which little is known. The purpose of this study was to determine demographic and diagnostic characteristics of physical therapy patients in the United States in order to more fully describe physical therapy practice. Subjects and Methods. We surveyed a convenience sample of 412 physical therapists about characteristics of their patients. Results. Patients with musculoskeletal conditions (63.4%) were the most common, followed by neurological (25.9%), cardiopulmonary (7.4%), and integumentary (3.3%) conditions. Young adults (28.2%) and middle-aged adults (35.0%) represented the majority of the respondents' patients, but individuals at either end of the lifespan (75 yrs=20%) were not uncommon. The race of patients receiving physical therapy services was comparable to US and regional population demographics, except in the West, where Hispanic patients (7.5%) were markedly less than regional population demographics (24.3%). Gender differences were also observed, with female patients (55.8%) more common than male (44.2%). Discussion and Conclusion. This study demonstrates that people of both sexes, and of all ages and races are generally, though not always, well represented in physical therapy practice, which supports the continued need for a broad professional physical therapy education curriculum. However, the data also demonstrates that some medical conditions are much more prevalent than others among patients receiving physical therapy services, and these differences should be considered when setting educational objectives and priorities in academic programs.

Key Words: Physical therapy, Patient characteristics, Diagnosis, Age, Gender, Race.

INTRODUCTION

Despite its relevance to setting and prioritizing educational objectives, only limited information is available about the people who utilize physical therapy services. Characterizing patient demographics is of particular importance to physical therapy, because unlike many health professions that focus on specific types of populations and/or medical conditions, physical therapists provide services to people of all ages and with a wide variety of diagnoses.1 Thus, the breadth and diversity of physical therapy practice presents challenges in terms of setting priorities for education.

Currently, the primary source of information about the demographics of physical therapy practice is the American Physical Therapy Association (APTA) Web site.2 The APTA Web site has information regarding demographic and socioeconomic factors of physical therapists in the United States, as well as the type of facility where they practice. Using the facility data, it is possible to make some inferences about selected patient characteristics, eg, that people working in school settings are providing services to children and adolescents, and that people working in skilled nursing facilities are primarily working with older adults. However, even in these types of facilities, more specific information about the patients' ages cannot be inferred, nor can information about race or medical condition. And for other types of facilities, such as outpatient clinics, acute care hospitals, etc, which employ approximately 85% of physical therapists, little can be inferred about patient characteristics.

Besides the APTA Web site,2 other information available about physical therapy patient characteristics is from a study conducted in Denmark, where the authors describe patients who were referred to physical therapy for musculoskeletal conditions.3 The patient demographics described by Jorgensen et al,3 however, are likely to differ from characteristics of individuals utilizing physical therapy services in the United States because of geographical differences and because diagnostic limits were placed on the patient population that they studied.

In the past, rapid and profound changes in certain medical diagnoses, such as poliomyelitis in the 1940s or amputations following World War II, were recognized and ultimately led to modifications and advances in physical therapy education and practiced More slowly evolving changes in patient characteristics, however, may not be so readily apparent. For example, the aging population in the US is well publicized, but the extent to which physical therapists are providing interventions for older adults is unknown. Whether there are regional differences in the characteristics of physical therapy patients, similar to those reported in medicine,5 is also unknown.

Given the limited information available and its potential impact on educational objectives, we developed a Web-based survey to obtain information about the demographic and diagnostic characteristics of patients seen by physical therapists across the United States. We surveyed physical therapists about the age, race, gender, and primary medical conditions and diagnoses of their patients. Our objective was to answer the following questions: To whom are physical therapists providing services? For what medical conditions and diagnoses are physical therapists providing services? How do physical therapy patients compare to the US population demographics? Do physical therapy patient demographics vary by region?