This can help you arrive at a decision with your patient’s best interest at heart, relying on evidence (peer-reviewed studies, quality assurance studies), experience, and situational considerations.
Where Did This Guideline Come From, and How Was It Developed?
A previous version of this referral guideline was written by Guy Terry PT, OCS for Kimbrough Ambulatory Care Center at Fort Meade, Maryland, and was later adopted for the Walter Reed Healthcare System. In both cases, there were limited resources and overlapping providers performing similar services. Mr. Terry (then Captain Terry) was Assistant Chief and then Chief of the Musculoskeletal Center – encompassing physical therapy, podiatry, and orthopedic surgery. KACC is part of the Walter Reed Army Healthcare System in the National Capital Region.
The impetus for the guideline was efficient use of the resources available (physical/occupational therapy, primary care, podiatry, orthopedic surgery, physiatry, and pain management) while ensuring that treatment was expedient and appropriate.
The major finding (both leading to and confirmed by the guideline) was that physical therapy could offer faster access to more appropriate, cost effective care, with higher patient satisfaction and no additional risk, as long as certain precautions were observed.
Expedited Referral (<72 Hours After Onset)
Patients and problems in this category will meet one or more of the following criteria:
- Quick return to specific work or sports-related tasks is critical, can be addressed by early intervention by a therapist, with no risk to the patient.
- Patients will have received any appropriate screening (listed later in the “Screening Needed” category)
- Early therapeutic intervention can avoid additional complications or sequellae.
Routine Referral (6 Weeks Or Longer After Onset)
Patients/problems in this category will meet all of the following criteria:
- Evidence that initial primary care management is sufficient for many of these patients, and an initial delay before instituting therapy does not pose a risk of complications or sequellae.
- Evidence that delay longer than 6 weeks may pose a risk of complications or sequellae.
- No additional screening is needed prior to starting therapy.
- Quick return to specific work or sports-related activities is not needed, or would pose a risk to the patient if initiated too early or aggressively.
Screening Needed Prior to Therapy Referral
Patients/problems in this category will meet the following criteria:
- The presentation of the injury meets the criteria for additional radiological screening.
- Patient demographics meet the criteria for additional radiological screening.
- The presentation of the injury meets criteria for additional specialist referral screening/management.