Featured Article| Volume 19, ISSUE 2, 104445, February 2023

Underused Physical Therapy Services in Primary Care Settings: An Overview

Published:September 15, 2022DOI:


      • Benefits and underutilization of physical therapy are evident.
      • Heightening familiarity with physical therapy optimizes primary patient care.
      • Collaboration with a physical therapist reduces invasive and costly treatment options.
      • A whole health delivery approach with physical therapy promotes optimal clinical outcomes.


      The combined effects of longer life, noncommunicable diseases, and injuries increase the need for rehabilitation services. Although physical therapists’ unique skill set on movement-related dysfunction allows for broad contributions to health care, physical therapy (PT) remains underutilized. This article situates the problem within the broader primary care context, focusing on PT’s ability to mitigate disability and dysfunction in complex syndromes including pelvic floor incontinence, vertigo, cancer, chronic neuromusculoskeletal pain, and long coronavirus disease (ie, lingering effects after acute coronavirus disease infection passes). The path from PT research to clinical implementation remains dependent on factors beyond research evidence. This overview underscores the need to address this evidence to practice gap.


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      1. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
        Lancet. 2020; 396: 1204-1222
        • Bonaccio S.
        • Connelly C.E.
        • Gellatly I.R.
        • Jetha A.
        • Martin Ginis K.A.
        The participation of people with disabilities in the workplace across the employment cycle: employer concerns and research evidence.
        J Bus Psychol. 2020; 35: 135-158
        • Institute of Medicine Committee on the Future of Primary Care
        Defining Primary Care: An Interim Report.
        National Academies Press, 1994
        • Cieza A.
        • Causey K.
        • Kamenov K.
        • Hanson S.W.
        • Chatterji S.
        • Vos T.
        Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.
        Lancet. 2020; 396: 2006-2017
        • Glasziou P.
        • Straus S.
        • Brownlee S.
        • et al.
        Evidence for underuse of effective medical services around the world.
        Lancet. 2017; 390: 169-177
        • Cabana M.D.
        • Rand C.S.
        • Powe N.R.
        • et al.
        Why don't physicians follow clinical practice guidelines? A framework for improvement.
        JAMA. 1999; 282: 1458-1465
        • American Physical Therapy Association
        What physical therapists do.
        • American Physical Therapy Association
        The Guide to Physical Therapy Practice 3.0.
        APTA, 2014
        • Norton P.
        • Brubaker L.
        Urinary incontinence in women.
        Lancet. 2006; 367: 57-67
        • Abrams P.
        • Andersson K.E.
        • Apostolidis A.
        • et al.
        • 6th International Consultation on Incontinence
        Neurourol Urodyn. 2018; 37: 2271-2272
        • Khandelwal C.
        • Kistler C.
        Diagnosis of urinary incontinence.
        Am Fam Physician. 2013; 87: 543-550
        • Fricke A.
        • Lark S.D.
        • Fink P.W.
        • Mundel T.
        • Shultz S.P.
        Exercise interventions to improve pelvic floor muscle functioning in older women with urinary incontinence: a systematic review.
        J Womens Health Phys Therap. 2021; 45: 115-125
        • Dumoulin C.
        • Cacciari L.P.
        • Hay-Smith E.J.C.
        Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women.
        Cochrane Database Syst Rev. 2018; 10: CD005654
        • Scott K.M.
        • Gosai E.
        • Bradley M.H.
        • et al.
        Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain.
        Int Urol Nephrol. 2020; 52: 655-659
        • Parekh A.R.
        • Feng M.I.
        • Kirages D.
        • Bremner H.
        • Kaswick J.
        • Aboseif S.
        The role of pelvic floor exercises on post-prostatectomy incontinence.
        J Urol. 2003; 170: 130-133
        • APTA
        Patient education.
        Date accessed: November 9, 2021
        • Nguyen-Huynh A.T.
        Evidence-based practice: management of vertigo.
        Otolaryngol Clin North Am. 2012; 45: 925-940
        • Cakir B.O.
        • Ercan I.
        • Cakir Z.A.
        • Civelek S.
        • Sayin I.
        • Turgut S.
        What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo?.
        Otolaryngol Head Neck Surg. 2006; 134: 451-454
        • Power L.
        • Murray K.
        • Szmulewicz D.
        Early experience with a multi-axial, whole body positioning system in the treatment of benign paroxysmal positional vertigo (BPPV).
        J Clin Neurosci. 2019; 61: 186-188
        • Rodrigues D.L.
        • Ledesma A.L.L.
        • de Oliveira C.A.P.
        • Bahamad Júnior F.
        Physical therapy for posterior and horizontal canal benign paroxysmal positional vertigo: long-term effect and recurrence: a systematic review.
        Int Arch Otorhinolaryngol. 2018; 22: 455-459
        • Hilton M.P.
        • Pinder D.K.
        The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.
        Cochrane Database Syst Rev. 2014; 12: CD003162
        • Stubblefield M.D.
        The underutilization of rehabilitation to treat physical impairments in breast cancer survivors.
        PM R. 2017; 9: S317-S323
        • Alappattu M.J.
        • Coronado R.A.
        • Lee D.
        • Bour B.
        • George S.Z.
        Clinical characteristics of patients with cancer referred for outpatient physical therapy.
        Phys Ther. 2015; 95: 526-538
        • DiSipio T.
        • Rye S.
        • Newman B.
        • Hayes S.
        Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis.
        Lancet Oncol. 2013; 14: 500-515
        • Scaffidi M.
        • Vulpiani M.C.
        • Vetrano M.
        • et al.
        Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery.
        Eur J Phys Rehabil Med. 2012; 48: 601-611
        • Davies C.
        • Levenhagen K.
        • Ryans K.
        • Perdomo M.
        • Gilchrist L.
        Interventions for breast cancer-related lymphedema: clinical practice guideline from the Academy of Oncologic Physical Therapy of APTA.
        Phys Ther. 2020; 100: 1163-1179
        • Pergolotti M.
        • Lyons K.D.
        • Williams G.R.
        Moving beyond symptom management towards cancer rehabilitation for older adults: answering the 5W's.
        J Geriatr Oncol. 2018; 9: 543-549
        • Kline R.M.
        • Arora N.K.
        • Bradley C.J.
        • et al.
        Long-term survivorship care after cancer treatment - summary of a 2017 National Cancer Policy Forum Workshop.
        J Natl Cancer Inst. 2018; 110: 1300-1310
        • Cheville A.L.
        • Troxel A.B.
        • Basford J.R.
        • Kornblith A.B.
        Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer.
        J Clin Oncol. Jun 1 2008; 26: 2621-2629
        • Dillard J.N.
        • Knapp S.
        Complementary and alternative pain therapy in the emergency department.
        Emerg Med Clin North Am. 2005; 23: 529-549
        • Walston Z.
        • McLester C.
        • McLester J.
        Effect of low back pain chronicity on patient outcomes treated in outpatient physical therapy: a retrospective observational study.
        Arch Phys Med Rehabil. 2020; 101: 861-869
        • Skou S.T.
        • Pedersen B.K.
        • Abbott J.H.
        • Patterson B.
        • Barton C.
        Physical activity and exercise therapy benefit more than just symptoms and impairments in people with hip and knee osteoarthritis.
        J Orthop Sports Phys Ther. 2018; 48: 439-447
        • Gaul C.
        • Liesering-Latta E.
        • Schäfer B.
        • Fritsche G.
        • Holle D.
        Integrated multidisciplinary care of headache disorders: a narrative review.
        Cephalalgia. 2016; 36: 1181-1191
        • Carvalho G.F.
        • Schwarz A.
        • Szikszay T.M.
        • Adamczyk W.M.
        • Bevilaqua-Grossi D.
        • Luedtke K.
        Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice.
        Braz J Phys Ther. 2020; 24: 306-317
        • CDC. Centers for Disease Control and Prevention
        Long COVID or post-COVID donditions.
        (Updated September 16, 2021)
        Date: 2022
        Date accessed: March 16, 2022
        • US Department of Health & Human Services
        Guidance on “long COVID” as a disability under the ADA, Section 504, and Section 1557.
        • Lentz T.A.
        • George S.Z.
        • Manickas-Hill O.
        • et al.
        What general and pain-associated psychological distress phenotypes exist among patients with hip and knee osteoarthritis?.
        Clin Orthop Relat Res. 2020; 478: 2768-2783
        • McKay S.E.
        • Buono F.D.
        • Walker J.
        • Glinski C.
        • Printz D.M.B.
        • Brienza R.
        Impact of interprofessional embedding of physical therapy in a primary care training clinic.
        J Interprof Care. 2021; 35: 532-537
        • Pontius E.A.
        • Anderson R.S.
        Physical therapy, occupational therapy, and speech language pathology in the emergency department: specialty consult services to enhance the care of older adults.
        Emerg Med Clin North Am. 2021; 39: 419-427
        • Rafferty M.R.
        • MacDonald J.
        • Byskosh A.
        • et al.
        Using implementation frameworks to provide proactive physical therapy for people with Parkinson disease: case report.
        Phys Ther. 2019; 99: 1644-1655
        • Agency for Healthcare Research and Quality
        Strategy 6E: rapid referral programs.
        (Updated March 2020)
        • Dufour S.
        • Hondronicols A.
        • Flanigan K.
        Enhancing pelvic health: optimizing the services provided by primary health care teams in Ontario by integrating physiotherapists.
        Physiother Can. 2019; 71: 168-175
        • Abbate L.M.
        • Jeffreys A.S.
        • Coffman C.J.
        • et al.
        Demographic and clinical factors associated with nonsurgical osteoarthritis treatment among patients in outpatient clinics.
        Arthritis Care Res (Hoboken). 2018; 70: 1141-1149
        • Pergolotti M.
        • Deal A.M.
        • Reeve B.B.
        • Muss H.B.
        The underutilization of occupational and physical therapy for older adults with cancer.
        J Clin Oncol. 2014; 32 (9548): 9548
        • Delitto A.
        • George S.Z.
        • Van Dillen L.
        • et al.
        Low back pain.
        J Orthop Sports Phys Ther. 2012; 42: A1-57


      Annabel Nunez-Gaunaurd, PhD, PT, MSPT, is an assistant professor in the Department of Physical Therapy at Florida International University in Miami and can be contacted at [email protected]


      Deana Goldin, PhD, DNP, APRN, is an associate professor in the Department Graduate Nursing at Florida International University.