Perspectives of Private Practice Physical Therapy Clinics in a Pragmatic Clinical Trial

Background & Aims

This study describes the varying perspectives of 4 private practice physical therapy (PT) outpatient health care systems (HCS) while participating in the current pragmatic clinical trial: Fibromyalgia Transcutaneous Electrical Nerve Stimulation (TENS) in PT (FM-TIPS). The primary aim of this mixed methods study is to define the barriers and benefits of participation in FM-TIPS from a private practice PT perspective. Pragmatic clinical trials related to the treatment of pain are more commonly performed to evaluate drug therapies (Hohenschutz-Schmidt 2022). Few pragmatic clinical trials exist in PT and to date, none have included private practices. The US Bureau of Labor Statistics indicates that private practice health care systems are the largest employers of physical therapists (39%). Understanding the experience of participation in private, non-academic healthcare systems is important to implementation of pragmatic trials testing efficacy in real-world settings.

Methods

Semi-structured interviews were conducted with the 4 healthcare system directors participating in FM-TIPS with a follow-up focus group. Transcripts were coded thematically by the research team. The major thematic categories are barriers and benefits of participation in this pragmatic clinical trial. Clinician demographics of physical therapists trained to participate in FM-TIPS from 25 clinics within the private physical therapy health care systems (n=70 clinicians from n=4 healthcare systems) participating in FM-TIPS were compared to national data from the American Physical Therapy Association (APTA).

Results

Preliminary barriers include naivety for evaluating and implementing research, lack of standard outcome measures, and the change of electronic medical records for private practice systems. There were mixed opinions regarding the effect of participating in clinical research on productivity and revenue loss. Preliminary benefits include rural healthcare providers being proud of their participation in a NIH sponsored research project, human subject protection training for staff, excellent communication with FM-TIPS study staff, exposure to new treatments, patient treatment benefits, and financial incentives for participation for the patient as well as the clinic. Demographics for 70 clinicians from all private practice healthcare systems were reported. Compared to national averages, clinicians in FMTIPS have higher percentages of specialty certifications and training from the APTA. The national average age of 40 years old is equal to FM-TIPS clinicians.

Conclusions

The novel experience of participating in a NIH sponsored pragmatic clinical trial in physical therapy by private practice healthcare systems has benefits in addition to challenges. Preliminary data suggests that all clinics interviewed would participate again in clinical research at this level. The learning curve for methodology and standardization may be a challenge, however, the reward from overcoming the challenges is captured in the stated benefits. While the age of the clinicians involved in the pragmatic trial is consistent with APTA national averages, APTA membership, APTA specialty certifications and post entry level training is higher than national averages for licensed PTs in the United States.

References

APTA. A Physical Therapy Profile: Demographics of the Profession, 2021-22. https://www.apta.org/apta-and-you/news-publications/reports/2023/physical-therapy-profile-demographics-profession-2021-22.

APTA. A Physical Therapy Profile: Wages for the Profession, 2021-22. https://www.apta.org/apta-and-you/news-publications/reports/2023/physical-therapy-profile-wages-profession-2021-22

APTA Specialist Certification (ABPTS). https://specialization.apta.org/about-abpts/abpts-certified-specialists-statistics.

US Bureau of Labor Statistics. https://www.bls.gov/oes/current/oes291123.htm

Hohenschurz-Schmidt et al., 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8675058/