AUTONOMY AND DIRECT ACCESS IN PHYSICAL THERAPY: A SCOPING REVIEW

C.P. Fuentes Durán¹, P.S. Sizer^1,2,3, M.V. Mauri-Stecca^1,4

Background: Physical therapists have a will and are entitled to practice their roles autonomously and to be professionals to whom users can directly access for diagnosis, intervention, prevention of dysfunctions, limitations in activity, and environmental barriers related to the movement health area. However, there are differences among the definitions of the terms "autonomy" and "direct access (DA)", related to physical therapy (PT), so that when used erroneously and interchangeably, they could lead to confusion instead of aiming at the real scope of professional practice.

Purpose: The purpose of the study was to identify, analyze, and clarify definitions and misconceptions associated with the terms "Autonomy" and "Direct access" so as to facilitate their understanding when being used in relationship with public policies.

Methods: A 5 stage-scoping review was carried out. The stages were: identification of the research question and its possible relevant research documents, selection of documents, data extraction, and reporting of results. The selection of documents was made in January 2020, along with the identification of keywords. In addition, specific search in meta-search engines and gray literature were used (Pubmed, EBSCO / CINAHL, Web of Sciences, PEDro, APTA, OXFORD ACADEMY, Opengrey, World-Confederation-for-Physical- Therapy WCPT, and Google-Scholar). Twenty-six documents were analyzed according to selected variables (bibliometric and interest) to achieve the afore-mentioned purpose.

Results: As a result, 72.2% of the documents define "autonomy" (based on Webster's dictionary) as "Having the right or power of self-government . . . developing independently of the whole". 61.1% of these documents established the concept of "professional autonomy", which ,according to APTA, corresponds to “independent and self-determined professional judgment and action”. 75% of the documents that define “direct access”, which were based on the WCPT, defines it as “a patient directly requesting the physical therapist to provide him/her services (as in self-referrals). The physical therapist freely decides his/her behavior and, therefore, is fully responsible for it ”. 33.3% included the concept of "self-referral"
on its definition. 50% of the documents reported at least one barrier associated with "DA training," "laws that rule society," and "PT care reimbursement system."

Conclusion(s): There is no single definition for “Autonomy” in PT; while there is a great consensus reported when defining Direct Access without actually agreeing on a total operational separation between them. Complete professional autonomy leads to Direct Access in Physical Therapy. Finally, threats are reported that must be considered when implementing these terms within the specific context of each country.

Implications: This project helps to clarify the key terminology to lay the foundations of a universal language, aiming at improving understanding within the profession and its responsibility that autonomous and direct access professionals imply. In this way, in countries like Chile, where the Physical Therapy career is starting its path towards professional autonomy, it can grant a correct use of the terminology for formulating future political regulations.

Funding, acknowledgements: The work was unfunded

Keywords: Autonomy, Direct Access, Physical Therapy

Topic: Globalisation: health systems, policies & strategies

Did this work require ethics approval? No

Institution: Universidad del Desarrollo - Facultad de Medicina CAS-UDD

Committee: Comité Ético Científico

Reason: This was a Scoping Review and did not involve primary data collection in human participants, therefore no ethical approval was required.