Patient Choice After Referral to Physical Therapy for Lower Back Pain and Knee Osteoarthritis.

Objective: To assess factors influencing Veterans' decisions to initiate physical therapy (PT) after referral for low back pain (LBP) or knee osteoarthritis (OA). Design: Qualitative study using individual semistructured telephone interviews. Setting: Durham Veterans Health Administration Health Care System. Participants: A total of 44 Veteran patients (N=44) aged 26-85 were referred for LBP or knee OA between January and August 2021. Results: Patient-level factors influencing PT initiation included confusion with navigating the health system, efficacy beliefs about PT, and thoughts about physical therapists' ability to diagnose their pain. At the provider level, discussion about PT care appeared to increase initiation of PT. At the system level, influences included wait times, availability of appointments outside business hours, and easy-to-access locations. Motivational themes included respondents' symptoms and functional limitations that drove them to initiate care. Respondents suggested that changes to wait times through same-day or rapid appointments, assistance and increased ease of the scheduling process, transportation support, convenient care locations, and information about PT, including its benefits, could improve PT care access. Conclusions: This study of patient perceptions of initiating PT care after referral identified tangible barriers to care at patient, provider, and system levels for respondents with LBP or knee OA. Patient knowledge and system-level barriers, including how challenging the system is to navigate, are major factors that reduce patients' use of PT after referral. Health systems and physical therapists should address barriers to care through patient education, scheduling assistance, and changes to the health care system, including options for same-day appointments.