ArticleMedicine2026
The association between state direct access laws and earlier use of physical therapy among Medicare patients with rotator cuff tears: A retrospective cohort study.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
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Abstract
Current literature supports physical therapy (PT) as an initial treatment for patients with musculoskeletal pain without severe trauma, but state laws can limit timely access depending on the level of direct access permitted. We assessed whether more permissive direct access laws are associated with earlier PT use among Medicare patients with an atraumatic rotator cuff tear (ARCT). We obtained claims files from 2016 to 2018 for all US Medicare fee-for-service beneficiaries with an ARCT diagnosis in 2017, using 2016 data for baseline confounders and 2018 data to capture outcomes. Earlier PT was defined in 2 ways: PT first - seeing only a physical therapist on the first shoulder-related outpatient visit within 90 days of ARCT diagnosis and early PT - seeing a physical therapist within 30 days of this first visit. Multivariable logistic regressions assessed whether more permissive PT access laws were associated with greater odds of earlier PT use, adjusting for confounders. Compared with patients in limited access states, those in unrestricted and provisional access states had higher odds of PT first (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.5-2.1 and OR = 1.6, 95% CI: 1.3-2.0, respectively). Relative to patients in states with limited access, patients in states with provisional access had (OR = 1.2, 95% CI: 1.1-1.4) higher odds of early PT. No significant differences were observed between unrestricted and provisional access states. State laws permitting more direct access to PT may encourage earlier use of PT among patients with ARCT. Further research should investigate whether these law-associated treatment differences also improve health outcomes and lower costs.
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