ArticlePloS one2026
The impact of physical therapy direct access policy on opioid shipments and opioid-related deaths: A difference-in-differences analysis.
Article in PloS one, 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
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Abstract
backgroundWe exploit state-level policy changes for physical therapy direct access to estimate the effect of enacting direct access physical therapy policy on per-capita opioid pill volume (PCPV) and opioid-related deaths (ORD) compared to states without direct access to physical therapy.
methodsWe used a staggered difference-in-differences analysis to assess changes in PCPV and ORD for states that did (treatment states) and did not enact (control states) direct access physical therapy policies between 2006-2014. Various sensitivity analyses including synthetic control methods were used to check the robustness of our results.
resultsTreatment states had higher baseline PCPV (29.9 vs. 27.3) and ORD (27.2 vs. 16.9) compared to the control states. Pre-trends in PCPV and ORD were parallel between treatment and control states. After direct access physical therapy policies were enacted, PCPV was significantly reduced by -4.6 (95% confidence interval: -6.2 to -3.0) percentage points, a 15.4% relative reduction. There was no significant difference in ORDs (-2.3 [95% confidence interval: -7.2 to 2.6]).
conclusionDirect access physical therapy policies significantly reduced PCPV but not ORDs. Our results suggest that administrative barriers to physical therapy may lead to greater opioid reliance and reduced population health.
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