Changing Perspectives on Diagnostic Imaging in Physical Therapy Education
Historical Perspective on Traditional Roles
The integration of diagnostic imaging into physical therapy practice is a relatively new idea. This idea has become possible not only out of necessity, but because of, and in response to, the shift in health-care philosophy over the past century. To understand the future challenges to be faced in completely integrating imaging into physical therapy (PT) practice, it is important to understand the setting on which it was established.
When physical therapy in the United States was established in the aftermath of World War I, it was within the biomedical model. This model remained unchanged for decades. The primary role of the physical therapist was to provide rehabilitation to a population of injured soldiers, workers, and individuals affected by poliomyelitis (polio).1
By the 1970s a new health-care philosophy was presented to address a multifaceted approach to disease management, the biopsychosocial model. Leaders in medicine recognized that this new model required a new infrastructure—which had to begin with the education of health-care professionals. It would be decades before interprofessional education became a standard in health-care education, and decades before the physical therapy profession in the United States would expand its role into primary care.
In the early 1970s most civilian physical therapists did not have access to diagnostic imaging. Not only was access restricted, but there were conflicting views on whether or not diagnostic imaging should be included as a part of physical therapy practice. Perhaps this was in part because of potential harm from exposure to ionizing radiation associated with conventional imaging modalities. As time passed, more advanced and less harmful imaging modalities were developed, such as magnetic resonance imaging (MRI) in the 1980s.2 Although the imaging technology evolved, physical therapists’ access to imaging did not.
Physical therapy education and practice in the United States has evolved over recent decades, and physical therapy is currently a doctorate-level profession with specialized areas of practice, including primary care, which requires considerable expertise in musculoskeletal evaluation.
In the past, many physical therapy education programs contained very little curricular content related to diagnostic imaging. The de-emphasis on diagnostic imaging education may have primarily been based on the limited scope of physical therapy practice in most U.S. states. The prevailing perception may have been that diagnostic imaging was not useful in most daily physical therapy practice. Another factor influencing the de-emphasis of diagnostic imaging education in physical therapy programs was reflected by the accreditation body, the Commission on Accreditation in Physical Therapy Education (CAPTE), which did not require diagnostic imaging to be included in physical therapy educational curriculums until 2004, when the document “A Normative Model of Physical Therapist Professional Education” was published. This document is intended to serve as ...