Direct Access and Advanced Practice Physical Therapy for Musculoskeletal Care: A Systematic Mixed Studies Review and a Cross-System Organizational Typology

Physical therapists and physical therapist assistants who work in outpatient or primary care musculoskeletal settings, clinic managers and clinical leads planning first-contact or triage services, and clinicians considering post-licensure education toward an advanced practice role.

Licensed physical therapists and physical therapist assistants in any practice setting, with particular relevance to outpatient orthopedics, primary care and program management. Physical therapist assistants contribute to these services under the direction and supervision of the physical therapist; evaluation, diagnosis and plan-of-care decisions remain with the physical therapist.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

Maddigan K, Davis C, Saville B, Nishimura K, Van Bussel J, Tawiah AK, Kowalski KL, Rushton AB. The educational pathway to Advanced Practice for the physiotherapist: A systematic mixed studies review. PLoS One. 2025;20(5):e0322626. doi:10.1371/journal.pone.0322626

Fischer M, Pinsault N, François M, Mignot S. How direct access to physiotherapy reshapes GP gatekeeping for musculoskeletal care in primary care: an exploratory organisational typology across health systems. Fam Med Community Health. 2026;14(2). doi:10.1136/fmch-2026-004078

Jurisdiction matters

Both papers draw on health systems outside the United States, and both use the title physiotherapist. Direct access rules, scope of practice, imaging and prescribing authority, and protected professional titles vary by state and by country. Nothing in this course describes what any individual clinician is permitted to do; readers must check their own practice act and payer rules.

After completing this course, you will be able to:

1. Describe the six post-licensure educational pathways identified by the systematic mixed studies review and state which pathway the review reported as consistently demonstrating all four pillars of advanced practice.
2. Name the organizational configurations of direct access physiotherapy reported in the cross-system typology and state how each one redistributed general practitioner gatekeeping for musculoskeletal care.
3. Explain what the two papers together do and do not establish about the education an advanced practice role requires and the system conditions a first-contact service depends on, including why direct access rules and professional titles must be checked locally.

1. Start Here: The Course Question and How to Use This Course
2. Part One: The Educational Pathway to Advanced Practice for the Physiotherapist
3. Advanced Practice and Its Four Pillars: What the Review Set Out to Map, and in Whom
4. How the Review Was Conducted: Searching, Screening and Judging Quality in Plain Words
5. Six Post-Licensure Pathways and What Each One Was Found to Produce
6. Confidence, Caveats and the Review's Conclusion About Masters Level Education
7. Part Two: Direct Access to Physiotherapy and General Practitioner Gatekeeping in Musculoskeletal Care
8. Direct Access, Gatekeeping and the Organizational Question the Typology Asked
9. How the Configurations Were Derived From Published Service Descriptions
10. Five Configurations, Four of Them Observed: From Protocol-Governed Triage to Advanced Practice
11. A Beveridge-Heavy Corpus: What the Typology Cannot Tell Us
12. Bringing It Together
13. Where the Two Papers Point in the Same Direction
14. Where They Diverge, and Which Paper Reported What
15. What This Could Mean for the Clinician, the Team and the Schedule
16. What Remains Open, and Why the Practice Act Is the Deciding Document
17. Key Takeaways
18. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 1.0 contact hour (60 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. Maddigan K, Davis C, Saville B, Nishimura K, Van Bussel J, Tawiah AK, Kowalski KL, Rushton AB. The educational pathway to Advanced Practice for the physiotherapist: A systematic mixed studies review. PLoS One. 2025;20(5):e0322626. doi:10.1371/journal.pone.0322626
2. Fischer M, Pinsault N, François M, Mignot S. How direct access to physiotherapy reshapes GP gatekeeping for musculoskeletal care in primary care: an exploratory organisational typology across health systems. Fam Med Community Health. 2026;14(2). doi:10.1136/fmch-2026-004078