Weekly Literature Review: Reflections from the Frontlines of Physical Therapy Research

Examining the function and execution of MSK care

Get your weekly dose of literature ahead of their scheduled posting. This week’s selected studies collectively address three recurring challenges in the profession: adherence, autonomy, and long-term sustainability. Below is a summary and reflection on five noteworthy papers and their practical implications.

Monday – Understanding Home Exercise Adherence

Title: Predictors of adherence to home-based physical rehabilitation therapies: a systematic review
Journal: Disability and Rehabilitation

Key Findings:

• Home exercise program non-adherence rates approach 70 percent.

• Top predictors of adherence: self-efficacy, motivation, intention to adhere, social support, and prior adherence behavior.

• The review reinforces behavioral frameworks like the Theory of Planned Behavior and Self-Determination Theory.

Reflection:
This review highlights that HEP non-adherence is more than a compliance issue, it is a behavioral and systems challenge. Interventions that do not account for psychological and contextual barriers are unlikely to succeed. Clinicians and digital health platforms alike must better integrate motivational science into the design of home exercise workflows.

Tuesday – Patient Experience with a Smartphone App

Title: Patient Perspectives on Using a Smartphone App to Support Home-Based Exercise
Journal: JMIR Human Factors

Key Themes:

• Patients appreciated clear instructions, reminders, and the structure provided by the app.

• Engagement dropped over time without therapist involvement or exercise variety.

• The therapeutic relationship was essential for long-term app engagement.

Reflection:
This study reinforces that digital health tools are most effective when they enhance, not replace, the therapist’s role. mHealth can support adherence and convenience, but its success depends on integration with real human connection and personalized instruction. This is a reminder to build blended care models, not isolated tech solutions.

Wednesday – Competency in Imaging Referral

Title: Physical Therapists Are Routinely Performing the Requisite Skills to Directly Refer for Musculoskeletal Imaging
Journal: Journal of Manual & Manipulative Therapy

Findings:

• Nearly 95 percent of PTs reported routinely triaging imaging appropriateness.

• Over two-thirds performed at least seven of nine validated imaging competencies.

• Advanced training (DPT, residency, board certification) was associated with higher competency levels.

Reflection:
This study provides substantial evidence that PTs are not only trained but actively practicing with the competencies required for direct imaging referral. Policymakers and regulators should take note, scope of practice should align with real-world clinical behavior and training. Expanding imaging privileges is both feasible and warranted.

Thursday – Productivity and Satisfaction in the Clinic

Title: Job Satisfaction and Productivity Requirements Among Physical Therapists and Physical Therapist Assistants
Journal: Journal of Allied Health

Findings:

• Sixty percent of clinicians reported productivity standards, averaging 82 percent billable time.

• Higher productivity standards were correlated with lower satisfaction, especially around communication, supervision, and recognition.

• PTAs reported slightly higher satisfaction with working conditions than PTs.

Reflection:
Productivity expectations are necessary, but poorly aligned systems erode morale. This study underscores the need to revisit how productivity is measured and incentivized in outpatient rehab. Clinician engagement, recognition, and autonomy must be prioritized to sustain both performance and satisfaction.

Friday – The Weight of Educational Debt

Title: Impacts of Educational Debt on Physical Therapist Employment Trends
Journal: BMC Medical Education

Findings:

• Higher educational debt was associated with more work hours, delayed retirement, and lower job satisfaction, especially for lower-income PTs.

• Debt levels were not significantly associated with specialization or setting.

• The data supports the Labor-Search Model, where economic pressures influence job decisions more than intrinsic satisfaction.

Reflection:
The financial burden of physical therapy education has profound implications for workforce development. If left unaddressed, educational debt may drive early-career clinicians into unsustainable work patterns, limit diversity, and diminish long-term retention. Systemic reform around tuition costs, compensation, and loan relief is overdue.

Final Reflection

This week’s literature paints a consistent picture: sustainable care models must account for human behavior, professional autonomy, and economic realities. Whether examining home exercise, clinical tech, scope of practice, or career pathways, one truth stands out—physical therapy is as much about systems and support as it is about movement and manual care.

As we move forward, we must design interventions, technologies, and policies that align with how people actually think, feel, and work. Evidence alone is not enough—we need frameworks that translate findings into practice at every level.

Next week’s review will focus on virtual rehabilitation, digital biomarkers, and AI in MSK care. Until then, stay curious and keep asking the hard questions that move our profession forward.