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The online version of this article, along with updated information and services, can
be found online at: http://ptjournal.apta.org/content/69/7/610
[Campbell SK, Anderson JC, Gardner HG: Use of survey research methods to study Suzann K Campbell
clinical decision making: Referral to physical therapy of children with cerebral Judith C Anderson
palsy. Phys Ther 69:610-615, 1989] H Garry Gardner
Key Words: Cerebral palsy, evaluation; Clinical competence; Decision making;
Pediatrics, evaluation.
Because of the lack of a strong body Why are physicians' decisions regard- rience can help to clarify the theory,
of research literature to support the ing referral of children with CP reveal where the opinions of physi-
efficacy of physical therapy in the important to study? First, understand- cians diverge from those of physical
management of physical disability, ing these decisions is important in a therapists, and lend direction to
therapists, physicians, and others must theoretical sense because we do not future research.
operate in the realm of uncertainty know what factors guide physicians'
when deciding whom to refer and referral decisions and because the Second, physicians appear to be
whom to treat in a cost-effective man- research literature on pediatric physi- increasingly aware of the lack of sci-
ner. Despite the increasing passage of cal therapy is unclear regarding what entific support for the efficacy of
direct-access legislation allowing phys- the expected outcomes of treatment physical therapy in treating CP and of
ical therapists more independence in should be. Outcomes may differ by the high cost involved in the long-
the decision of whom to treat, physi- type of CP and by severity. The lack of term care of children with develop-
cal therapy decision making remains data describing such possible differ- mental disabilities. In an era when
strongly influenced by physicians' ences in outcome makes it impossible third-party payment for such services
decisions regarding patient referral. to use quantitative decision analysis is threatened, lack of accountability
This article describes a survey approaches to selecting management looms large as a problem. To give just
research approach to studying physi- options, such as intensive physical one example, in an article on the eco-
cians' decisions regarding referral. A therapy, orthopedic surgery or neuro- nomics of long-term care of children
study, now in the pilot stage, regard- surgery, or use of rehabilitation tech- following neonatal intensive care, the
ing referral of young children with nology, for this population. Studying authors indicated that physical therapy
cerebral palsy (CP) to physical therapy the opinions of decision makers of and occupational therapy were
will be used as an example. different levels of expertise and expe- responsible for the greatest costs in
the area of outpatient services follow-
ing hospital discharge, and those chil-
dren at intermediate risk for develop-
S Campbell, PhD, FAPTA, is Professor, Department of Physical Therapy, College of Associated mental disability used these resources
Health Professions, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL 60612 (USA). as much as children at exceptionally
J Anderson, MS, PT, is Graduate Research Assistant, Department of Physical Therapy, College of high risk.1 The authors also noted the
Associated Health Professions, and Doctoral Student, Department of Sociology, University of Illinois lack of documented efficacy of these
at Chicago. services. An understanding of how
HG Gardner, MD, is Pediatrician, DuPage Pediatrics, Ltd, 805 Plainfield Rd, Darien, IL 60559, and physicians deal with the uncertainty
President, Illinois Academy of Pediatrics. involved in early diagnosis of a condi-
This work was supported in part by Grant MCJ 9101, Bureau of Health Care Delivery and Assis- tion with undocumented benefit from
tance, US Public Health Service, to the Department of Occupational Therapy, University of Illinois therapy can be helpful in developing
at Chicago, and by intramural research funds from the College of Associated Health Professions, marketing strategies for increasing
University of Illinois at Chicago.
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