Another Gorman, 2011). Despite these evident benefits

Another example of how “political”
interests (practice act barriers) and financial implications have played a role
in the provision of healthcare in regards to EBP is physical therapists’ ability
to order plain film radiographs (x-rays). 
At the present, several states allow physical therapists to order plain
film radiographs as well as various government agencies including the military,
Indian Health Services, and the Veterans Administration Health System (Boyles
& Ira Gorman, 2011). 
This allowance for ordering radiographs stems from the advancement of
direct access of physical therapists in 48 states, which allows physical
therapists to see patients without a physician order (Boyles
& Ira Gorman, 2011). 
Boyles et al. presents several instances of physical therapists ordering
of radiographs, including several private based organizations like Kaiser
Permanente in California and University of Wisconsin Hospital and Clinics and
these found that physical therapists were able to order radiographs without any
detriment in care or adverse reactions when compared to physicians or
orthopaedic surgeons with the end results trending towards overall improvements
in efficiency of care and cost savings (Boyles
& Ira Gorman, 2011). 
Despite these evident benefits to patient care and improvements in
overall efficiency of healthcare delivery (i.e. EBP), several state practice
acts prohibit ordering of radiographs or are silent on the matter; resulting in
the need for legal action to allow appropriate interpretation (Boyles
& Ira Gorman, 2011). 
Furthermore, according to Boyles et al. another issue with physical
therapists ordering radiographs is due to “reimbursement policy (insurance
company and/or third part payer policy” (Boyles
& Ira Gorman, 2011, p. 834). 
This means that even if a state practice act allows a physical therapist
to order radiographs, there is the chance that particular insurance companies
may not reimburse for these radiographs.  

A final example of these political interests (and
related financial implications) preventing appropriate provision of EBP can be
found in the thrust joint manipulation (TJM) debate or “turf battle” between
physical therapists and chiropractors.  Similar
to dry needling, there is appropriate evidence to support TJM (for particular
conditions and presentations) and it is currently indicated for usage in
chronic neck pain (at the thoracic spine level) according to the JOSPT Clinical
Practice Guidelines revised in 2017 (Blanpied et al.,
2017).  The
APTA has produced many materials summarizing the excellent evidence that is
available in support of this well-proven and effective intervention for
musculoskeletal conditions of the spine; yet, the allowance for physical
therapists to practice this skilled-intervention has been met with resistance
at every turn at the national and state level; primarily by chiropractors.  In a 2007 editorial by Peter Huijbregts he
states that the two professions are “in a position of direct economic competition
within the health care market.

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