October 09, 2025
2 min read
Key takeaways:
- Researchers found a “relatively low” rate of physician referrals to physical therapy for patients with knee osteoarthritis.
- Approximately 16% of patients received an early referral to physical therapy.
Physician referrals to physical therapy remain infrequent in knee osteoarthritis, with 16.5% of patients receiving a referral within 15 days of the index visit, according to data published in Arthritis Care & Research.
“Despite several clinical practice guidelines recommending non-pharmacological treatments as frontline approaches for managing knee OA, these interventions remain underutilized in clinical practice,” Samannaaz S. Khoja PT, PhD, a research assistant professor in the department of physical therapy at the University of Pittsburgh, and colleagues. “The findings of this study suggest that the referral to physical therapy for conservative care of knee OA is relatively low and is influenced by factors at the patient, physician and practice levels.”
Data were derived from Khoja SS, et al. Arthritis Care Res. 2025;doi:10.1002/acr.25630.
To examine the frequency and timing of physician referrals to physical therapy, oral pain medications and therapeutic injections in patients with knee OA, Khoja and colleagues performed a retrospective study of data from 9,835 patients who presented with the disease.
The researchers assessed variables such as time to physical therapy referral, number of local licensed physical therapists, patient characteristics, physician specialty and practice location. An early physical therapy referral was defined as referral within 15 days of the index visit.
Within 1 year, 26% of patients (n = 2,550) received at least one referral to physical therapy, with 50% of referrals occurring at the index visit and 75% of referrals occurring within the first 34 days after the index visit. In total, 16.5% of patients (n = 1,629) received an early referral to physical therapy, according to the researchers.
“More commonly used knee OA treatments over 12-month period from the index visit included therapeutic injections or pharmacological agents,” Khoja and colleagues wrote.
According to the researchers, patients with high or missing knee pain scores, and those from rural areas, were less likely to receive an early referral to physical therapy. Meanwhile, women, patients with high BMI and those residing in counties with more physical therapists had a greater chance of receiving a referral.
In addition, orthopedic surgeons were most likely to give early referral to physical therapy compared with primary care physicians and other specialists.
“These findings reflect geographic disparities in care due to decreased accessibility of resources, including supply of physical therapists,” Khoja and colleagues wrote.
For more information:
Samannaaz S. Khoja PT, PhD, can be reached at rheumatology@healio.com.
Perspective
According to the NIH, about 14 million U.S. adults experienced symptomatic knee osteoarthritis for which many treatment options exist.
As providers, our treatment recommendations are based upon many factors that influence our decisions. However, as this study points out, referral for physical therapy, the recommended first treatment, has declined and medication prescribing and therapeutic injection administration has increased.
There are several variables that contribute to this trend, including knowledge of the benefits of physical therapy, access to physical therapy, level of pain reporting or lack thereof, higher BMI, and female gender. It is essential that we continue educating and encouraging patients regarding non-pharmacologic methods to treat knee OA.
We have become a medication treatment focused society while research continues to show the benefits of exercise, lifestyle modifications focused on healthy weight and healthy diet, and exercise for OA and a host of other diseases.
Devin Weidman, MSN, APRN-C
Disclosures: Weidman reports no relevant financial disclosures.
