Diagnosis means the primary dysfunction toward which the physical therapist directs treatment. The dysfunction is recognized by the physical therapist based on information obtained from the history, signs, symptoms, examination, and tests the therapist performs or requests.
Clinicians implement strategies that predominantly involve the use of exercise and physical agents to change or prevent circumstance that affect patient’s life style. Choosing the most useful and least harmful strategy for a given patient is one of the clinical decisions made by the clinician daily. Establishing a physical therapy diagnosis allows the clinician to name and classify clusters of symptoms, signs, and demographic data of similar patients who have responded successfully to a specific treatment. Using the systematic process of classifying clinical data, developing categories based on the classification process, and naming categories of successfully treated patients increases the probability that the clinician will replicate or surpass the best
results obtained in previous situations.
Physical therapists thus must establish diagnostic categories that direct their treatment prescriptions and that provide a means of communication both within the profession and with other practitioners and consumers about the conditions that require their particular expertise for effective treatment and prognostication. Additionally, for professional credibility, physical therapists must refrain from using diagnostic labels that they cannot confirm through their own recognized examination and testing methods. The delineation of diagnoses that are based on signs and symptoms and that direct treatment prescriptions will also aid therapists in the process of identifying those conditions that are outside of their scope, which is a primary requirement for safe and ethical practice.
Very often it is mistaken that the physical therapist must be able to make a differential medical diagnosis to identify the specific disease. That type of differential medical diagnosis requires a medical education. The generic definition of the term diagnosis as stated in this communication will help establish which conditions require a diagnosis by physicians and which conditions require diagnosis by physical therapists.

At present direct patient access to physical therapy services is legal in the majority of U.S. jurisdictions. Treatment may be provided without a referral and without restrictions in 16 states and without a referral but with certain restrictions in 29 states. Three states permit a physical therapist to conduct a patient evaluation without a referral but do not permit treatment without a referral. Two states require a referral for evaluation as well as treatment. While state law may permit treatment without a referral, payers may still require a referral. The vast majority of U.S. jurisdictions have some form of patient access to evaluation and treatment by licensed physical therapists. Access to physical therapist services is critical to ensuring optimum patient functional status and independence.
Throughout the experience of obtaining direct access at the state level, physical therapists have been questioned about their ability to identify a patient’s signs and symptoms correctly, especially those that may represent cancer or other life-threatening conditions, if a physician has not first screened the patient. The misguided presumption is that physical therapists are not sufficiently educated or clinically trained to correctly diagnose an underlying pathological condition. This argument falsely concludes that direct access to physical therapists is therefore a threat to the safety of the public.
Physical therapists do not provide a medical diagnosis. However, they are well prepared to identify when a patient’s signs and symptoms potentially lie outside the scope of physical therapist diagnosis and require a referral to a physician for further diagnostic work-up and identification of underlying pathology. The examination process, routinely employed by physical therapists, ensures that direct access to physical therapists also allows referral to physicians when indicated.
With more than 30 years of experience with direct access in the states that permit it, there is absolutely no evidence that physical therapists misinterpret a patient’s signs and symptoms as non-pathological leading to serious injury or death. Physical therapist malpractice rates do not differ between states with patient direct access and those with a physician referral requirement. Furthermore, when the numbers of complaints against physical therapists filed with state licensure boards were examined prior to and after elimination of the physician referral requirement, no increase of complaints centered on patient harm was found.