The impact of physical therapy assistants on rehabilitation clinical outcomes: a systematic review of the literature

ObjectiveThe impact of physical therapy assistants (PTAs) remains a key area of considerable interest, yet no systematic review has occurred after decades of research. This first-time systematic review is to examine PTAs impact on clinical outcomes in all physical therapy settings while providing the most current scientific perspective on this important topic.MethodsThis review used PubMed, SPORTDiscus, CINAHL, and Web of Science from database inception until May 5th, 2024. Inclusion criteria were articles examining clinical outcomes related to the utilization of PTAs published since 2000, retrospective or prospective studies, randomized controlled trials, case series, and full-text articles in English. The Methodological Index for Non-Randomized Studies (MINORS) scale graded articles. A narrative approach to systematic review was undertaken.ResultsSeven articles met inclusion criteria from 573 initially retrieved. Articles were 'moderate quality' and examined 82,175 patients and 25,765 nursing facilities across inpatient rehabilitation settings (n = 3 articles) and outpatient settings (n = 4 articles). In outpatient settings, the use of PTAs was associated with increased physical therapy utilization and mixed clinical outcomes. For inpatient rehabilitation, three articles indicated mixed results with some concluding no difference in clinical outcomes while others reported increased fall risk. No articles examined the impact of PTAs on outcomes in acute care or home care settings in the last two decades.ConclusionThis systematic review of moderate quality observational studies found mixed clinical outcomes when PTAs were involved, although evidence is limited. Additional research is needed to improve both the quality and quantity of literature on this topic.ImpactUnderstanding the impact of PTAs on physical therapy practice is critical to optimize clinical outcomes, mitigate workforce constraints, ensure patient access, and address policy issues associated with decreasing reimbursement and supervision restrictions.