This report is not a clinical practice guideline, and the articles used do not necessarily reflect optimal clinical practice but instead represent a plausible average episode of physical therapy. The report reflects the estimated economic value of an average physical therapy intervention for an average patient for whom physical therapy is a plausible and safe treatment option, as compared to a commonly used alternative.

For example, physical therapy is compared with surgery when a patient ethically could be given a choice between either alternative.

Findings from the report should be interpreted on a per-condition basis and not necessarily compared across the eight analyzed conditions.

The quality-adjusted life year, or QALY, is the academic standard for measuring the impact of different kinds of medical treatments to lengthen and/or improve patients' lives. It combines quantity and quality of life into one metric, allowing analysts to compare changes in health status both within and across conditions measured in the same units. That's why the metric has served as a fundamental component of cost-effectiveness analyses in the U.S. and around the world (ICER). The QALY is measured in a range from 0 to 1, with death at 0 (or 0%) and a state of perfect health at 1 (or 100%).

For this report, we have used QALYs only for making comparisons; they were not intended, nor would we condone their use, to reduce the value of an intervention due to the severity of a person's illness, age, or disability.

To calculate dollar savings for treatment of each of the eight conditions included in the report, our economic analysis used the QALY to quantify in dollar terms the quality-of-life benefits of physical therapist services compared with either an alternative non-physical therapy-based intervention or no intervention. This QALY benefit was then multiplied by the value of the statistical life year, or VSLY. VSLY is estimated based on the value of a statistical life, which represents the dollar amounts willing to be spent within the health care system to reduce risks of mortality in society.

The primary purpose of the report was to demonstrate the cost-effectiveness of physical therapist services compared with the alternative type of intervention employed for specific conditions.

The economic analysis was grounded in the strength of the evidence available in the literature, and so the costs provided in the literature (inflation-adjusted to 2023 dollars) were used in the analysis. We understand that the costs used from selected studies, although inflation-adjusted, are still based on a snapshot in time. We also recognize that costs vary widely across the country, and we considered costs within a reasonable range of estimates compared with the latest treatment costs available from other credible sources.

Net benefit is the average net economic benefit delivered per episode of care, calculated as quality-of-life benefits minus net costs (which may be positive or negative). 

Using averages of any kind is typical for economic analysis and interpretation of clinical data. 

This report uses the best available literature for economic modeling for each condition-based intervention comparison. We identified gaps in evidence and suggested when further research would help with future modeling or when evidence from a study outside the United States has been adapted to apply to the U.S. health care system.  

For example, if there was insufficient evidence from U.S. studies on an intervention area, we adapted comparable evidence from relevant health systems in other nations. In other cases, alternative studies were used, or a decision was made not to pursue an economic analysis of a given condition. 

To maintain consistency across different studies, we sought literature that estimates the q-adjusted life years — QALYs — of an intervention, among other appropriate measures. For a closer look at how and why these metrics were used in creating our economic models, read our Approach and Methodology chapter in the technical report.

For the first iteration of this analysis, we modeled only conditions that are backed by the strongest evidence, that are highly prevalent in rehabilitation practice, and that are associated with notable U.S. health care spending. We designed the methodology to be consistently applicable to additional conditions that we may identify for future reports.

Macro-economic studies to identify the economic value of health care services in U.S. acute care settings have some limitations, such as the ability to identify value specific to one profession delivering care in this setting, and because of the fixed facility-based payment models. Also, rehabilitation is ingrained in usual care across these settings, limiting the number of studies involving non-rehabilitation alternative treatments. 

A growing body of scientific evidence supports the high-value, lower-cost interventions that physical therapy offers patients and the health care system. "The Economic Value of Physical Therapy in the United States" draws from this body of evidence to make a compelling case for the impact of physical therapy on not only individuals but society as a whole.

The results in this report demonstrate that, where medically appropriate, more widespread use of the selected physical therapist services would deliver both health and economic benefits to patients and to the U.S. health care system.  

Join APTA in promoting the value of physical therapy as demonstrated in this report to inform consumers, policymakers, payers, and employers about the significant role and economic value that physical therapist services bring to the health care system. Use this report: 

• In tandem with strong clinical evidence to show both the impact and economic value of physical therapy. 
• To educate your patients and their families about the economic value of physical therapy for a variety of conditions. 
• To advocate for coverage and payment for physical therapist services. 
• To improve interdisciplinary collaboration to increase referrals.