APTA Dismisses NATA 'Study' Promotion

Once again, the National Athletic Trainers' Association (NATA) has vainly attempted to find some justification for its expansive view of athletic trainer services in its efforts to secure athletic trainer parity with physical therapists.

This time the "evidence" is found in a retrospective "study" (that would probably be better categorized as an "infomercial") conducted by an orthopaedic surgeon, a physician assistant, and two athletic trainers. The "study" purports to show that athletic trainer services are cheaper than the services of physical therapists; that the utilization of athletic training is lower than that of physical therapy; and that comparable outcomes are achieved by the provision of both services.

Because of the lack of any citation, it appears that the report of the "study" was not published in any peer review journal. Likewise, there is no mention of an Institutional Review Board (IRB) approval.

Among the "study's" many failings are the following:

Small "Study" Size: The "study" looked at only 36 patients-16 of whom were workers compensation patients with half of those reportedly treated under a physician extender model (involving an athletic trainer) and the other half under a physical therapy model. Twenty non-workers compensation patients were likewise treated under the same models. In all instances, the treatment followed rotator cuff surgery.

Lack of Random Assignment: Although the patients' charts were reportedly picked at random, there is no indication that the assignment to treatment models was also randomized. Likewise, there were no criteria listed for the assignment of patients to the physical therapy model or to the physician/athletic trainer model.

Lack of Patient Comparability: There is no reported evidence that patients in the different treatment models were matched for age, sex, previous functional level, etc. Nor is there mention of even the most basic demographic information.

No Actual Physical Therapy Costs: None of the cited physical therapy charges were actual charges. An estimated "average" treatment charge of $130 was provided by physical therapists from 5 facilities with no mention of whether or not the patients in the "study" were treated in those facilities. There is also no indication of whether these were "billed charges" or "paid charges" or whether they were comparable with the calculation of the "costs" for athletic training.

Orthopaedic Bias: As the report on the "study" itself notes, "because patient satisfaction was based on subjectivity measured by the orthopedic surgeon who operate on the patient, some level of bias cannot be excluded."

Outcomes Impacted By Orthopaedic Bias: The report refers to "comparable subjective outcomes." These subjective outcomes were subject to the same bias as noted above because the measure of outcomes was based on "patient satisfaction," as determined, not by the patient, but by the surgeon.

Questionable "Findings:" It is difficult to confidently determine the meaning of most of the data. Without appropriate statistical testing, what is the real meaning of three tenths of a point difference in satisfaction ratings-which did not even come from the patients themselves? Workers compensation patients received fewer visits from the athletic trainers than did the non-workers comp patients. Yet the average costs for the workers comp patients were higher, thereby implying that these patients received less care at higher costs. However, the reverse is true for the physical therapy patients, who appear to have received more care at slightly lower costs. So, which group of workers comp patients received the care with the better value?

NATA's promotion of this extremely questionable "study" is but another example of its willingness to grasp at any straw in support of its ongoing opposition to the recent Medicare decision that excludes athletic trainers from reimbursement under Medicare's "incident to" provision. APTA will continue to monitor information disseminated by NATA relative to physical therapists and the practice of physical therapy, and respond as appropriate.