Send a Referral for Physical Therapy
For a patient who has already completed physical therapy and needs a new PT order, you should send a direct referral to physical therapy, not a specialist consult. This is a straightforward administrative process that does not require specialist evaluation.
Clinical Reasoning
Physical therapy referrals and specialist consultations serve fundamentally different purposes:
When to Send a PT Referral (Your Situation)
- Patient has previously completed PT and demonstrated benefit
- Condition has recurred or progressed requiring additional therapy
- No new diagnostic uncertainty exists
- Functional status has declined from baseline
The evidence supports direct referral to physiotherapy when patients need supervised physical exercise or individually tailored interventions 1. Guidelines recommend considering "the possibility for referral to a physiotherapist for individually tailored graded physical exercise or strength training" when patients cannot initiate physical activity independently 1.
When to Request a Specialist Consult Instead
You would request a specialist consult if:
- New or unexplained symptoms have emerged since last PT course
- Inadequate response to previous PT treatment
- Diagnostic uncertainty about the underlying condition
- Red flags suggesting serious pathology (fractures, tumors, neurological deficits)
- Significant functional deficits requiring specialist assessment (e.g., joint instability, large range-of-motion restrictions) 2
Practical Implementation
Simply write a new PT prescription/referral that includes:
- Diagnosis or reason for referral
- Specific functional limitations
- Treatment goals
- Any precautions or contraindications
The stepped-care approach in guidelines supports this: patients receive education and self-management first, then "one or more treatment options by a specialist if indicated," with PT being a treatment option rather than requiring specialist gatekeeping 1.
Common Pitfalls to Avoid
- Don't delay care by routing through unnecessary specialist appointments when the diagnosis is clear
- Don't send vague referrals stating only "pain" - this occurred in 33% of referrals in one study and necessitates additional diagnostic work by the PT 3
- Do specify the condition and functional goals to optimize PT effectiveness
- Consider early referral based on pain severity and functional limitations rather than waiting 4
Physical therapists have the clinical expertise to evaluate whether further medical workup is needed and will refer back to you if red flags emerge 5.