Characterization of Direct Access Upper Extremity Rehabilitation Services by Military Occupational Therapists

Direct access care is a common service option in the military as occupational therapists (OTs) are credentialed to provide upper extremity neuromusculoskeletal evaluation as physician extenders. Military OTs evaluate and treat service members with upper extremity injuries following advanced training provided in the military. Direct access service is an advanced clinical privilege afforded only to OTs in the federal system. Although military OTs maintain and deliver direct access services for the upper extremity, no literature exists describing learning strategies used for gaining these skills, the patterns of services delivered, or types of interventions delivered to military populations. Therefore, the purpose of this study was to characterize direct access learning and services of military OTs. An electronic survey was developed using the military software Intelink. An 87-item survey was created with 3 sections devoted to demographic variables, direct access upper extremity diagnostic evaluation and rehabilitation intervention variables, and metacognitive strategy use for self-regulated learning. Descriptive statistics were used to summarize the survey data into frequencies. Inferential statistical analysis was used to assess the association of variables collected. A total of 103 OTs completed the survey. Significant associations were observed between advanced qualification training and provision of direct access OT services. This study is the first to characterize direct access upper extremity service delivery within the military population. The results of this study support the continued need for advanced education to address direct access upper extremity neuromusculoskeletal capability in the military.