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Social determinants of health are associated with physical therapy use: a systematic review
  1. Amanda Day Braaten1,
  2. Cannon Hanebuth1,
  3. Holt McPherson1,
  4. Dashae Smallwood1,
  5. Samantha Kaplan2,
  6. David Basirico1,
  7. Derek Clewley1,
  8. Zachary Rethorn1
  1. 1 Doctor of Physical Therapy, Duke University Division of Orthopaedic Surgery, Durham, North Carolina, USA
  2. 2 Medical Center Library & Archives, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Amanda Day Braaten, Doctor of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, USA; amanda.braaten{at}


Objective The purpose of this systematic review is to identify and summarise the social determinants of health (SDH) cited in the literature and evaluate their association with individuals using physical therapy services.

Design A systematic review using qualitatively synthesised information to describe the association between SDH and physical therapy use.

Data sources The electronic databases Medline, Embase and Scopus were searched from inception to February 2021, identifying observational and qualitative studies.

Eligibility criteria Published studies included all adults, aged 18 or older, who independently sought to use physical therapy, in all practice settings from all geographical locations.

Results Of the 9248 studies screened, 36 met the inclusion criteria for the review. The participants represented 8 countries and totaled 2 699 437. The majority of the papers reported moderate strength of association for each SDH. Female gender, non-Hispanic white race/ethnicity, increased education attainment, urban environment, access to transportation, employment, high socioeconomic status and private insurance were associated with higher likelihood of physical therapy use.

Conclusion This systematic review identifies predisposing and enabling factors impacting physical therapy usage among adults in different countries and across physical therapy settings. The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.

  • health
  • public health
  • physiotherapy
  • economics
  • education

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  • Contributors Conception or design of the work was completed by all members. Data collection was collected by Amanda Braaten, Cannon Hanebuth, Dashae Smallwood, Holt McPherson, and David Basirico. Data analysis and interpretation was done by Amanda Braaten and Holt McPherson. Drafting the article was done primarily by Amanda Braaten, with several paragraphs written by Samantha Kaplan and Cannon Hanebuth. Critical revision of the article was done by Amanda Braaten, Zachary Rethorn, and Derek Clewley. Final approval of the version to be published was done by Amanda Braaten, Zachary Rethorn and Derek Clewley.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.