Social determinants of health are associated with physical therapy use: a systematic review

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.