Community Integration as a Key Role of the Rural Primary Care Physical Therapist: A Qualitative Case Study

Abstract Importance Rural communities face poor health outcomes due to limited health care access and provider shortages. Physical therapists are increasingly recognized as potential contributors to primary care delivery, yet little is known about their actual roles in rural settings. Objective The objective of this study was to explore the unique professional experiences of physical therapists in the rural Upper Midwest. Design A qualitative, exploratory case study design was used. Data was collected through semi-structured interviews and field observations. Analysis included inductive, in-vivo coding methods and thematic analysis guided by the Culturally Sustaining Pedagogy theoretical framework. Setting This study was situated in 5 communities in a rural, Upper Midwest state. Participants Five physical therapists with over 4.5 years of rural clinical experience were included in this study. Results Four key themes and associated subthemes were derived regarding the role of rural physical therapists: (1) operating as a primary care provider: physical therapists filled primary care roles through rurality-imposed autonomy, health care coordination, and health education; (2) employing a wide breadth of practice: therapists required broad generalist knowledge across practice settings; (3) patient-centeredness: patient-centered care involved fostering cultural norms and decentering of the therapist's own values; and (4) Community integration: Community engagement beyond their role as a physical therapist and understanding local culture were crucial for community acceptance and providing appropriate care. Conclusions Physical therapists in rural communities in an Upper Midwest state are fulfilling expanded primary care roles to address health care shortages, while deeply integrating within communities to provide appropriate and acceptable care. Their experiences highlight the complexity of rural health care delivery and potential for physical therapists to help alleviate provider shortages. Relevance As health care shortages persist in rural areas and the understanding the role of the primary care physical therapist continues to grow, this study shows that physical therapists are uniquely positioned to support primary care delivery.