Background and Purpose. Orthopedic Clinical Specialist (OCS) certification has been available since 1989, however, no prospective studies exist demonstrating better patient outcomes with OCS certification. The purpose of this study was to prospectively explore if there are differences in effectiveness as measured by health, work status and patient satisfaction; efficiency, as measured by visits, treatment duration, number of treatment codes and cost; value (unit of functional improvement per dollar charged), and utilization (unit of functional improvement per visit) depending on OCS status of PTs working in orthopedic outpatient settings.

Subjects. Six PTs with OCS certification and 11 PTs without certification working in 8 clinics volunteered and recruited 279 subjects.

Methods. Consecutively sampled new subjects completed researcher-developed questionnaires and the acute Short Form 12-Item Health Survey (SF-12v2) at their initial and sixth visits. In addition, at the sixth visit subjects completed the Physical Therapy Outpatient Satisfaction Survey. A post study chart review was done. Adjusted change scores, standardized response means, and minimal clinically important differences were used to compare health, value, and utilization.

Results. No difference was found between groups in work status, satisfaction, number of visits, treatment duration, and total number of treatment codes billed. The mean (± SD) of total cost and cost per visit in the non-OCS group were less than in the OCS group $700.59 ±239.43 vs. $837.05±239.67 (p < .001) and $122.97 +39.32 vs. $147.23 ±39.37 (p < .001), respectively. The OCS group demonstrated better mean (± SD) Mental Component Summary (MCS) scores 4.7 ±7.8 vs. 0.6±7.8 (p = .004) and better utilization for the dimensions of bodily pain 1.3 ±1.8 vs. 0.6 ± 1.8 (p = .002), mental health 0.92 ± 1.74 vs. 0.30 ± 1.73 (p < .005), and MCS 0.76 ± 1.62 vs. 0.20 ± 1.61 (p < .006). The OCS group had more standardized response means interpreted as large, and more “minimal clinically important differences” in health, value, and utilizations than the non-OCS group.

Discussion and Conclusion. Non- OCS certified PTs were more cost effective, but cost was confounded by clinic differences in billing. OCS certified PTs had better treatment quality in dimensions of mental health and bodily pain, rather than better physical function outcomes as previously demonstrated retrospectively by Hart and Dobrzykowski.

Key Words: Health-related quality of life, Orthopaedic clinical specialist, Outcomes, Patient satisfaction

LLU Discipline

Physical Therapy


Physical Therapy


School of Allied Health Professions

First Advisor

Nicceta Davis

Second Advisor

Joseph J. Godges

Third Advisor

John Waite

Fourth Advisor

Grenith J. Zimmerman

Degree Name

Doctor of Physical Therapy (DPT)

Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Orthopedic Procedures; Physical Therapy Modalities; Certification; Patient Satisfaction.



Page Count

v; 59

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives