Physical therapists are well positioned to be the providers of choice for patients who experience low back pain. Successful physical therapist practice in a primary care setting requires knowledge in medical screening, sound clinical decision making, and clinical reasoning to select optimal physical therapy interventions. This session will discuss the development and implementation of a pilot program specific to the management of low back pain in a direct access environment at the Cleveland Clinic. Topics covered will include: (1) organizational stakeholder collaboration and policy navigation; (2) scheduling logistics; and (3) integration of documentation. The speakers will share lessons learned from the implementation of this project. Case studies will be used to highlight physical therapist practice and value of access to physical therapy services in a primary care setting.

Meet the Speakers:

Ian Stephens, PT, DPT, OCS graduated from Ohio University in 1998 with a master's degree in physical therapy. He received a transitional doctorate in physical therapy from Regis University in 2011. He is a board-certified clinical specialist in orthopaedic physical therapy and a faculty member for Cleveland Clinic’s orthopaedic physical therapy residency program. He is clinical rehabilitation manager at the Cleveland Clinic, and his clinical interests include low back pain, neck pain, headache, and chronic pain.

Christine Schulte, PT, MBA is director of outpatient rehabilitation for the Cleveland Clinic Rehabilitation and Sports Therapy. She received a bachelor’s degree in physical therapy from Cleveland State University in 1986 and a master’s degree in business administration from the University of Phoenix in 2006. She has served in her current role as director of outpatient operations for the main campus and the western region sites of Cleveland Clinic Rehabilitation and Sports Therapy since 2010. Her responsibilities include operational directions for 25 locations and 35 cost centers, with more than 150 employees. Schulte’s administrative role brings vast experience with employee engagement, policy and procedure development, marketing, budgetary process, productivity standards, time management controls, treatment guidelines, scheduling, and operational efficiencies. She works closely with her team to ensure compliance and quality of care throughout the region and has been instrumental in implementing medical record update procedures and a documentation audit process. She also continues to evaluate and treat patients in her specialty of aquatics. Prior to this role, she enjoyed 20 years at Marymount Hospital in Garfield Heights, Ohio. At Marymount her career afforded her a variety of experiences in rehabilitation settings including acute care, inpatient rehabilitation units, skilled nursing facilities, home care, outpatient, and sports therapy. Her role expanded as she gained responsibility for additional clinical operations as administrative director for Marymount Hospital Rehabilitation Services, pain management, laboratory services, occupational medicine, and employee wellness as well as program director for a patient’s first initiative.

Sandra Passek, PT, DPT is rehabilitation manager of clinical informatics at the Cleveland Clinic Rehabilitation and Sports Therapy. She graduated from The Ohio State University in 1994 and received a transitional doctorate in physical therapy from Simmons College in 2011. For the past 8 years, she has led several EMR implementations across the Cleveland Clinic Health System. She is responsible for the consolidation and development of the documentation platform including 9 hospitals, 47 outpatient locations, 3 inpatient rehabilitaiton facilities, and 3 skilled nursing units. She also directs collection and data management for patient-reported outcome measures.

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Completion Instructions

Complete the assessment with a 70% or higher score. Submit your evaluation feedback. Print your certificate.

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Ian Stephens, PT, DPT; Christine Schulte, PT, DPT; Sandra Passek, PT, DPT

Learning objectives

  1. Apply strategies to evaluate, initiate, and implement a direct access physical therapy program in a large health system.
  2. Identify whether your organizational policies are conducive to physical therapist practice in a direct access setting.
  3. Demonstrate understanding of screening tools used to identify patients who may require further physical therapy after assessment in a primary care setting.
  4. Demonstrate understanding of physical therapy treatment interventions and application via case-based learning.


The Recorded Live Q and A can be found under the resources tab.


  • Students
  • Veterans Administration (VA)

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Type:E-Learning Course
Credit Categories
Domains:Ian Stephans, Passek, Schulte, Back pain
Available discounts:
  • Non Member
    (until 12/31/2030)
  • Member
    (until 12/31/2030)
* Prices in US Dollar