Background

Early physical therapy (PT) helps Veterans move better, feel less pain, and be more satisfied with their care while also helping to lower health care costs and reduce the need for opioid pain medicines.

Musculoskeletal problems, such as joint or muscle pain, are one of the most common reasons Veterans visit primary care. These problems can lead to limited appointment availability, more referrals for imaging and specialists, and increased use of pain medications.

The Physical Therapy Embedded into Rural PACTs (PACT-PT) program places physical therapists directly into Patient Aligned Care Teams (PACTs). With PACT-PT, Veterans can receive same-day exams and care for muscle, joint, and mobility concerns during their primary care visit.

Early PT intervention gives Veterans faster access to care, helps prevent complications from delayed treatment, and can reduce the number of primary care visits and unnecessary referrals to specialty providers.

To increase its impact, PACT-PT became a Veterans Health Administration (VHA) Office of Rural Health (ORH) Enterprise-Wide Initiative (EWI) in fiscal year 2025. In many rural communities, PT services are limited, and Veterans may need to travel long distances for care. PACT-PT brings PT services closer to home, offering rural Veterans easier access to full PT exams, treatment, and ongoing management for musculoskeletal and mobility conditions.

Through PACT-PT, Veterans can get timely help for their musculoskeletal concerns and return more quickly to meaningful daily and life activities.

Goals and Objectives

The main goal of PACT-PT is to embed physical therapists into rural VA Medical Centers (VAMCs) and Community-Based Outpatient Clinics (CBOCs) so that rural Veterans with musculoskeletal or mobility concerns receive early PT intervention.

The program has several key objectives:

• Connect Veterans to the soonest and most appropriate care, including same-day access to PT when possible, to support timely treatment.
• Deliver high-quality, accessible, and integrated health care that brings PT into the Veteran’s primary care team.
• Expand the PACT-PT model throughout VHA to improve rural Veterans’ access to PT services.

Within this program, PACT-PT therapists serve as active members of the Veteran’s care team, working closely with primary care and other health professionals.

Methodology

PACT-PT is being put into place at seven rural VAMCs and CBOCs to give Veterans a more coordinated, team-based experience of care. It usually takes about four to six months to fully embed PT into a PACT clinic.

The implementation follows several phases:

• Phase 1: Develop a strategy to recruit sites, invite interested VAMCs to apply, and create a dashboard to track key performance indicators (KPIs).
• Phase 2: Select participating sites, set initial KPIs for comparing sites, engage key stakeholders, and prepare implementation training and resources for the clinics.
• Phase 3: Secure needed staff and space, and set up clinic processes and procedures, including communication and education for the care team.
• Phase 4: Launch the clinic, begin seeing Veterans, and collect and analyze PACT-PT dashboard data and Veteran satisfaction information.
• Phase 5: Carry out ongoing quality improvement activities, track results over time, and share outcomes with stakeholders to build support for long-term sustainment.

Throughout these phases, participating rural sites receive consulting, coaching, and mentoring to help them successfully establish and maintain PACT-PT services in their primary care clinics.

Impact on Rural Veteran Health

Rural Americans and rural Veterans often face higher rates of disease and disability, shorter life expectancies, and more frequent chronic pain and discomfort. At the same time, they may have limited access to specialists with expertise in musculoskeletal and mobility conditions.

As of February 2025, PACT-PT has been put into place in 179 facilities across 111 VHA health care systems. About 130,000 Veterans have received care through this program, and approximately 48,000 of them (37%) are rural or highly rural Veterans.

Results from the PACT-PT program so far include:

• Reduced wait times for physical therapy services by about 31%.
• High Veteran satisfaction, with ratings up to 97% on VA VSignals surveys.
• Improved employee satisfaction measured through VA ESignals surveys, with staff rating their satisfaction at 4.5 out of 5 and reporting a 4.1 out of 5 likelihood of staying in their positions.
• Veterans reaching their functional goals in fewer visits, with average visits reduced from 4.7 to 2.3 per episode of care.

Key Takeaways

PACT-PT therapists see Veterans for many types of musculoskeletal and mobility conditions. These can include back and neck pain, joint pain, muscle strains, dizziness, falls, headaches, pelvic floor concerns, movement difficulties, and needs for durable medical equipment, such as walkers, crutches, and canes.

• PACT-PT therapists provide same-day examinations and treatments focused on physical function and pain, which helps rural Veterans receive care more easily and quickly.
• PACT-PT reduces the time rural Veterans spend traveling to multiple providers and appointments, supporting a faster return to regular daily life and meaningful activities.
• PACT-PT improves Veterans’ health outcomes by helping them reach functional goals in fewer PT visits.
• The program increases health care efficiency by reducing downstream medical use, such as referrals to specialty care, imaging, and new opioid prescriptions.
• PACT-PT enhances both Veteran and provider experience and satisfaction by bringing PT into the primary care team and streamlining care.

Download the Printable PDF for Healthcare Providers and Researchers.

References

• Hon S, Ritter R, Allen DD. Cost-Effectiveness and Outcomes of Direct Access to Physical Therapy for Musculoskeletal Disorders Compared to Physician-First Access in the United States: Systematic Review and Meta-Analysis. Phys Ther. 2021 Jan 4;101(1): pzaa201. doi: 10.1093/ptj/pzaa201. PMID: 33245117.
• Wu V, Goto K, Carek S, et al. Family Medicine Musculoskeletal Medicine Education: A CERA Study. Fam Med. 2022;54(5):369-375. https://doi.org/10.22454/FamMed.2022.975755.
• U.S. Department of Veterans Affairs, Veterans, Dependents of Veterans, and VA Beneficiary Survey Record (43VA008/ 86 FR 6992).
• Amtmann D, Cook KF, Johnson KL, Cella D. The PROMIS initiative: involvement of rehabilitation stakeholders in development and examples of applications in rehabilitation research. Arch Phys Med Rehabil. 2011;92(10 Suppl): S12-S19.
• Stryczek KC, Stevenson L, Barnard J, Disasa E, Hess E, & Langner P. Physical Therapy Embedded within PACT (PT-PACT) Operational Support Mixed Methods Evaluation. FY 2024.

Contact

• Mark Havran, DPT, ATC, CSCS, Physical Therapy Program Manager, VHA Office of Rehab & Prosthetic Services, VA Central Iowa Health Care, Des Moines, IA. Mark.Havran@va.gov
• Ashley Cassel, PT, DPT, OCS, Chief of Outpatient Physical Therapy, Minneapolis VA Health Care System, Minneapolis, MN. Ashley.Cassel@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00644.
• Suggested Citation: Havran, M., Simone, A., Peterson, B., Rowedder, C., Cassel, A., Stryczek, K. C., & Langner, P. (2025). Physical Therapy Embedded into Rural PACTs. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

Rural Health - Navigation

• Office of Rural Health Home page:
  https://www.ruralhealth.va.gov/index.asp
• Enterprise-Wide Initiatives (EWI) page:
  https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp
• Veterans Rural Health Resource Centers (VRHRC) page:
  https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp