Referring to our clinic
For Referring Clinicians:
We work with the medical community to improve the circle of care, patient outcomes, and support your practice.
Your patient can contact us directly to schedule an appointment.
Alternatively, please have your office fax the referral to 437-887-2471 or email to info@bluespaceclinic.com
Specialized Physiotherapy- Click to see selected research for clinicians
Vestibular, Dizziness, Vertigo, & Balance Rehabilitation
Referral Indication:
Patients with dizziness and vertigo symptoms often wait for months to see a specialist- often to receive a vestibular rehabilitation referral at the end. Patients can benefit greatly when presenting with general dizziness and vertigo symptoms due to peripheral and central causes, as well as age-related loss of balance. Patients at falls risk can benefit greatly from vestibular rehabilitation to return to functional baseline.
Communication
We will communicate with you regarding our assessment findings, physical therapy progress, and any concerns that may require further tests or medical management.
Specific Conditions
- Benign Paroxysmal Positional Vertigo (BPPV)
- Unilateral vestibular loss/hypofunction
- Vestibular neuritis
- Labyrinthitis
- Ramsay Hunt
- Post-surgical
- Vestibular schwannoma/acoustic neuroma
- High velocity vestibulo-ocular reflex (VOR) loss
- Other related conditions
- Bilateral vestibular loss/hypofunction:
- Ototoxicity
- Idiopathic Presbyvestibulopathy
- High velocity VOR loss
- Dizziness and imbalance after concussion/mild traumatic brain injury
- Persistent Postural Perceptual Dizziness (PPPD)
- Cerebellar Atrophy with Bilateral Vestibulopathy (CABV)
Research for referring clinicians:
Cochrane Database of Systematic Reviews and clinical practice guidelines
“There is moderate to strong evidence that vestibular rehabilitation is a safe, effective management for unilateral peripheral vestibular dysfunction, based on a number of high‐quality randomised controlled trials.”
Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit.
Patients can expect a comprehensive assessment, an individualized exercise program, clinical maneuvers for BPPV, psychoeducation, and individualized for returning to meaningful functional activities.
For complex vestibular patients, our comprehensive assessment includes oculomotor and vestibulo-ocular evaluation, cerebellar exam, complete balance and gait exam including force plate, COP testing, and other neurological and musculoskeletal assessments as indicated. Individual rehabilitation includes functionally active neurological rehabilitation to improve overall mobility, strength, and return to baseline.
Neuro (Stroke, SCI, and other) Physiotherapy
General Referral Indications
For physicians, timely referral reduces repeat visits for unresolved deficits, administrative burdens from extended disability claims, and medico-legal risk by aligning care with evidence-based guidelines.[1]
Early referral to neuro physiotherapy for central and peripheral neurological disorders can significantly improve patient function, reduce long-term disability, and lower complication risk.[1][2]
Conditions That Benefit the Most
- Stroke (ischemic or hemorrhagic)
- Traumatic brain injury (TBI)
- Spinal cord injury (SCI), complete or incomplete
- Parkinson’s disease
- Multiple sclerosis (MS)
- Guillain-Barré syndrome (GB)
- Peripheral nerve injuries
- Neuro-related functional decline post-hospitalization
- Radiculopathies and myelopathies (including myotomal changes)
Practical Benefits of Referrals (For Your Practice)- Selected Research
- We see complex patients on a daily basis- Supporting patients who have plateaued with rehabilitation or have had mixed success.
- Fewer administrative burden for persistent mobility or ADL deficits.[3]
- Reduced administrative workload—fewer extended sick leave notes and disability form completions.[4]
- Lower referral and pain management burden through better non-pharmacologic symptom management.[5]
- Decreased urgent patient or caregiver calls for functional deterioration.[6]
Clinical Benefits of Referrals (For the Patient)- Selected Research
- Reduced disability and morbidity across multiple neurological conditions.[2]
- Improved independence in ADLs and mobility via task-specific neurorehabilitation.[7]
- Reduction in spasticity and abnormal tone with targeted interventions.[8]
- Enhanced gait, posture, and balance, lowering fall risk.[9]
- Improved cardiovascular and muscular endurance for deconditioned neuro patients.[10]
- Fewer readmissions and complications, improving overall health trajectories.[3]
References
- Winstein, C. J., et al. (2016). Guidelines for adult stroke rehabilitation and recovery. Stroke, 47(6), e98–e169. https://pubmed.ncbi.nlm.nih.gov/35045827/
- Mehrholz, J., et al. (2020). Electromechanical-assisted training for walking after stroke. Cochrane Database of Systematic Reviews, (10). https://pubmed.ncbi.nlm.nih.gov/32526477/
- Loh, E., et al. (2017). Early versus delayed rehabilitation after neurological injury: Outcomes analysis. Neurorehabilitation and Neural Repair, 31(8), 703–712. https://pubmed.ncbi.nlm.nih.gov/28684913/
- Wade, D. T., et al. (2015). Administrative burden in neurological rehabilitation practice. Clinical Rehabilitation, 29(12), 1120–1127. https://pubmed.ncbi.nlm.nih.gov/26535161/
- Geneen, L. J., et al. (2019). Physical activity and exercise for chronic pain in adults. Cochrane Database of Systematic Reviews, (4). https://pubmed.ncbi.nlm.nih.gov/31173121/
- Tistad, M., et al. (2021). Telephone follow-up post-stroke and caregiver outcomes. BMC Health Services Research, 21, 682. https://pubmed.ncbi.nlm.nih.gov/34222227/
- Langhorne, P., et al. (2018). Early supported discharge services for people with acute stroke. Cochrane Database of Systematic Reviews, (7). https://pubmed.ncbi.nlm.nih.gov/29153286/
- Li, F., et al. (2020). Non-pharmacological management of post-stroke spasticity. Frontiers in Neurology, 11, 69. https://pubmed.ncbi.nlm.nih.gov/32050041/
- Chen, L., et al. (2022). Balance training effectiveness in neurological populations: Systematic review and meta-analysis. Journal of Neurology, 269, 3823–3835. https://pubmed.ncbi.nlm.nih.gov/35484391/
- Billinger, S. A., et al. (2021). Physical activity and exercise recommendations for stroke survivors. Stroke, 52(8), 2810–2818. https://pubmed.ncbi.nlm.nih.gov/34222227/
Pre- and Post- Surgical Physiotherapy
General Indication
Pre-and post-op physical therapy reduces morbidity, improves outcomes, reduces complications, and accelerates recovery across orthopedic, cardiopulmonary, and abdominal surgeries[1],[2],[3].
Which patients should be referred?
While most clinicians are aware of post-op rehab benefits for orthopedic and cardiac surgery, patients are under-referred for other surgeries, especially for the high-risk and frail population. Refer patients prior to general MSK and other surgeries, especially for accelerated return to function, ADLs, reduce post-op complications, and reduced hospital stay.
Selected Research for clinicians:
Pre-surgery Physiotherapy- Clinical Benefits
Prehabilitation lowers complication rates, reduces morbidity, and optimizes functional reserve before the first incision. Supported by high-quality systematic reviews and meta-analyses across surgical disciplines.
- Reduced incidence of postoperative complications, such as DVT and pneumonia [2], [4]
- For frail patients for major surgeries, multimodal prehab reduces complications by up to 44% and shortens hospital stay [6]
- Lower preoperative pain scores [1]
- Improved preoperative functional capacity and muscular strength [1]
- Enhanced cardiopulmonary reserve and exercise tolerance [1], [4]
- Shortened postoperative length of stay [2]
- Improved health-related quality of life indices [1], [7]
- Increased rates of home discharge versus institutional care [2]
Post-op Physiotherapy Clinical- Benefits
Structured postoperative rehabilitation reduces overall post-op complications, accelerates mobility, reduces hospital stay, and leads to long-term functional recovery. Benefits demonstrated in randomized trials, meta-analyses, and long-term cohort evidence.
- Lower incidence of post-op complications (thromboembolic, pulmonary) [5], [6]
- Sustained improvement in quality of life metrics [7]
- Accelerated restoration of mobility and ADL independence [5]
- Reduction in length of hospital stay [2], [5]
- Enhanced psychosocial outcomes and self-efficacy [7]
- Reduced readmission rates and long-term healthcare utilization [6]
- Improved postoperative cardiopulmonary performance [6], [8]
References
- Punnoose, A., Claydon-Mueller, L. S., & Weiss, O. (2023). Prehabilitation for patients undergoing orthopedic surgery: A systematic review and meta-analysis. JAMA Network Open, 6(4), e238050. https://pubmed.ncbi.nlm.nih.gov/37052919/
- McIsaac, D. I., et al. (2022). Prehabilitation in adult patients undergoing surgery: An umbrella review of systematic reviews. British Journal of Anaesthesia, 128(2), 244–257. https://pubmed.ncbi.nlm.nih.gov/34922735/
- Skořepa, P., et al. (2024). The impact of prehabilitation on outcomes in frail and high-risk patients undergoing major abdominal surgery: A systematic review and meta-analysis. Clinical Nutrition, 43(3), 629–648. https://pubmed.ncbi.nlm.nih.gov/38306891/
- Kann, M. R., et al. (2025). The impact of surgical prehabilitation on postoperative patient outcomes: A systematic review. Journal of Surgical Research, 306, 165–181. https://pubmed.ncbi.nlm.nih.gov/39778235/
- Dávila Castrodad, I. M., et al. (2019). Rehabilitation protocols following total knee arthroplasty: A review of study designs and outcome measures. Annals of Translational Medicine, 7(Suppl 7), S255. https://atm.amegroups.org/article/view/28298/html
- Delimanoli, E., et al. (2024). Cardiac rehabilitation after open-heart surgery: A narrative systematic review. Journal of Cardiovascular Development and Disease, 11(11), 376. https://pubmed.ncbi.nlm.nih.gov/39590219/
- Scandelli, F., et al. (2024). Effects of supervised rehabilitation on psychosocial and participation-related outcomes after lumbar spine surgery: A systematic review and meta-analysis. Journal of Clinical Medicine, 13(23), 7246. https://www.mdpi.com/2077-0383/13/23/7246
- Chen, Z., et al. (2022). The efficacy of pulmonary rehabilitation exercise training on complications and mortality after lung cancer resection: A systematic review and meta-analysis. Translational Cancer Research, 11(5), 1371–1383. https://tcr.amegroups.org/article/view/64720/html
Complex and Comorbid patients- Physiotherapy
General Referral Indications
Patients with multiple comorbidities, multi-system impairments, or high rehabilitation needs benefit from early physiotherapy referral to stabilize function, improve quality of life, and prevent avoidable utilization[1],[2]. Integrating physiotherapy within complex care pathways aligns with global best-practice guidance and reduces care fragmentation[3].
Conditions That Benefit the Most
- Multi-morbidity with overlapping limitations (e.g., cardiometabolic disease + cerebrovascular disease)
- Autonomic dysfunction (e.g., POTS) with cardiovascular/neurological overlap
- Chronic pain syndromes (fibromyalgia, CRPS, central sensitization)
- Advanced cardiovascular or pulmonary disease with additional impairments
- Long COVID with multi-system sequelae and deconditioning
- Oncology rehabilitation with treatment-related fatigue, neuropathy, and deconditioning
- Post-ICU syndrome with multi-organ deficits and frailty
- Frailty syndromes with concurrent chronic disease burden
Benefits of Referral (Practical Benefits for Your Practice)
- Fewer repeat consults for unresolved functional decline and smoother discharge trajectories[4].
- Reduced administrative load for disability paperwork, home-care approvals, and justification letters via earlier functional gains and telerehab support[5].
- Lower volume of urgent caregiver/patient calls through proactive goal-oriented rehabilitation and clear care plans[6],[7].
Benefits of Referral (Clinical Benefits for Patients)
- Improved functional independence across cardiovascular, pulmonary, and neuromuscular domains[1],[2].
- Reduced pain, fatigue, and symptom burden with exercise-based and multimodal rehabilitation approaches[8].
- Greater participation in ADLs, community, and vocational roles through structured, goal-directed programs[6],[7].
- Lower hospitalization and readmission rates with demonstrated cost-effectiveness of coordinated rehabilitation pathways[9].
References
- De Biase, S., Cook, L., Skelton, D. A., Witham, M., & Ten Hove, R. (2020). The COVID-19 rehabilitation pandemic. Age and Ageing, 49(5), 696–700.
- Anderson, L., et al. (2016). Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology, 67(1), 1–12.
- World Health Organization. (2017). Rehabilitation in health systems. Geneva: WHO.
- Foster, C., et al. (2018). Reablement interventions and their effectiveness: A systematic review of international literature. BMC Health Services Research, 18, 173.
- Kairy, D., et al. (2013). A systematic review of clinical outcomes, process, utilization and costs associated with telerehabilitation. Disability and Rehabilitation, 35(6), 427–447.
- Hoogeboom, T. J., et al. (2014). The impact of physical therapy on patient-reported outcomes in older adults with comorbidity. Journal of Geriatric Physical Therapy, 37(2), 65–72.
- Siegert, R. J., & Taylor, W. J. (2004). Theoretical aspects of goal-setting in rehabilitation. Disability and Rehabilitation, 26(1), 1–8.
- Geneen, L. J., et al. (2017). Physical activity and exercise for chronic pain in adults: An overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, 4, CD011279.
- Palstam, A., et al. (2016). Economic evaluation of rehabilitation after stroke: A systematic review. Journal of Rehabilitation Medicine, 48(9), 801–812.
Oncology Physiotherapy
General Referral Indications
Early referral to oncology physiotherapy is appropriate for any patient at risk of functional decline or experiencing treatment-related side effects across the cancer continuum (prehabilitation, active treatment, survivorship, advanced disease). Timely physiotherapy improves functional outcomes, reduces complications, and enhances health-related quality of life[1][2].
Conditions That Benefit the Most
- Cancer-related fatigue and global deconditioning[1]
- Chemotherapy-induced peripheral neuropathy (CIPN) with balance/falls risk[3]
- Lymphedema; post-surgical shoulder dysfunction and range-of-motion limitation[4]
- Sarcopenia/cachexia with muscle weakness and reduced exercise tolerance[5]
- Cardiotoxicity or pulmonary toxicity requiring onco-cardio-pulmonary rehabilitation[6]
- Pain syndromes, including safe mobility with bone metastases precautions[7]
- Falls risk and mobility impairment across treatment phases[8]
Benefits of Referral (Practical – For Physicians)
- Fewer repeat consults for unresolved functional or symptom issues[1]
- Reduced administrative workload (fewer disability forms, equipment justifications)[2]
- Lower frequency of urgent patient/caregiver calls regarding fatigue, falls, or mobility crises[3]
- Faster readiness for surgery or oncologic therapy via prehabilitation pathways[6]
Benefits of Referral (Clinical – For Patients)
- Improved functional capacity, independence, and participation in ADLs/IADLs[1][5]
- Reduced symptom burden (fatigue, pain, dyspnea, neuropathy)[3][6]
- Higher treatment tolerance and completion rates; fewer dose reductions/delays where studied[2][6]
- Lower complication rates, hospitalizations, and readmissions[4][7]
- Enhanced quality of life and psychosocial well-being throughout survivorship and advanced disease[1][8]
References
- Stout, N. L., et al. (2020). A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA: A Cancer Journal for Clinicians, 70(4), 246–259.
- Silver, J. K., & Baima, J. (2013). Cancer prehabilitation: An opportunity to decrease treatment-related morbidity and improve outcomes. American Journal of Physical Medicine & Rehabilitation, 92(8), 715–727.
- Hershman, D. L., et al. (2014). Prevention and management of chemotherapy-induced peripheral neuropathy: ASCO guideline. Journal of Clinical Oncology, 32(18), 1941–1967.
- Keeley, V., & Crooks, S. (2016). Lymphedema following cancer therapy: Current perspectives. Cancer Management and Research, 8, 117–125.
- Cruz-Jentoft, A. J., et al. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16–31.
- Scott, J. M., et al. (2018/2019). Exercise therapy in cardio-oncology: Rationale and evidence. JACC: CardioOncology, 1(1), 34–44.
- Gagnon, B., & Bruera, E. (1998). Drug treatment of neuropathic cancer pain. Drugs, 55(4), 499–514.
- Schmitz, K. H., et al. (2010). ACSM roundtable on exercise guidelines for cancer survivors. Medicine & Science in Sports & Exercise, 42(7), 1409–1426.
- National Comprehensive Cancer Network (2024). Survivorship Guidelines.
Pediatric Physiotherapy
General Referral Indications
Early PT streamlines your clinic—fewer repeat visits for persistent deficits, fewer caregiver crisis calls, and less paperwork for therapy approvals and disability documentation[3].
Refer early to pediatric physiotherapy for congenital, developmental, acquired, and injury-related conditions to improve long-term motor outcomes, reduce complications, and lift quality of life[1][2].
Conditions That Benefit the Most
- Cerebral palsy (all GMFCS levels)
- Developmental coordination disorder (DCD)
- Spina bifida and other neural tube defects
- Pediatric stroke and traumatic brain injury (TBI)
- Spinal cord injury (SCI)
- Muscular dystrophies and other neuromuscular disorders
- Down syndrome and other genetic syndromes with hypotonia or motor delay
- Juvenile idiopathic arthritis (JIA) and other pediatric rheumatologic conditions
- Brachial plexus injuries (neonatal and acquired)
- Gait abnormalities (idiopathic toe walking, intoeing, out-toeing)
- Post-surgical orthopedic and neurorehabilitation cases
Benefits of Referral (Practical Benefits for Your Practice)
- Fewer repeat consults for unresolved motor/developmental concerns as function improves with early, evidence-based programs[3].
- Reduced administrative burden (funding justifications, school/therapy letters) by aligning care with guideline-supported pathways[4].
- Fewer caregiver crisis calls and unplanned reviews owing to earlier functional gains and clearer home programs[5].
- Lower medico-legal exposure via adherence to pediatric rehab guidance and early intervention standards[1][4].
Benefits of Referral (Clinical Benefits for Patients)
- Improved gross and fine motor function with task-specific, intensity-appropriate interventions (e.g., goal-directed training, CIMT, strength/fitness)[2][5][6].
- Greater independence in age-appropriate ADLs and participation in school/physical activity programs[6][7].
- Better gait, posture, and balance; reduced fall risk and secondary orthopedic complications with targeted gait/balance training and orthotic optimization[2][7].
- Improved tone management (spasticity/hypotonia) through combined physical strategies and interdisciplinary care plans[8][4].
- Prevention of secondary complications (contractures, deformities) and better long-term cost-effectiveness of care via early, guideline-concordant intervention[4][1].
References
- World Health Organization. (2012). Early childhood development and disability: A discussion paper.
- Novak, I., et al. (2013). A systematic review of interventions for children with cerebral palsy: State of the evidence. Developmental Medicine & Child Neurology, 55(10), 885–910.
- Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal, 66(3), 258–273.
- National Institute for Health and Care Excellence. (2017). Cerebral palsy in under 25s: Assessment and management (NG62).
- Anttila, H., et al. (2008). Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatrics, 8, 14.
- Verschuren, O., et al. (2016). Exercise and physical activity recommendations for people with cerebral palsy. Developmental Medicine & Child Neurology, 58(8), 798–808.
- Reedman, S. E., et al. (2019). Physical activity for children with cerebral palsy: Feasibility and effectiveness. Physical Therapy, 99(12), 1644–1654.
- Fehlings, D., et al. (2010). Botulinum toxin in the management of children with cerebral palsy. Paediatrics & Child Health, 15(2), 89–93.
MSK physiotherapy
General Indications of Referral
Early physical therapy (PT) referral for musculoskeletal (MSK) conditions not only improves clinical outcomes, but also makes your day-to-day practice run smoother — fewer repeat visits for the same complaint, reduced opioid refill requests, and less admin from sick notes or repeat imaging [3]. High-quality evidence supports timely PT in reducing morbidity, complications, and chronicity in MSK cases [1],[2].
Conditions That Benefit Most from Early Referral
- Acute and chronic MSK Pain
- Sarcopenia and other geriatric deconditioning
- Osteoporosis/ Osteopenia
- Fracture rehabilitation
- Falls Training
- Tendinopathies and other Chronic Injuries
- Osteoarthritis
- Grade 1-3 Sprains and Strains
- Postural and overuse syndromes
- Pre and Post-surgical MSK rehab
Practical Benefits of Referrals (For Your Practice)- Selected Research
- Fewer repeat consults for unresolved pain — reducing re-referrals for the same case[5].
- Lower opioid prescribing burden — PT reduces reliance on analgesics, meaning fewer refill requests[3],[6].
- Reduced imaging requests — early PT correlates with decreased secondary imaging utilization[5].
- Less time managing extended sick leave — faster functional recovery minimizes administrative delays[2].
- Happier Patients- Improved patient-reported outcomes — sustained gains in PROMs and HRQoL[5],[7].
Clinical Benefits of Referrals (For the Patient)- Selected Research
- Reduced morbidity and complication rates — lower incidence of persistent disability and post-injury complications[1],[4].
- Faster recovery timelines — earlier return to work, sport, and ADLs[2],[5].
- Significant pain reduction — lower VAS scores and reduced opioid dependence[3],[6].
- Improved patient-reported outcomes — sustained gains in PROMs and HRQoL[5],[7].
References
- Punnoose, A., et al. (2023). Prehabilitation for orthopedic surgery: A systematic review and meta-analysis. JAMA Network Open, 6(4), e238050. https://pubmed.ncbi.nlm.nih.gov/37052919/
- McIsaac, D. I., et al. (2022). Prehabilitation in adults undergoing surgery: An umbrella review. British Journal of Anaesthesia, 128(2), 244–257. https://pubmed.ncbi.nlm.nih.gov/34922735/
- O’Keeffe, M., et al. (2020). Effect of physical therapy referral timing on outcomes in low back pain. BMJ, 368, m143. https://pubmed.ncbi.nlm.nih.gov/32071103/
- Skořepa, P., et al. (2024). Prehab in frail patients undergoing major abdominal surgery: Systematic review. Clinical Nutrition, 43(3), 629–648. https://pubmed.ncbi.nlm.nih.gov/38306891/
- Valkenet, K., et al. (2017). Preoperative physical therapy and postoperative outcomes: Systematic review. Physiotherapy, 103(1), 1–9. https://pubmed.ncbi.nlm.nih.gov/27397681/
- Gränicher, P., et al. (2022). Exercise-based prehabilitation in orthopedics: Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. https://pubmed.ncbi.nlm.nih.gov/37052919/
- Delimanoli, E., et al. (2024). Cardiac rehab after open-heart surgery: Narrative review. Journal of Cardiovascular Development and Disease, 11(11), 376. https://pubmed.ncbi.nlm.nih.gov/39590219/
- Hayden, J. A., et al. (2021). Exercise therapy for chronic low back pain: Cochrane systematic review. Cochrane Database of Systematic Reviews, 2021(9). https://pubmed.ncbi.nlm.nih.gov/34528278/
