Geospatial analysis of accessibility to outpatient physical and occupational therapy services in Texas: a cross-sectional study

Background: Access to rehabilitation services is a critical component of equitable health care delivery, yet disparities in service availability and geographic accessibility remain understudied. This study examined spatial accessibility to outpatient physical and occupational therapy services across Texas, a large and demographically diverse state, to identify regional disparities and inform workforce and policy planning. Methods: A descriptive, cross-sectional geospatial analysis was conducted using outpatient clinic location data from the Texas Health and Human Services database (2022) and population data from the 2020 U.S. Census. Clinic addresses were verified and geocoded, and accessibility was analyzed in two ways: an origin–destination cost matrix to calculate travel time to the nearest clinic, and the two-step floating catchment area (2SFCA) method to determine the accessibility index. Hot and cold spots were identified using the Getis-Ord Gi* statistic. Analyses were performed in ArcGIS Pro. Results: The study included 2,255 outpatient rehabilitation clinics across 6,896 census tracts. Travel times to the nearest clinic varied widely, with rural regions experiencing the longest travel times. The 2SFCA analysis revealed disparities, with low-accessibility clusters concentrated in rural and border regions, and high-accessibility clusters in urban metropolitan areas. Hot spot analysis confirmed statistically significant disparities across the state. Conclusions: There are substantial geographic disparities in outpatient rehabilitation access in Texas, particularly in rural and border regions. These findings underscore the need for targeted workforce placement, policy interventions, and improved transportation infrastructure to address inequities in rehabilitation access. Future research should incorporate longitudinal data and expand to additional rehabilitation professions to inform comprehensive health service planning.