Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

Caffrey, Aoife; Smart, Keith; FitzGerald, Oliver

doi:10.1002/acr2.1022

Cited by 9 publications

(16 citation statements)

References 19 publications

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“…Of the 63 articles screened for full text, a total of 28 articles were included in the review. The 28 included studies were published from 1999 to 2022 [ 9 , 16 , 17 , 18 , 19 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. The following study designs were identified: 10 RCTs, 9 prospective longitudinal cohort studies, 4 case control studies, 3 retrospective observational studies, and 2 prospective observational studies [ 9 , 16 , 17 , 18 , 19 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Gallotti,

Campagnola,

Cocchieri

et al. 2023

JCM

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Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists’ characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261.

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Section: Resultsmentioning

confidence: 99%

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Gallotti,

Campagnola,

Cocchieri

et al. 2023

JCM

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“…A referral rule with high specificity can overcome inappropriate referrals to an outpatient rheumatology clinic. This specificity results in a lower individual and societal burden of musculoskeletal symptoms and a reduction of waiting times for rheumatology outpatient clinics (21). When looking for which referral rule is most effective in keeping inappropriate referrals from expensive outpatient care, CARE seems most accurate of the 2 existing rules.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance and Clinical Utility of Referral Rules to Identify Primary Care Patients at Risk of an Inflammatory Rheumatic Disease

Delft

Barreto

Mil

et al. 2022

Arthritis Care & Research

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Objective. To determine the diagnostic performance and clinical utility of the Rotterdam Early Arthritis Cohort (REACH) and the Clinical Arthritis Rule (CARE) referral rules in an independent population of unselected patients from primary care.Methods. This study consisted of adults who were suspected of the need for referral to a rheumatologist by their general practitioner. Diagnostic accuracy measures and a net benefit approach were used to compare both rules to usual care for recognizing inflammatory arthritis and inflammatory rheumatic diseases (IRDs). Using the least absolute shrinkage and selection operator method and cross-validation we created an optimal prediction rule for IRD.Results. This study consisted of 250 patients, of whom 42 (17%) were diagnosed with inflammatory arthritis and 55 (22%) with an IRD 3 months after referral. Considering inflammatory arthritis, the area under the receiver operating characteristic curve (AUC) was 0.72 (95% confidence interval [95% CI] 0.64-0.80) for REACH and 0.82 (95% CI 0.75-0.88) for CARE. Considering IRD, the AUC was 0.66 (95% CI 0.58-0.74) for REACH and 0.76 (95% CI 0.69-0.83) for CARE. CARE was of highest clinical value when compared to usual care. The composite referral rule for IRD of 10 parameters included sex, age, joint features, acute onset of symptoms, physical limitations, and duration of symptoms (AUC 0.82 [95% CI 0.75-0.88]).Conclusion. Both validated rules have a net benefit in recognizing inflammatory arthritis as well as IRD compared to usual care, but CARE shows superiority over REACH. Although the composite referral rule indicates a greater diagnostic performance, external validation is needed.ClinicalTrials.gov identifier: NCT03454438.

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“…Furthermore, studies on MSKD care in primary care or the ED have had follow-up periods ranging from six to 24 months (e.g. [26,[39][40][41][42]). Thus, the Markov model will cover a 24-month period.…”

Section: Study Design and Costing Approachesmentioning

confidence: 99%

Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation

Gagnon

Hébert

Guertin

et al. 2022

Preprint

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Objectives: 1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period. Methods: A randomized clinical trial was conducted among individuals (n=78) aged 18 to 80 years presenting with a musculoskeletal disorder at a Quebec City (Canada) hospital in 2018-2019. Two models of care were compared: management by a physiotherapist and an ED physician versus usual management by an ED physician. Participants follow-ups were conducted at 1 and 3 months post-initial ED visit. Obj.1: The health care costs incurred by the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method and compared using generalized linear models. Obj. 2: The cost-utility analysis over a 3-month time horizon will combine economic and clinical variables (estimated through quality-adjusted life years) using a Societal perspective. The results of the cost-utility analysis will be reported using an ICER. Obj. 3: The ICER will be estimated using a hybrid decision tree (0-3 months post-visit) and Markov model (3-24 months post-visit); the analysis will be conducted from a Societal perspective over a two-year time horizon. Conclusion: This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services.

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Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

Cited by 9 publications

References 19 publications

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Diagnostic Performance and Clinical Utility of Referral Rules to Identify Primary Care Patients at Risk of an Inflammatory Rheumatic Disease

Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation

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