Substitution of doctors with physiotherapists in the management of common musculoskeletal disorders: a systematic review

Marks, Darryn; Comans, Tracy; Bisset, Leanne; Scuffham, Paul Anthony

doi:10.1016/j.physio.2016.11.006

Cited by 50 publications

(48 citation statements)

References 35 publications

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“…There are few and relatively small studies, with primarily observational study designs, investigating the effects of triaging to physiotherapists in primary care on resource use [19–21, 25]. This study had a robust randomised design adapted pragmatically to the clinical environment but was based on a small population.…”

Section: Discussionmentioning

confidence: 99%

More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment

Bornhöft

Thorn

Svensson

et al. 2019

BMC Musculoskelet Disord

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Background A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment. Methods Nurse-assessed patients with MSD ( N = 55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1 year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results. Results The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis. Conclusion From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings. Trial registration ClinicalTrials.gov NCT02218749 . Registered August 18, 2014.

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Section: Discussionmentioning

confidence: 99%

More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment

Bornhöft

Thorn

Svensson

et al. 2019

BMC Musculoskelet Disord

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“…In Australia, advanced musculoskeletal practitioners have been introduced to orthopaedic interface-services and emergency departments 11. A recent systematic review examining the substitution of medical doctors for physiotherapists in the management of musculoskeletal disorders has supported this expansion of roles, with physiotherapists demonstrating parity of clinical outcomes with orthopaedic surgeons, with greater patient satisfaction 9. Following the introduction of independent physiotherapist prescribing in the UK,12 a proposal for the endorsement of registered physiotherapists as autonomous prescribers has been submitted to the Physiotherapy Board of Australia,13 aiming to further address health service inefficiencies and improve access to medicines for all Australians, across all communities regardless of their geographical location13; as well as improving clinicians’ job satisfaction, leading to increased retention of skilled physiotherapists 13.…”

Section: Introductionmentioning

confidence: 99%

Perceptions of Australian physiotherapy students about the potential implementation of physiotherapist prescribing in Australia: a national survey

et al. 2019

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ObjectivesTo explore the perceptions of Australian physiotherapy students about (1) the potential implementation and use of non-medical prescribing by physiotherapists in Australia and (2) how physiotherapist prescribing might impact the care that the physiotherapy profession can provide in the future.DesignA cross-sectional descriptive survey of physiotherapy students across Australia was completed using an online questionnaire developed by subject-experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all students enrolled in any accredited, entry-level Australian university physiotherapy programme. A reminder email was sent 4 weeks later.SettingParticipants completed an online questionnaire.Participants526 physiotherapy students from universities across all states with entry-level programmes.Outcome measuresQuantitative data underwent primary descriptive analysis. Thematic analysis was used to synthesise qualitative data.Results87% of participants supported the introduction of physiotherapist prescribing in Australia. 91% of participants stated that they would train to prescribe following introduction. Participants identified improvements in clinical and cost effectiveness, timely access to appropriate prescription medicines and optimisation of quality healthcare as key drivers for the introduction.ConclusionsStudent physiotherapists support the introduction of physiotherapist prescribing in Australia, reporting potential benefits for patients, health services and the physiotherapy profession. Stakeholders should use the results of this study in conjunction with supporting literature to inform future decisions regarding physiotherapist prescribing in Australia.

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“…Many general medical services previously performed by GPs are being performed by other professions, not only advanced nurse practitioners and pharmacists, but also physiotherapists and occupational therapists. 10 As well as role substitution, the different mix of skills provides an opportunity to add value to patient care. In particular, physiotherapists and occupational therapists place less emphasis on a medical model of illness, which focuses on the diagnosis and categorisation of disease according to the International Classification of Diseases (ICD-10), and more emphasis on a functional approach, using the International Classification of Functioning, Disability and Health.…”

Section: Therapists Working In Primary Carementioning

confidence: 99%

Putting function first: redesigning the primary care management of long-term conditions

Williams

Law²

2018

Br J Gen Pract

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Long-term conditions comprise the biggest burden on the NHS, involving more than half of all GP consultations, 65% of outpatient visits, and 70% of inpatient bed days. 1 Their prevalence rises with age, affecting 50% of people by the age of 50 years and 80% by the age of 65 years. As older people accumulate more long-term conditions, they become increasingly frail and are at higher risk of falls, disability, admission to hospital, and the need for long-term care. In order to address this burden, a revolution is needed in their primary care management. Physical capability, or 'physical functioning', describes an individual's capacity to undertake physical tasks of everyday living. Care and support are needed when a person is no longer able to manage tasks such as washing, dressing, and feeding. Indeed, failure to get to the toilet on time is a frequent reason for admission to residential care. 2 Maintaining physical function is one of the most important factors for quality of life among older adults and a central goal for all people with long-term conditions. Physical inactivity is one of the strongest predictors of physical disability in older people, and physically active people have better levels of physical and psychosocial functioning. Although normal ageing leads to a decline in physical fitness, this decline is much worse if a person has a sedentary occupation or lifestyle. However, the detrimental effects of prolonged sitting on mortality can be ameliorated by 60-75 minutes of moderateintensity physical activity per day, such as brisk walking. 3 This is much more than the minimum physical activity recommendation of 30 minutes' moderate-intensity physical activity on 5 days per week, which over half of the UK adult population do not meet. Indeed, a quarter are classified as 'inactive', participating in less than 30 minutes' physical activity per week. There is an inverse association of physical activity with age and with multimorbidity. So, the drastic decline in physical functioning that many older people experience is not an inevitable part of ageing. The National Institute for Health and Care Excellence (NICE) has issued guidelines for the prevention of frailty, disability, and dementia in mid-life 4 and recommend that

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Substitution of doctors with physiotherapists in the management of common musculoskeletal disorders: a systematic review

Cited by 50 publications

References 35 publications

More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment

More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment

Perceptions of Australian physiotherapy students about the potential implementation of physiotherapist prescribing in Australia: a national survey

Putting function first: redesigning the primary care management of long-term conditions

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