The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders<scp>:</scp> a systematic review of the literature

Demont, Anthony; Bourmaud, Aurélie; Kechichian, Amélie; Desmeules, François

doi:10.1080/09638288.2019.1674388

Cited by 59 publications

(51 citation statements)

References 33 publications

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“…Finally, the physiotherapists considered the leadership support, professional autonomy, and the mentorship support as the most helpful resources for leveraging the benefits of direct access. These benefits also resonate with earlier studies [ 1 , 4 , 24 , 25 ]. Other resources included attending conferences and workshops on the topic, training, electronic resources, and other published literature.…”

Section: Discussionsupporting

confidence: 89%

“…On the other hand, emerging evidence indicates that direct access physiotherapy can offer improved outcomes in terms of quality of life, disability, and healthcare costs compared to primary physician-led medical care. [ 27 ] Similarly, service users should also be educated about direct access and its benefits, as this would help gain their trust and turn them into allies in this quest. The results of physiotherapists perceiving more barriers for direct access with age, seniority, and experience is a serious lapse and should be addressed as it indicates that they are feeling disheartened about gaining professional autonomy which may have repercussions in the quality of their care as well.…”

Section: Recommendationsmentioning

confidence: 99%

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Physiotherapists’ perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study

Alnaqbi¹,

Shousha

AlKetbi

et al. 2021

PLoS ONE

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Background There are two primary ways of accessing physiotherapy for service users around the world. The direct access, as opposed to the indirect access which requires a referral from a general physician, has several merits including better quality, timeliness, cost effectiveness of treatment and better probability of preventing acute conditions from turning into chronic ailments. Despite these benefits, several countries including the UAE, do not allow direct access to physiotherapists. This study aims to understand the level of awareness among practicing physiotherapists in the United Arab Emirates (UAE) about direct access and to determine whether any of their demographic variables influence the way they perceive the concept. Further, the study sought to explore the perceived barriers and benefits of direct access according to the participating physiotherapists. Subjects and methods An observational cross-sectional study was employed. The questionnaire survey developed by Bury and Stokes in 2013 was adapted and employed in this study. The instrument had six sections with close-ended items using a Likert five-point scale to rate them. Two hundred and sixty-four physiotherapists answered the questionnaire shared with them through a web link. Finally, MANOVA was employed to explore any influence of demographic variables on the opinions of the respondents. Results The findings showed that 70% of participants were aware about direct access while nearly 30% were completely unaware. Younger physiotherapists were more willing to endorse the practice whereas older ones were more apprehensive of the barriers. The main barriers reported were the limited support from the physicians and policy makers, professional autonomy, and the limited scope of practice for the physiotherapists, as well as evidence-based practice. The impact of demographic variables on direct access indicated that physiotherapists under the age of 23 endorsed direct access more strongly than other age groups. Conclusion More efforts are needed to implement direct access in the UAE, considering the benefits of improved professional status, cost savings, patient satisfaction, and higher efficiency. This study recommends leadership support, professional autonomy, and mentorship as possible ways to achieve this goal.

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Section: Discussionsupporting

confidence: 89%

Section: Recommendationsmentioning

confidence: 99%

Physiotherapists’ perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study

Alnaqbi¹,

Shousha

AlKetbi

et al. 2021

PLoS ONE

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“…In Denmark, patients are referred by their general practitioner to physiotherapy treatment, but as it is the case in many countries, an increased interest on and advocate for direct access to physiotherapy are emerging. This is among other things advocated as a possible way to ensure a better clinical outcome and reduce the number of contacts to the physiotherapists [49,50]. When looking at the distribution of the contacts only 65 (8.6%) patients received group exercise, hence the majority of treatment was individual based.…”

Section: Clinical Course and Healthcare Utilizationmentioning

confidence: 99%

Socio-demographic, clinical and psychological predictors of healthcare utilization among patients with musculoskeletal disorders: a prospective cohort study

Budtz

Mose

Christiansen

2020

BMC Health Serv Res

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Background: Musculoskeletal disorders are common in the general population and a leading cause for care seeking. Despite the large number of patients with musculoskeletal disorders seeking care, little is known of the clinical course, pathways and predictors of healthcare utilization among these patients. The purposes of the study were to 1) describe the clinical course and related healthcare utilization in primary care physiotherapy and secondary healthcare among patients with neck, shoulder and low-back pain treated in physiotherapy practice, and 2) identify independent clinical, socio-demographic, psychological and general health predictors of healthcare utilization. Methods: The study was a prospective cohort study of patients seeking physiotherapy treatment for neck, shoulder, or low-back pain in physiotherapy practices across Denmark. A total of 759 physiotherapy patients completed questionnaires containing information on clinical course and potential predictors of healthcare utilization. Healthcare utilization was obtained from the Danish National Health Service Register and National Patient Register. Associations between potential predictors and low/high primary care physiotherapy utilization and hospital contacts in relation to specific neck, shoulder or low-back disorders were analysed using binomial regression analyses and adjusted for age, sex, duration of pain and comorbidity. Results: During 6 months follow-up, patients experienced clinically relevant improvements in pain, fear avoidance and psychological wellbeing. Patients with higher baseline pain and disability and who were on sickness leave were more likely to have high primary care physiotherapy utilization. Hospital contacts were predicted by higher levels of pain, disability and low psychological wellbeing. Conclusions: Clinical factors and sickness leave seems to be the main predictors of primary care physiotherapy utilization, whereas for secondary care contacts, psychological factors may also be of importance. The study contributes to the ongoing research into clinical pathways and may identify future target areas to reduce healthcare utilization in patients with musculoskeletal disorders.

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“…However, there is still no firm conclusion regarding the safety of DAPT since few studies primarily focused on adverse events [ 24 ]. Recently, Demont et al found weak to moderate quality of evidence supporting DAPT as an effective intervention on disability, quality of life, and healthcare costs, but no difference for pain compared to physician-led management [ 6 ]. Physical therapy has positively impacted the healthcare system’s efficiency, reducing healthcare utilization (e.g., less imaging, medication, and secondary consultation) [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many healthcare systems (e.g., United States, United Kingdom, Australia) have implemented this model of care since it has demonstrated better clinical outcomes. Moreover, DAPT has reported a lower economic burden [ 3 , 4 ]—either for direct (e.g., number of visits, imaging) and indirect costs (e.g., lost workdays)—compared to traditional models of care (e.g., physician-centered paradigm) (for further details, refer to Table 1 ) [ 4 , 5 , 6 , 7 ]. The model of DAPT was mainly implemented to manage musculoskeletal disorders (MSDs) [ 8 ], a group of clinical conditions (e.g., low back pain, neck pain, shoulder pain) with a huge epidemiological burden and worldwide healthcare systems workload [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Direct Access to Physical Therapy: Should Italy Move Forward?

Maselli

Piano²,

Cecchetto³

et al. 2022

IJERPH

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Direct access to physical therapy (DAPT) is the patient’s ability to self-refer to a physical therapist, without previous consultation from any other professional. This model of care has been implemented in many healthcare systems since it has demonstrated better outcomes than traditional models of care. The model of DAPT mainly focuses on the management of musculoskeletal disorders, with a huge epidemiological burden and worldwide healthcare systems workload. Among the healthcare professionals, physical therapists are one of the most accessed for managing pain and disability related to musculoskeletal disorders. Additionally, the most updated guidelines recommend DAPT as a first-line treatment because of its cost-effectiveness, safety, and patients’ satisfaction compared to other interventions. DAPT was also adopted to efficiently face the diffuse crisis of the declining number of general practitioners, reducing their caseload by directly managing patients’ musculoskeletal disorders traditionally seen by general practitioners. World Physiotherapy organization also advocates DAPT as a new approach, with physical therapy in a primary care pathway to better control healthcare expenses. Thus, it is unclear why the Italian institutions have decided to recognize new professions instead of focusing on the growth of physical therapy, a long-established and autonomous health profession. Furthermore, it is unclear why DAPT is still not fully recognized, considering the historical context and its evidence. The future is now: although still preliminary, the evidence supporting DAPT is promising. Hard skills, academic paths, scientific evidence, and the legislature argue that this paradigm shift should occur in Italy.

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The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature

Cited by 59 publications

References 33 publications

Physiotherapists’ perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study

Physiotherapists’ perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study

Socio-demographic, clinical and psychological predictors of healthcare utilization among patients with musculoskeletal disorders: a prospective cohort study

Direct Access to Physical Therapy: Should Italy Move Forward?

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