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Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial

Objectives To assess the clinical effectiveness, effect on waiting times, and patient acceptability of PhysioDirect services in patients with musculoskeletal problems, compared with usual care. Design Pragmatic randomised controlled trial to assess equivalence in clinical effectiveness. Patients wer...

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Autores principales: Salisbury, Chris, Montgomery, Alan A, Hollinghurst, Sandra, Hopper, Cherida, Bishop, Annette, Franchini, Angelo, Kaur, Surinder, Coast, Joanna, Hall, Jeanette, Grove, Sean, Foster, Nadine E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558547/
https://www.ncbi.nlm.nih.gov/pubmed/23360891
http://dx.doi.org/10.1136/bmj.f43
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author Salisbury, Chris
Montgomery, Alan A
Hollinghurst, Sandra
Hopper, Cherida
Bishop, Annette
Franchini, Angelo
Kaur, Surinder
Coast, Joanna
Hall, Jeanette
Grove, Sean
Foster, Nadine E
author_facet Salisbury, Chris
Montgomery, Alan A
Hollinghurst, Sandra
Hopper, Cherida
Bishop, Annette
Franchini, Angelo
Kaur, Surinder
Coast, Joanna
Hall, Jeanette
Grove, Sean
Foster, Nadine E
author_sort Salisbury, Chris
collection PubMed
description Objectives To assess the clinical effectiveness, effect on waiting times, and patient acceptability of PhysioDirect services in patients with musculoskeletal problems, compared with usual care. Design Pragmatic randomised controlled trial to assess equivalence in clinical effectiveness. Patients were individually randomised in a 2:1 ratio to PhysioDirect or usual care. Setting Four physiotherapy services in England. Participants Adults (aged ≥18 years) referred by general practitioners or self referred for musculoskeletal physiotherapy. Interventions PhysioDirect services invited patients to telephone a physiotherapist for initial assessment and advice, followed by face-to-face physiotherapy if necessary. Usual care involved patients joining a waiting list for face-to-face treatment. Main outcome measures Numbers of appointments, waiting time for treatment, and non-attendance rates. Primary outcome was physical health (SF-36v2 physical component score) at six months. Secondary outcomes included four other measures of health outcome, mental component score and scales from the SF-36v2, time lost from work, and patient satisfaction and preference. Participants were not blind to allocation, but outcome data were collected blind to allocation. Results Of 1506 patients allocated to PhysioDirect and 743 to usual care, 85% provided primary outcome data at six months (1283 and 629 patients, respectively). PhysioDirect patients had fewer face-to-face appointments than usual care patients (mean 1.91 v 3.11; incidence rate ratio 0.59 (95% confidence interval 0.53 to 0.65)), a shorter waiting time (median 7 days v 34 days; arm time ratio 0.32 (0.29 to 0.35)), and lower rates of non-attendance (incidence rate ratio 0.55 (0.41 to 0.73)). After six months’ follow-up, the SF-36v2 physical component score was equivalent between groups (adjusted difference in means −0.01 (−0.80 to 0.79)). Health outcome measures suggested a trend towards slightly greater improvement in the PhysioDirect arm at six week follow-up and no difference at six months. There was no difference in time lost from work. PhysioDirect patients were no more satisfied with access to physiotherapy than usual care patients, but had slightly lower satisfaction overall at six months (difference in satisfaction −3.8% (−7.3% to −0.3%); P=0.031). PhysioDirect patients were more likely than usual care patients to prefer PhysioDirect in future. No adverse events were detected. Conclusions PhysioDirect is equally clinically effective compared with usual care, provides faster access to physiotherapy, and seems to be safe. However, it could be associated with slightly lower patient satisfaction. Trial registration Current Controlled Trials ISRCTN55666618.
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spelling pubmed-35585472013-01-31 Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial Salisbury, Chris Montgomery, Alan A Hollinghurst, Sandra Hopper, Cherida Bishop, Annette Franchini, Angelo Kaur, Surinder Coast, Joanna Hall, Jeanette Grove, Sean Foster, Nadine E BMJ Research Objectives To assess the clinical effectiveness, effect on waiting times, and patient acceptability of PhysioDirect services in patients with musculoskeletal problems, compared with usual care. Design Pragmatic randomised controlled trial to assess equivalence in clinical effectiveness. Patients were individually randomised in a 2:1 ratio to PhysioDirect or usual care. Setting Four physiotherapy services in England. Participants Adults (aged ≥18 years) referred by general practitioners or self referred for musculoskeletal physiotherapy. Interventions PhysioDirect services invited patients to telephone a physiotherapist for initial assessment and advice, followed by face-to-face physiotherapy if necessary. Usual care involved patients joining a waiting list for face-to-face treatment. Main outcome measures Numbers of appointments, waiting time for treatment, and non-attendance rates. Primary outcome was physical health (SF-36v2 physical component score) at six months. Secondary outcomes included four other measures of health outcome, mental component score and scales from the SF-36v2, time lost from work, and patient satisfaction and preference. Participants were not blind to allocation, but outcome data were collected blind to allocation. Results Of 1506 patients allocated to PhysioDirect and 743 to usual care, 85% provided primary outcome data at six months (1283 and 629 patients, respectively). PhysioDirect patients had fewer face-to-face appointments than usual care patients (mean 1.91 v 3.11; incidence rate ratio 0.59 (95% confidence interval 0.53 to 0.65)), a shorter waiting time (median 7 days v 34 days; arm time ratio 0.32 (0.29 to 0.35)), and lower rates of non-attendance (incidence rate ratio 0.55 (0.41 to 0.73)). After six months’ follow-up, the SF-36v2 physical component score was equivalent between groups (adjusted difference in means −0.01 (−0.80 to 0.79)). Health outcome measures suggested a trend towards slightly greater improvement in the PhysioDirect arm at six week follow-up and no difference at six months. There was no difference in time lost from work. PhysioDirect patients were no more satisfied with access to physiotherapy than usual care patients, but had slightly lower satisfaction overall at six months (difference in satisfaction −3.8% (−7.3% to −0.3%); P=0.031). PhysioDirect patients were more likely than usual care patients to prefer PhysioDirect in future. No adverse events were detected. Conclusions PhysioDirect is equally clinically effective compared with usual care, provides faster access to physiotherapy, and seems to be safe. However, it could be associated with slightly lower patient satisfaction. Trial registration Current Controlled Trials ISRCTN55666618. BMJ Publishing Group Ltd. 2013-01-29 /pmc/articles/PMC3558547/ /pubmed/23360891 http://dx.doi.org/10.1136/bmj.f43 Text en © Salisbury et al 2013 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Research
Salisbury, Chris
Montgomery, Alan A
Hollinghurst, Sandra
Hopper, Cherida
Bishop, Annette
Franchini, Angelo
Kaur, Surinder
Coast, Joanna
Hall, Jeanette
Grove, Sean
Foster, Nadine E
Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
title Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
title_full Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
title_fullStr Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
title_full_unstemmed Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
title_short Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
title_sort effectiveness of physiodirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558547/
https://www.ncbi.nlm.nih.gov/pubmed/23360891
http://dx.doi.org/10.1136/bmj.f43
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