A physiotherapy telephone assessment and advice service for patients with musculoskeletal problems can improve the process of care while maintaining clinical effectiveness.

QUESTION

Does a physiotherapy telephone assessment and advice service (PhysioDirect) affect physical health and improve the process of care in patients with musculoskeletal problems?

DESIGN

Randomised controlled trial with concealed allocation and blinded outcome assessment.

SETTING

Four community physiotherapy services drawing patients from 94 general practices in England.

PARTICIPANTS

Adults referred by a general practitioner or self-referred to physiotherapy for a musculoskeletal problem were eligible for inclusion. Referral from a consultant and an inability to communicate in English were key exclusion criteria. Randomisation of 2256 participants at a ratio of 2:1 allocated 1513 to PhysioDirect and 743 to the usual care physiotherapy.

INTERVENTIONS

PhysioDirect participants were invited to telephone a physiotherapist for initial assessment and advice followed by further telephone advice and face-to-face physiotherapy if necessary. After the initial call most participants were sent written advice about self management and exercises. The usual-care comparison group joined a waiting list for face-to-face physiotherapy management.

OUTCOME MEASURES

The primary outcome was change in physical health, measured with the physical component summary (PCS) measure from the SF-36 questionnaire at 6 weeks and 6 months. Secondary clinical outcome measures included the Measure Yourself Medical Outcomes Profile, global improvement in the main problem, and questions about satisfaction from the General Practice Assessment Questionnaire; and measures of process of care, including number of appointments, and waiting time.

RESULTS

Primary outcome data were obtained from 85% of participants at 6 months. There was no difference in the SF-36 PCS measure between the PhysioDirect and comparison groups at 6 months (Mean difference (MD) = -0.01, 95% CI -0.80 to 0.79) and 6 weeks (MD 0.42, 95% CI -0.28 to 1.12). There were no differences between the groups in other clinical outcomes at 6 months, but there were small improvements in the PhysioDirect group at 6 weeks in the global improvement score (MD 0.15 units, 95% CI 0.02 to 0.28) and in the Measure Yourself Medical Outcomes Profile score (MD -0.19 units, 95%CI -0.30 to -0.07). 47% of PhysioDirect participants were managed entirely by telephone, and they had fewer face-to- face appointments (mean 1.9 vs 3.1), and a shorter wait for physiotherapy treatment (median 7 vs 34 days) than the comparison group. PhysioDirect participants were less satisfied with the service than the comparison group (MD -3.8%, 95% CI -7.3 to -0.3).

CONCLUSION

Providing an initial telephone physiotherapy service for patients with musculoskeletal problems that reduced waiting time and required fewer appointments was as effective as providing face-to-face physiotherapy, but was associated with slightly lower patient satisfaction.