Region Västra Götaland, Närhälsan Health Unit, Primary Health Care, Lidköping, Sweden.
Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
BMC Musculoskelet Disord. 2019 Jul 13;20(1):329. doi: 10.1186/s12891-019-2690-1.
In Swedish primary care, the healthcare process for patients with knee osteoarthritis (KOA) can be initiated by a physician or physiotherapist assessment. However, it is unclear how the different assessments affect the healthcare processes and patient reported outcomes over time. The purpose of this study was to examine the differences in health-related quality of life (HrQoL), adjusted for pain and physical function, for patients with KOA when the healthcare process is initiated by a physiotherapist assessment compared to a physician assessment in primary care.
An assessor-blinded randomised controlled pragmatic trial. Using a computer-generated list of random numbers, patients seeking primary care during 2013-2017 with suspected KOA were randomised to either a physiotherapist or physician for primary assessment and treatment. Data was collected before randomisation and at 3, 6, and 12-month follow-ups. Primary outcome was HrQoL using EuroQol 5 dimensions 3 levels questionnaire, index (EQ-5D-3L index) and a visual analogue scale (VAS) (EQ-5D-3L VAS); pain intensity was measured with VAS (0-100) and physical function measured with the 30-s chair stand test. Mixed effect model analyses compared repeated measures of HrQoL between groups. The significance level was p < 0.05 and data was applied with intention-to-treat.
Patients were randomised to either a physiotherapist (n = 35) or physician (n = 34) for primary assessment. All 69 patients were included in the analyses. There were no significant differences in HrQoL for patients assessed by a physiotherapist or a physician as primary assessor (EQ-5D-3L index, p = 0.18; EQ-5D-3L VAS, p = 0.49). We found that HrQoL changed significantly 12 months after baseline assessment for all patients regardless of assessor (EQ-5D-3L index, p < 0.001; EQ-5D-3 L VAS, p = 0.0049). No adverse events or side effects were reported.
There were no differences in HrQoL, when adjusted for pain and physical function, for patients with KOA when the healthcare process was initiated with physiotherapist assessment compared to physician assessment in primary care. Both assessments resulted in significantly higher HrQoL at the 12-month follow-up. The results imply that physiotherapists and physicians in primary care are equally qualified as primary assessors.
Retrospectively registered at http://clinicaltrial.gov , ID: NCT03715764.
在瑞典的初级保健中，膝关节骨关节炎（KOA）患者的医疗过程可以由医生或物理治疗师评估启动。然而，目前尚不清楚不同的评估如何影响医疗过程以及随着时间的推移患者报告的结果。本研究的目的是检查当医疗过程由物理治疗师评估而不是由医生评估时，KOA 患者的健康相关生活质量（HrQoL），调整疼痛和身体功能后，与初级保健中的医生评估相比有何不同。
采用评估者盲法随机对照实用试验。使用计算机生成的随机数列表，2013-2017 年期间在初级保健中寻求治疗的疑似 KOA 患者被随机分配给物理治疗师或医生进行初步评估和治疗。在随机分组前和 3、6 和 12 个月的随访中收集数据。主要结局指标是使用 EuroQol 5 维 3 级问卷（EQ-5D-3L 指数）和视觉模拟量表（EQ-5D-3L VAS）测量的健康相关生活质量（HRQoL）；疼痛强度用 VAS（0-100）测量，身体功能用 30 秒坐立试验测量。混合效应模型分析比较了两组间重复测量的 HRQoL。显著性水平为 p<0.05，数据采用意向治疗。
患者被随机分配给物理治疗师（n=35）或医生（n=34）进行初步评估。所有 69 名患者均纳入分析。作为初级评估员，由物理治疗师或医生评估的患者在 HRQoL 方面没有显著差异（EQ-5D-3L 指数，p=0.18；EQ-5D-3L VAS，p=0.49）。我们发现，无论评估者如何，所有患者在基线评估后 12 个月的 HRQoL 均显著改变（EQ-5D-3L 指数，p<0.001；EQ-5D-3L VAS，p=0.0049）。未报告不良事件或副作用。
当调整疼痛和身体功能时，与初级保健中的医生评估相比，当医疗过程由物理治疗师评估启动时，KOA 患者的 HRQoL 没有差异。两种评估方法在 12 个月的随访中均显著提高了 HRQoL。结果表明，初级保健中的物理治疗师和医生作为初级评估员同样合格。
在 http://clinicaltrial.gov 上进行回顾性注册，ID：NCT03715764。
