Elective Surgery Centre, Silkeborg Regional Hospital, 8600 Silkeborg, Denmark.
University of Southern Denmark, Department of Sports Science and Clinical Biomechanics, 5100 Odense, Denmark; Department of Rehabilitation, University Hospital of Copenhagen, Herlev and Gentofte, Denmark.
Physiotherapy. 2020 Sep;108:120-128. doi: 10.1016/j.physio.2017.08.004. Epub 2017 Aug 30.
Patients with musculoskeletal diseases can potentially be assessed by an extended scope physiotherapist (ESP) instead of by an orthopaedic surgeon (OS).
To evaluate the effectiveness of the diagnostic musculoskeletal assessment performed by ESP compared to OS.
MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PEDro and reference lists of included studies and previous reviews were searched in November 2015.
Studies were included if they evaluated adults with a musculoskeletal disease referred to an outpatient orthopaedic clinic where a diagnostic assessment had been conducted by an ESP.
Data were extracted using a customised data extraction sheet. Two reviewers using checklists evaluated methodological independently.
We included one randomised controlled trial and 31 observational studies. Diagnostic agreement between ESPs and OSs was 65 to 100% across studies. Health care cost savings for diagnostic assessments performed by ESPs were 27 to 49% compared to OSs. Overall, 77 to 100% of the patients were satisfied with the ESP assessment. Results were comparable on diagnostic agreement, cost and satisfaction in studies with high, moderate and low risk of bias.
Risk of bias in the included studies.
Diagnostic assessments performed by ESP may be as beneficial as or even better than assessment performed by OSs in terms diagnostic agreement, costs and satisfaction. However, the methodological quality was generally too low to determine the clear effectiveness of ESP assessment, and more high quality studies are needed. Systematic review registration number: PROSPERO CRD42014014229.
患有肌肉骨骼疾病的患者可以由扩展范围的物理治疗师（ESP）进行评估，而不是由矫形外科医生（OS）进行评估。
评估 ESP 进行的肌肉骨骼诊断评估与 OS 相比的有效性。
2015 年 11 月，检索了 MEDLINE、Cochrane 对照试验中心注册库、EMBASE、CINAHL、PEDro 和纳入研究及先前综述的参考文献列表。
如果研究评估了患有肌肉骨骼疾病的成年人，这些患者被转诊到门诊矫形诊所，ESP 对其进行了诊断评估，则将其纳入研究。
使用自定义数据提取表提取数据。两名使用清单的审查员独立评估方法学。
我们纳入了一项随机对照试验和 31 项观察性研究。ESP 和 OS 之间的诊断一致性在所有研究中为 65%至 100%。与 OS 相比，ESP 进行的诊断评估可节省 27%至 49%的医疗保健费用。总体而言，77%至 100%的患者对 ESP 评估感到满意。在高、中、低偏倚风险研究中，在诊断一致性、成本和满意度方面，结果具有可比性。
纳入研究的偏倚风险。
ESP 进行的诊断评估在诊断一致性、成本和满意度方面可能与 OS 评估一样有益，甚至更好。然而，总体而言，研究方法质量普遍较低，无法确定 ESP 评估的明确效果，因此需要更多高质量的研究。系统评价注册号：PROSPERO CRD42014014229。
