Who should see orthopaedic outpatients--physiotherapists or surgeons?

Orthopaedic outpatient waiting lists are long and the majority of referrals are for conditions that do not respond to surgical intervention. Many of these patients are best managed by physiotherapy, orthotics or steroid injections, which can be administered by an appropriately trained physiotherapist. The effectiveness of a physiotherapist with extended training in orthotics and steroid injection was compared with staff grade orthopaedic surgeons in the management of orthopaedic outpatients judged unlikely to require surgery from the general practitioner's referral letter. Some 221 patients with mechanical low back pain and foot and shoulder disorders were seen by a physiotherapist and 97 by staff grade surgeons over a 10-month period. Outcome was assessed by postal questionnaire or telephone contact 6-12 months following discharge. Outcome was satisfactory in 80 per cent of patients overall, 65 per cent of low back and 69 per cent of neck pain, 80 per cent of foot and 83 per cent of shoulder disorders. An appropriately trained physiotherapist is as effective as staff grade surgeons in managing orthopaedic outpatients unlikely to benefit from surgical intervention. This has implications both in reduction of outpatient waiting lists and hospital doctor hours of work.