File
Bornhöft L1,2, Larsson MEH1,2, Nordeman L1,2, Eggertsen R3, Thorn J3
1University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden, 2Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden, 3University of Gothenburg, Sahlgrenska Academy, Institute of Medicine, Gothenburg, Sweden
Background: Physiotherapists and general practitioners (GPs) both act as primary assessors for patients with musculoskeletal disorders in primary care. Previous studies have shown that initial triaging to physiotherapists at primary health care centres has advantages regarding efficiency in the work environment and utilization of health care.
Purpose: This study aimed primarily to determine whether triaging to physiotherapists affects the progression of health aspects over time differently than traditional management with initial GP assessment. The secondary aim was to determine whether triaging to physiotherapists affects patients' attitudes of responsibility for musculoskeletal disorders.
Methods: Working age patients of both genders seeking primary care for musculoskeletal disorders and nurse-assessed as suitable for triaging to physiotherapists were randomised to initial visits with either physiotherapists or GPs and followed up at 2, 12, 26 and 52 weeks. Outcome measures were current and mean (3 months) pain intensities, functional disability, risk for developing chronic musculoskeletal pain, health-related quality of life and attitudes of responsibility for musculoskeletal conditions.
Results: The physiotherapist-triaged group showed significant improvement for health-related quality of life at 26 weeks and showed consistent but non-significant tendencies to greater reductions of current pain, mean pain the latest 3 months, functional disability and risk for developing chronic pain. The triage model did not consistently affect patients' attitudes of responsibility for musculoskeletal disorders.
Conclusion(s): In a pragmatic trial, triaging to physiotherapists for primary assessment in primary care lead to at least as positive health effects as primary assessment by GPs for patients with musculoskeletal disorders.
Implications: It is feasible to change the management of patients with musculoskeletal disorders applying to primary care by letting physiotherapists perform initial assessments and engaging GPs as secondary consultants when necessary without discernible disadvantages for the patients' health.
Keywords: Triage, physiotherapy, primary care
Funding acknowledgements: This work was supported by The Healthcare sub-committee, Region Västra Götaland [461251]
Purpose: This study aimed primarily to determine whether triaging to physiotherapists affects the progression of health aspects over time differently than traditional management with initial GP assessment. The secondary aim was to determine whether triaging to physiotherapists affects patients' attitudes of responsibility for musculoskeletal disorders.
Methods: Working age patients of both genders seeking primary care for musculoskeletal disorders and nurse-assessed as suitable for triaging to physiotherapists were randomised to initial visits with either physiotherapists or GPs and followed up at 2, 12, 26 and 52 weeks. Outcome measures were current and mean (3 months) pain intensities, functional disability, risk for developing chronic musculoskeletal pain, health-related quality of life and attitudes of responsibility for musculoskeletal conditions.
Results: The physiotherapist-triaged group showed significant improvement for health-related quality of life at 26 weeks and showed consistent but non-significant tendencies to greater reductions of current pain, mean pain the latest 3 months, functional disability and risk for developing chronic pain. The triage model did not consistently affect patients' attitudes of responsibility for musculoskeletal disorders.
Conclusion(s): In a pragmatic trial, triaging to physiotherapists for primary assessment in primary care lead to at least as positive health effects as primary assessment by GPs for patients with musculoskeletal disorders.
Implications: It is feasible to change the management of patients with musculoskeletal disorders applying to primary care by letting physiotherapists perform initial assessments and engaging GPs as secondary consultants when necessary without discernible disadvantages for the patients' health.
Keywords: Triage, physiotherapy, primary care
Funding acknowledgements: This work was supported by The Healthcare sub-committee, Region Västra Götaland [461251]
Topic: Musculoskeletal
Ethics approval required: Yes
Institution: University of Gothenburg
Ethics committee: Regional ethical review board in Gothenburg
Ethics number: DNR 358-14
All authors, affiliations and abstracts have been published as submitted.
