Direct Access To Physiotherapy Research Articles

Reducing strain on primary healthcare systems through innovative models of care: the impact of direct access physiotherapy for musculoskeletal conditions—an interrupted time series analysis

ObjectivesTo evaluate the longitudinal impact of introducing a national, direct access physiotherapy model of care on the rates of primary and secondary care consultations for musculoskeletal (MSK) conditions.DesignInterrupted time series...

Gender-stratified analysis of psychosocial factors and physical function in higher education students with musculoskeletal pain

Purpose To evaluate the prevalence of psychosocial factors in higher education students with musculoskeletal pain and whether these factors are associated with physical function. Materials and methods Participants were higher education students with musculoskeletal pain. The data were collected using questionnaires: the Patient-Specific Functional Scale, the Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-SF) and the Mental Health Index (MHI-5). The associations were analysed using a generalised linear model, adjusted for the region of Finnish Student Health Service in Finland, age, level of education and field of study. Results A total of 242 women and 104 men (N = 346, mean age 28 ± 8 years) participated in the study. The prevalence of psychosocial factors varied from 16% to 25% among women and 14% to 18% among men, depending on the measurement tool used. Psychosocial factors were associated with lower physical function in women (p = .011) and men (p < .001) when measured with ÖMPSQ-SF, but not with MHI-5. Conclusions Psychosocial factors are prevalent among higher education students experiencing musculoskeletal pain. Furthermore, psychosocial factors exhibit an association with lower physical function when assessed using the ÖMPSQ-SF but not when using the MHI-5. These findings emphasise the importance of addressing psychosocial factors through screening in direct access physiotherapy.

Impact of direct access on the quality of primary care musculoskeletal physiotherapy: a scoping review from a patient, provider, and societal perspective.

Worldwide many countries provide direct access in physiotherapy. The aim of this scoping review was to synthesize the available evidence on the quality of primary care musculoskeletal physiotherapy from different perspectives. Systematic searches were conducted in three databases up to September 2022. Studies were included when regarding assessment of at least one of the following perspectives: patient (quality of Life, patient satisfaction, pain, functioning, adverse events), provider (treatment compliance, responsibility, liability, status, prestige, job satisfaction), and society (number of referrals, amount of medical imaging, medication use, number of sessions needed for rehabilitation, and overall costs and cost-effectiveness). Selection and methodological quality assessment of systematic reviews were performed. Data extraction and analysis were performed separately for systematic reviews and individual primary studies. Five systematic reviews as well as 17 primary studies were included. From a patient perspective, no significant effect of direct access was found for pain and a tendency in favour of direct access was found for quality of life, functioning, and well-being. Concerning providers, higher treatment compliance was found in direct access to physiotherapy and decision-making was more accurate. From a societal perspective, significant differences in favour of direct access physiotherapy were found for waiting time, prescribed medication, and medical imaging. In addition, there was a tendency towards lower health care costs. Emerging evidence suggests that direct access physiotherapy could provide at least equal quality of care for patients and better opportunities for providers and the society on selected outcomes.

Recognition of a patient with neck autonomic dysfunction: findings from a rare case report of harlequin syndrome in direct access physiotherapy.

Harlequin syndrome is a rare autonomic condition consisting of unilateral facial flushing and sweating induced by heat, emotion or physical activity. The affected side presents anhidrosis and midline facial pallor due to denervation of the sympathetic fibers. This case describes a patient who reported right-side redness of the face associated with hyperhidrosis during physical activity. She had two previous major motor vehicle accidents. The patient demonstrated difficulties in the visual accommodation of the left eye, but cranial nerve assessment was unremarkable; the patient was then referred to an ophthalmologist, who excluded any autonomic dysfunction as the primary cause of convergence and visual acuity. A left-sided sympathetic dysfunction with Harlequin sign diagnosis was made followed by a progressive compensatory adaptation of the right face. The patient was educated and reassured about the benign nature of her problem. Knowledge of the autonomic nervous system is still limited in clinical practice. Although challenging, physiotherapists should develop the knowledge and ability needed to perform appropriate assessment of autonomic dysfunctions. A dispositional reasoning model should be considered in differential diagnosis.

New models of care integrating more autonomous roles for physiotherapists: a narrative review

With the increased prevalence of non-communicable diseases and chronic disorders, including musculoskeletal disorders, access to care is limited in many health care systems and new multidisciplinary collaborative models of care have now been implemented in several countries in an effort to improve access to care. The paper aimed to describe the characteristics and present relevant evidence supporting different models of care that integrate physiotherapists as primary or secondary care practitioners for the management of patients with non-communicable diseases or chronic disorders. On the basis of a literature review up to August 2020 in 4 major bibliographical databases, we searched for studies of any design, including systematic reviews with or without meta-analysis and position statements, that were related to direct access physiotherapy and advanced practice physiotherapy models of care. The impact of direct access physiotherapy and advanced practice physiotherapy models of care is presented in terms of clinical outcomes, patient satisfaction, health care resource use and costs. These models appear to provide equal or better outcomes in terms of access to care, quality of care, and patients’ satisfaction. The strength of the evidence is variable, and outcomes vary depending on clinical settings, roles of physiotherapists, and characteristics of patients. This review highlights that these enhanced roles for physiotherapists, such as diagnosing, ordering diagnostic tests, or referring patients to physicians, in both primary and secondary care settings, are beneficial and may help optimize patients’ journey by providing earlier access to effective and efficient services compared with physician-led usual care models.

Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial.

The objective was to evaluate the effects of direct-access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two-way analyses of variance, log-linear analysis, and chi-square tests. Seventy-eight patients suffering from MSKDs were included (40.2±17.6years old; 44% women). For the primary clinical outcome, participants in the PT group (n=40) had statistically lower levels of pain and pain interference at 1 and 3months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1month, less prescription medication was used, including opioids, but there were no differences at 3months. Although over-the-counter medication was recommended more at baseline in the PT group, there were no differences in use at 1month, and the PT group had used them less at 3months. There were no differences between groups at follow-up for imaging tests, other professionals consulted, and hospitalization rates. Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3months after discharge.

Development of a patient-reported outcome measure for neck pain in military aircrew: qualitative interviews to inform design and content

IntroductionThe prevalence of flight-related neck pain is 70% in UK fast jet pilots; much higher than the general population. The Aircrew Conditioning Programme and direct access physiotherapy exist to minimise...

Direct access physiotherapy for patients with musculoskeletal disorders: a systematic review

Abstract Background Although the benefits of physiotherapy is well supported in the literature, the impact of having direct access to physiotherapy is not well established. Update of the current available evidence is warranted. The aim of this systematic review was to update the current evidence regarding the impact of direct access physiotherapy compared to usual care for patients with musculoskeletal disorders. Methods Systematic searches were conducted in 5 bibliographic databases up until May 2018. Two independent raters reviewed studies and used the Quality Assessment Tool for Quantitative Studies to conduct the methodological quality assessment and a data extraction regarding patient outcomes, adverse events, health care utilization and processes, patient satisfaction and health care costs. Results Sixteen studies of weak to moderate quality were included. Five studies found no significant differences in pain reduction between usual family physician led care and direct access physiotherapy. However, three studies reported better clinical outcomes in patients with direct access in terms of function and quality of life. Five studies did not observe any adverse events with direct access physiotherapy. Three studies showed shorter waiting time and four studies reported fewer number of physiotherapy visits with direct access. Three studies showed that patients with direct access were less likely to have medication and imaging tests prescribed compared to usual care. Five studies reported higher levels of satisfaction for direct access. In terms of health care costs, four studies demonstrated that costs were lower with direct access and one study reported similar costs between both types of care. Conclusions Emerging evidence, although of weak to moderate quality, suggest that direct access physiotherapy provides equal or better outcomes than family physician led care models for musculoskeletal disorders patients. More methodologically strong studies are needed. Key messages This review supports the efficacy, safety and cost-effectiveness of direct access PT, while increasing access to care with a more efficient use of resources. There is a need for more methodologically strong studies to evaluate the efficiency of direct access models of care of physiotherapy for patients with MSKD.

Impact of a direct access occupational physiotherapy treatment service

Musculoskeletal disorders (MSDs) cause significant morbidity and absence from work for both manual and sedentary occupations. To examine the impact of a direct access physiotherapy treatment service in an occupational setting. This was a pilot study carried out as a service audit. Physiotherapy patients were assessed pre- and post-treatment using the work function score (WFS), a visual analogue scale for pain (VASP) and adjusted clinical score (ACS). Self-report questionnaires were completed on sickness absence, attendance at work and the World Health Organization (five) Well-being Index. There were 231 participants. Patient improvement was reported in WFS (63%), ACS (84%) and VASP (94%). Compared with those who had one or two sessions, improvement was most likely after three to four sessions for WFS [odds ratio (OR): 4.5; 95% confidence interval: 1.4-14.3, P < 0.05], VASP (OR: 32.2; 95% confidence interval: 3.5-294.2, P < 0.01) and five to six sessions for ACS (OR: 6.9; 95% confidence interval: 1.9-25.9, P < 0.01). While the self-reported questionnaire response rate was low at 29%, respondents indicated that there was potential to reduce and prevent sickness absence and improve mental well-being. Brief physiotherapy treatment for MSDs may have the potential to improve not only clinical status and pain as expected but also work function, psychological well-being and sickness absence. Further research is warranted to confirm these positive impacts and to endorse physiotherapy as an effective intervention in occupational settings and a useful component in rehabilitation and 'Fit for Work' programmes.

Improving general practitioner access to physiotherapy: a review of the economic evidence.

The provision of physiotherapy via general practitioner (GP) 'direct access' arrangements or in primary care itself has become increasingly common in the UK. Evidence on the economics and the cost-effectiveness of alternative methods of organizing access to physiotherapy services is reviewed, and the likely impacts of different organizational models are discussed. GP direct access physiotherapy and primary care provision appear to have a lower average cost than consultant access physiotherapy models, while GP direct access appears to minimize health care resource use per patient. Primary care physiotherapy provision appears to minimize the costs to patients of seeking care, and appears to generate a greater demand for service than other models. The extent to which physiotherapy provision in primary care can substitute for physiotherapy and other resources in the hospital sector is discussed, as is the extent to which patients may benefit from receiving physiotherapy in primary care. It is argued that continued expansion of access to physiotherapy should be critically appraised, and its ability to improve health status compared with that achievable in alternative patient groups who might benefit from physiotherapy in hospital or rehabilitation settings.