A physiotherapy service based on initial telephone assessment has the ability to provide faster access to the service and cut waiting times, a study involving University of Bristol researchers published today on bmj.com suggests.
Providing access to physiotherapy has long been a problem in the NHS with waiting times of several week or months. Furthermore, waiting lists may be congested with those who will benefit from physiotherapy advice but have little to gain from a course of face-to-face appointments.
With an ageing population and rising healthcare expectations, healthcare providers need to explore new ways of delivering healthcare with one such suggestion being initial assessment by telephone. However, this has not yet been rigorously evaluated.
Researchers from around the UK therefore assessed the effectiveness of PhysioDirect, where the patient can telephone a physiotherapist for initial assessment and advice without waiting for a face-to-face appointment. Services which have already implemented PhysioDirect claim it has reduced waiting times and was popular with patients. Researchers compared PhysioDirect with usual care in a randomised controlled trial.
The study led by Professor Chris Salisbury at the University of Bristol involved 2,256 patients aged 18 or over with musculoskeletal problems who were studied between July and December 2009: 1,513 to PhysioDirect and 743 to usual care. This study has been awarded by the Efficacy and Mechanism Evaluation (EME) Programme, which is funded by the Medical Research Council and managed by the National Institute for Health Research.
Almost half the PhysioDirect patients (711) were managed entirely by telephone. They also had fewer face-to-face appointments than those in usual care and fewer physiotherapy consultations of any type. The PhysioDirect patients also had a shorter wait for physiotherapy treatment (seven days versus 34 days) and were less likely to fail to attend appointments.
The study found that care based on PhysioDirect is equally clinically effective compared with usual care and provides faster access to advice and treatment. However, no evidence was found of improved patient satisfaction.
The authors say the fact that 47 per cent of PhysioDirect patients were managed entirely on the telephone, and were almost as satisfied with their consultations as usual care patients, shows that physiotherapists are able to provide assessments and advice by telephone in a way that is reasonably acceptable to patients.
The researchers conclude that PhysioDirect “is equally clinically effective compared with usual care, provides faster access to physiotherapy, and seems to be safe” but there is no evidence that it is associated with increased patient satisfaction.
Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
1. The Efficacy and Mechanism Evaluation programme supports later-phase “science-driven” clinical trials and evaluative studies, which seek to determine whether a health intervention (e.g. a drug, diagnostic technique or device) works and in some cases how or why it works.
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