Cost-effectiveness physiotherapy in musculoskeletal disorders
A new report from the National Institute for Health Research (NIHR) shows that investments in physiotherapy services for musculoskeletal disorders improve patient outcomes and reduce overall healthcare costs.
This thematic assessment includes more than 30 physiotherapy-related published studies funded by the NIHR and selected studies from other research organizations that have made a difference for musculoskeletal care in conditions such as rheumatoid arthritis, low back pain and chronic knee joint pain. Musculoskeletal disorders are the main cause of pain and disability in the UK and affects more than one in four people. The evidence that comes from Moving Forward: physiotherapy for musculoskeletal health and well-being emphasizes the importance of physiotherapy for the treatment of these disorders.
Physiotherapy is important for preventing and reducing the negative effects of musculoskeletal disorders. Moving Forward is mainly aimed at physiotherapeutic staff involved in direct clinical practice, but is also relevant for other clinicians in the musculoskeletal care team.
The research shows that investment in high-quality rehabilitation adapted to the individual needs of the patient leads to better results, reduces further research and treatment and lowers costs. Physiotherapists who gave advice on lower back pain reduced their absence at work by about five days on average. Patients also come into contact with a physiotherapist more quickly. A telephone assessment by physiotherapists meant that people had to wait seven days for contact with a physiotherapist, compared to a usual average waiting time of 34 days. A rehabilitation program with targeted exercises reduced pain in the knee joints and health care costs and the stretching and strengthening of the hand exercises improved function for people with rheumatoid arthritis. Finally, there is overwhelming evidence that exercise and activity are effective and should be a core treatment for musculoskeletal pain. An NIHR assessment of more than 60 studies - most commonly for osteoarthritis of the knee - clearly showed benefit from physical activity.
There were small increases in Quality Adjusted Life Years (QALY) associated with PhysioDirect (telephone service), which combined with a very small increase in costs meant that it would probably be a cost-effective option overall. The IMPaCT Back study, which was published in 2014, was funded by the Health Foundation with support from the NIHR. The study showed that layered care can be implemented in daily clinical practice. It changes the referral behavior of general practitioners, leads to improvements in the outcomes of patient disability and halves free time without increasing health care costs.
Nadine Foster, director of Keele Clinical Trials Unit and NIHR Research Professor of Musculoskeletal Health in Primary Care, explains that this is a wonderful showcase of high-quality physiotherapist-led research that makes a difference in the lives of patients with musculoskeletal disorders. It provides evidence of the difference that investing in musculoskeletal pain research provides for patients and the NHS.
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