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Health effects of direct triaging to Physical Therapists in primary care for patients with musculoskeletal disorders

06-06-2019
Globally, the prevalence of musculoskeletal disorders (MSAs) has been increasing steadily for many years, leading to an increase in the number of people treated with disability of around 20% between 2006 and 2016. First-line MSDs cover a wide range of conditions and are responsible for 14-17% of consultations in primary care. Although self-management may be sufficient for some disorders, other treatments require and over time develop into chronic disorders that interfere with daily activities and reduce the quality of life in the long term. Standard management in primary care includes traditional primary assessment by general practitioners. Physiotherapists also see this group of patients as primary assessors or after referrals by physicians.

In primary care, physiotherapists and general practitioners (GPs) both act as primary assessors for patients with musculoskeletal disorders. Earlier studies demonstrated that initial triage to physiotherapists in primary health care centers has benefits with regard to work environment efficiency and health care use. In this study, one wants to be able to determine first of all whether trending for physiotherapists influences the progression of health aspects over time differently than with traditional management with the first GP assessment. The secondary aim was to determine whether triage to physiotherapists influences patients' attitudes towards responsibility for musculoskeletal disorders.

This is a pragmatic study in which both recruitment and treatment strategies were determined on the basis of clinical, non-study-related parameters and were initiated in three first-line health centers in Sweden.
Efficacy patients of both sexes seeking primary care for musculoskeletal disorders and a nurse who was found suitable for triage to physiotherapists were randomized for the first consultation with physiotherapists or general practitioners. They received questionnaires for self-evaluation before the first consultation and were followed for 2, 12, 26 and 52 weeks with the same questionnaires. Outcome measures were current and average (3 months) pain intensities, functional limitations, risks for developing chronic musculoskeletal pain, health-related quality of life and responsibility for musculoskeletal disorders. In the meantime, trends were analyzed using a regression model for repeated measurements.

The physiotherapist-triaded group showed significant improvement in health-related quality of life after 26 weeks and showed consistent but non-significant tendencies for greater reduction in current pain, average pain in the last 3 months, functional limitation and risk for development of chronic pain compared to traditional management. The triage model did not consistently influence patients' attitudes towards responsibility for musculoskeletal disorders.

Triaging to primary care physiotherapists leads to at least as positive health effects as primary assessment by general practitioners and can also be recommended as an alternative management route for patients with musculoskeletal disorders.

Ther Adv Musculoskel Dis 2019

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