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

Erik Cattrysse; Jona Van Den Broeck; Robin Petroons; Amber Teugels; Aldo Scafoglieri; Emiel van Trijffel

doi:10.33393/aop.2024.3023

Authors

Erik Cattrysse Experimental Anatomy Research group (EXAN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels - Belgium https://orcid.org/0000-0003-4325-9576
Jona Van Den Broeck Experimental Anatomy Research group (EXAN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels - Belgium https://orcid.org/0000-0002-1648-0788
Robin Petroons Experimental Anatomy Research group (EXAN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels - Belgium https://orcid.org/0009-0006-2491-2604
Amber Teugels Experimental Anatomy Research group (EXAN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels - Belgium https://orcid.org/0009-0003-6656-5944
Aldo Scafoglieri Experimental Anatomy Research group (EXAN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels - Belgium https://orcid.org/0000-0002-9692-9513
Emiel van Trijffel Experimental Anatomy Research group (EXAN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels - Belgium and Ziekenhuisgroep Twente, ZGT Academy, Almelo - The Netherlands

DOI:

https://doi.org/10.33393/aop.2024.3023

Keywords:

Direct access, Physiotherapy, Quality of care, Scoping review

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

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References

Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197-2223. https://doi.org/10.1016/S0140-6736(12)61689-4 PMID:23245608 DOI: https://doi.org/10.1016/S0140-6736(12)61690-0

Vos T, Barber RM, Bell B, et al; Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743-800. https://doi.org/10.1016/S0140-6736(15)60692-4 PMID:26063472 DOI: https://doi.org/10.1016/S0140-6736(15)60692-4

Davenport TE, Sebelski CA. The physical therapist as a diagnostician: how do we, should we, and could we use information about pathology in our practice? Phys Ther. 2011;91(11):1694-1695. https://doi.org/10.2522/ptj.2011.91.11.1694 PMID:22046051 DOI: https://doi.org/10.2522/ptj.2011.91.11.1694

Williams CM, Maher CG, Hancock MJ, et al. Low back pain and best practice care: a survey of general practice physicians. Arch Intern Med. 2010;170(3):271-277. https://doi.org/10.1001/archinternmed.2009.507 PMID:20142573 DOI: https://doi.org/10.1001/archinternmed.2009.507

Foster NE, Hartvigsen J, Croft PR. Taking responsibility for the early assessment and treatment of patients with musculoskeletal pain: a review and critical analysis. Arthritis Res Ther. 2012;14(1):205. https://doi.org/10.1186/ar3743 PMID:22404958 DOI: https://doi.org/10.1186/ar3743

World Physiotherapy. Country profiles reveal global state of the physical therapy profession 2019. https://world.physio/news/country-profiles-reveal-global-state-physical-therapy-profession. Accessed January 2024.

Bürge E, Monnin D, Berchtold A, Allet L. Cost-effectiveness of physical therapy only and of usual care for various health conditions: systematic review. Phys Ther. 2016;96(6):774-786. https://doi.org/10.2522/ptj.20140333 PMID:26678447 DOI: https://doi.org/10.2522/ptj.20140333

Mitchell JM, de Lissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997;77(1):10-18. https://doi.org/10.1093/ptj/77.1.10 PMID:8996459 DOI: https://doi.org/10.1093/ptj/77.1.10

American Physical Therapy Association (APTA). Vision Statement for the Physical Therapy Profession. 2022. https://www.apta.org/apta-and-you/leadership-and-governance/policies/vision-statement-for-the-physical-therapy-profession. Accessed January 2024.

Leemrijse CJ, Swinkels ICS, Veenhof C. Direct access to physical therapy in the Netherlands: results from the first year in community-based physical therapy. Phys Ther. 2008;88(8):936-946. https://doi.org/10.2522/ptj.20070308 PMID:18566108 DOI: https://doi.org/10.2522/ptj.20070308

Bishop A, Ogollah RO, Jowett S, et al; STEMS study team. STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain. BMJ Open. 2017;7(3):e012987. https://doi.org/10.1136/bmjopen-2016-012987 PMID:28286331 DOI: https://doi.org/10.1136/bmjopen-2016-012987

Galliker G, Scherer DE, Trippolini MA, Rasmussen-Barr E, LoMartire R, Wertli MM. Low back pain in the emergency department: prevalence of serious spinal pathologies and diagnostic accuracy of red flags. Am J Med. 2020;133(1):60-72.e14. https://doi.org/10.1016/j.amjmed.2019.06.005 PMID:31278933 DOI: https://doi.org/10.1016/j.amjmed.2019.06.005

Jette DU, Ardleigh K, Chandler K, McShea L. Decision-making ability of physical therapists: physical therapy intervention or medical referral. Phys Ther. 2006;86(12):1619-1629. https://doi.org/10.2522/ptj.20050393 PMID:17138843 DOI: https://doi.org/10.2522/ptj.20050393

Brooks G, Dripchak S, Vanbeveren P, Allaben S. Is a prescriptive or an open referral related to physical therapy outcomes in patients with lumbar spine-related problems? J Orthop Sports Phys Ther. 2008;38(3):109-115. https://doi.org/10.2519/jospt.2008.2591 PMID:18383644 DOI: https://doi.org/10.2519/jospt.2008.2591

Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. https://doi.org/10.7326/M18-0850 PMID:30178033 DOI: https://doi.org/10.7326/M18-0850

Whiting P, Savović J, Higgins JPT, et al; ROBIS group. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol. 2016;69:225-234. https://doi.org/10.1016/j.jclinepi.2015.06.005 PMID:26092286 DOI: https://doi.org/10.1016/j.jclinepi.2015.06.005

Babatunde OO, Bishop A, Cottrell E, et al. A systematic review and evidence synthesis of non-medical triage, self-referral and direct access services for patients with musculoskeletal pain. PLoS One. 2020;15(7):e0235364. https://doi.org/10.1371/journal.pone.0235364 PMID:32628696 DOI: https://doi.org/10.1371/journal.pone.0235364

Piscitelli D, Furmanek MP, Meroni R, De Caro W, Pellicciari L. Direct access in physical therapy: a systematic review. Clin Ter. 2018;169(5):e249-e260. PMID:30393813

Demont A, Bourmaud A, Kechichian A, Desmeules F. The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature. Disabil Rehabil. 2021;43(12):1637-1648. https://doi.org/10.1080/09638288.2019.1674388 PMID:31603709 DOI: https://doi.org/10.1080/09638288.2019.1674388

Ojha HA, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther. 2014;94(1):14-30. https://doi.org/10.2522/ptj.20130096 PMID:24029295 DOI: https://doi.org/10.2522/ptj.20130096

Gallotti M, Campagnola B, Cocchieri A, Mourad F, Heick JD, Maselli F. Effectiveness and consequences of direct access in physiotherapy: a systematic review. J Clin Med. 2023;12(18):5832. https://doi.org/10.3390/jcm12185832 PMID:37762773 DOI: https://doi.org/10.3390/jcm12185832

Reddington M, Baxter S, Walters SJ, Cole A. Patients’ expectations and experiences of accelerated access to physiotherapy for sciatica: qualitative findings from a mixed-methods study. Physiotherapy. 2022;115:102-110. https://doi.org/10.1016/j.physio.2022.01.003 PMID:35452918 DOI: https://doi.org/10.1016/j.physio.2022.01.003

Crowell MS, Mason JS, McGinniss JH. Musculoskeletal imaging for low back pain in direct access physical therapy compared to primary care: an observational study. Int J Sports Phys Ther. 2022;17(2):237-246. https://doi.org/10.26603/001c.31720 PMID:35136693 DOI: https://doi.org/10.26603/001c.31720

Wood L, Bishop A, Goodwin R, Stynes S. Patient satisfaction with the first contact physiotherapy service: results from the national evaluation survey. Musculoskeletal Care. 2022;20(2):363-370. https://doi.org/10.1002/msc.1599 PMID:34709711 DOI: https://doi.org/10.1002/msc.1599

Halfpap J, Riebel L, Tognoni A, Coller M, Sheu RG, Rosenthal MD. Improving access and decreasing healthcare utilization for patients with acute spine pain: five-year results of a direct access clinic. Mil Med. 2022 Mar 12:usac064. https://doi.org/10.1093/milmed/usac064 PMID:35284938 DOI: https://doi.org/10.1093/milmed/usac064

GOV-UK. Our health, our care, our say: a new direction for community services. 2006. https://www.gov.uk/government/publications/our-health-our-care-our-say-a-new-direction-for-community-services. Accessed January 2024.

Stewart J, Kempenaar L, Lauchlan D. Rethinking yellow flags. Man Ther. 2011;16(2):196-198. https://doi.org/10.1016/j.math.2010.11.005 PMID:21185221 DOI: https://doi.org/10.1016/j.math.2010.11.005

Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012;85(4):343-350. PMID:22335313

Pinnington MA, Miller J, Stanley I. An evaluation of prompt access to physiotherapy in the management of low back pain in primary care. Fam Pract. 2004;21(4):372-380. https://doi.org/10.1093/fampra/cmh406 PMID:15249525 DOI: https://doi.org/10.1093/fampra/cmh406

Deyle GD. Direct access physical therapy and diagnostic responsibility: the risk-to-benefit ratio. J Orthop Sports Phys Ther. 2006;36(9):632-634. https://doi.org/10.2519/jospt.2006.0110 PMID:17017267 DOI: https://doi.org/10.2519/jospt.2006.0110