G. Daker-white et al., A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments, J EPIDEM C, 53(10), 1999, pp. 643-650
Citations number
28
Categorie Soggetti
Envirnomentale Medicine & Public Health","Medical Research General Topics
Objective-To evaluate the effectiveness and cost effectiveness of specially
trained physiotherapists in the assessment and management of defined refer
rals to hospital orthopaedic departments,
Design-Randomised controlled trial.
Setting-Orthopaedic outpatient departments in two hospitals.
Subjects-481 patients with musculoskeletal problems referred for specialist
orthopaedic opinion.
Interventions-Initial assessment and management undertaken by post-Fellowsh
ip junior orthopaedic surgeons, or by specially trained physiotherapists wo
rking in an extended role (orthopaedic physiotherapy specialists).
Main outcome measures-Patient centred measures of pain, functional disabili
ty and perceived handicap.
Results-A total of 654 patients were eligible to join the trial, 481 (73.6%
) gave their consent to be randomised. The two arms (doctor n=244, physioth
erapist n=237) were similar at baseline. Baseline and follow up questionnai
res were completed by 383 patients (79.6%). The mean time to follow up was
5.6 months after randomisation, with similar distributions of intervals to
follow up in both arms. The only outcome for which there was a statisticall
y or clinically important difference between arms was in a measure of patie
nt satisfaction, which favoured the physiotherapist arm. A cost minimisatio
n analysis showed no significant differences in direct costs to the patient
or NHS primary care costs. Direct hospital costs were lower (p<0.00001) in
the physiotherapist arm (mean cost per patient = pound 256, n=232), as the
y were less likely to order radiographs and to refer patients for orthopaed
ic surgery than were the junior doctors (mean cost per patient in arm =poun
d 498, n=238).
Conclusions-On the basis of the patient centred outcomes measured in this r
andomised trial, orthopaedic physiotherapy specialists are as effective as
post-Fellowship junior staff and clinical assistant orthopaedic surgeons in
the initial assessment and management of new referrals to outpatient ortho
paedic departments, and generate lower initial direct hospital costs.