Intermediate Care pathways for musculoskeletal conditions – Are they working? A systematic review

Hussenbux, A.; Morrissey, Dylan; Joseph, Corey; McClellan, Carey

doi:10.1016/j.physio.2014.08.004

Cited by 35 publications

(36 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Findings of this study with regard to waiting time to treatment and total time in ED are consistent with reports from other similar studies [6] [7], strengthening the likelihood that the incorporation of EPPs in ED can have a positive effect on reducing time for patients with musculoskeletal problems who can be seen by the EPPs. In addition, by enabling the EPPs to see many of the patients with musculoskeletal problems, other ED practitioners, such as medical and nursing staff can be available to manage patients attending ED with non-musculoskeletal dysfunctions, thereby having the potential to benefit all patients attending an ED.…”

Section: Discussionsupporting

confidence: 89%

“…They can work independently from medical and nursing staff, undertaking expert patient management for patients attending emergency and accident departments with musculoskeletal dysfunction. Integration of EPPs in EDs has been reported to improve patient outcomes [3]- [7], improve patient flow [7]- [9], streamline care without additional use of resources such as use of radiographic investigation [4] [10], reduce costs [4] and improve patient satisfaction [1] [4] [5] [7] [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of Musculoskeletal Emergency Physiotherapy Practitioners

Salt¹

2016

OJTR

View full text Add to dashboard Cite

Relevance and Method: The purpose of this project was to evaluate the effectiveness of the Emergency Physiotherapy Practitioner (EPP) service against quality care indicators identified as part of the "gold standard" for emergency care in England. The study was prospective and evaluated time to initial assessment, total time in the emergency department and un-planned re-attendance rate within a seven-day period for all patients seen by the EPP's over a period of one year. Outcomes: One thousand and seven patients were seen by EPPs in the emergency department. The median wait time for treatment by an EPP was 34.5 minutes (95th percentile = 122). Regional median wait time was 45 minutes (95th percentile = 138). National median wait time was 55 minutes (95th percentile = 192). Median total time spent in ED for patients seen by EPPs was 99 minutes (95th percentile = 224). Regional median total time in ED was 223 (95th percentile = 239). Nationally median total time in ED was 136 minutes (95th percentile = 336). Three percent of patients seen by an EPP returned to the ED, compared to 6% regionally and 7.5% nationally. Conclusions: EPPs excelled in all three indicators and exceeded regional and national figures. The re-return rate met the current standard of being less than 5%. It could be justified that the addition of the EPPs to the emergency department was an efficient and effective service development.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Effectiveness of Musculoskeletal Emergency Physiotherapy Practitioners

Salt¹

2016

OJTR

View full text Add to dashboard Cite

show abstract

“…Several studies have reported that patients are either equally [ 3 , 6 ] or even more satisfied with physiotherapist-led triage than with standard practice [ 4 , 8 ]. Still, scientific evidence for the effectiveness of this model of care remains limited and there is a scarcity of high-quality studies [ 22 ]. Few of the studies report on health outcomes using standardised outcome measures [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial

Samsson

Bernhardsson

Larsson

2016

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundPhysiotherapist-led orthopaedic triage, where physiotherapists diagnose and determine management plans, aims to enhance effectiveness and provide the best care. However, scientific evidence for the effectiveness of this model of care remains limited, and there are few studies reporting on patients’ perceptions of the care provided. The purpose of this study was to evaluate patients’ perceived quality of care in a physiotherapist-led orthopaedic triage in primary care, compared with standard practice.MethodsIn a randomised controlled trial, patients of working age referred for orthopaedic consultation at a primary healthcare clinic in Sweden received either physiotherapist-led triage (n = 102) or standard practice (orthopaedic surgeon assessment) (n = 101). Neither subjects nor clinicians were blinded.The questionnaire Quality from the Patient's Perspective (QPP) was used to evaluate perceived quality of care focusing on the caregivers’ medical-technical competence and identity-orientated approach. Also, to what extent patients’ expectations were met, and their intention to follow advice was evaluated.ResultsFor this study, 163 patients (80 %) were analysed (physiotherapist-led triage (n = 83), standard practice (n = 80)). Participants perceived significantly higher quality of care with the triage than with the standard practice in regards to receiving best possible examination and treatment (medical-technical competence) (p < 0.001). This was also found in regards to receiving information about examination and treatment (p < 0.001), results (p < 0.001), and self-care (p < 0.001), the caregiver’s understanding (p < 0.001), respect (p < 0.001) and commitment (p < 0.001) as well as the opportunity to participate in decision-making (p = 0.01) (identity-orientated approach). Participants in the physiotherapist-led triage group reported to a significantly higher extent that their expectations of the treatment were met (p < 0.001), as well as the intent to follow the advice and instructions received (p = 0.019).ConclusionsThis paper reports on patients’ perceptions of quality of care in a physiotherapist-led orthopaedic triage compared with standard practice. Patients in both groups reported that they perceived good quality of care, with the patients in the physiotherapist-led triage reporting significantly higher perceived quality of care than those in the standard practice group. This model of care seems to meet patients’ expectations and result in a greater intention to follow advice and instructions for self-management.Our findings are in line with existing literature that this model of care provides an opportunity to shape patient-centered care that can improve access and offer care on the most appropriate level, with maintained good quality of care.Trial registrationClinical Trials NCT02265172. Registered 10 June 2014

show abstract

“…Within the UK, the pathway for providing MSK services has developed significantly over the last 15 years 3. Primary care treatment is effective in managing many MSK problems but a significant proportion of patients will be referred through an intermediate care pathway where more diagnostic tests may be undertaken and physiotherapy care provided 4. A proportion of these patients have symptoms resistant to initial therapy and are referred on to hospital-based secondary care for assessment by orthopaedic, rheumatology or sports medicine doctors 5.…”

Section: Introductionmentioning

confidence: 99%

Determining responsiveness and meaningful changes for the Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways

et al. 2019

View full text Add to dashboard Cite

ObjectivesWe have previously developed and validated the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways, showing encouraging psychometric test results. The objective of this study was to determine the responsiveness of MSK-HQ following MSK treatments and to determine the minimally important change (MIC).SettingWe collected data in four cohorts from community physiotherapy and secondary-care orthopaedic hip, knee and shoulder clinics.Participants592 individuals were recruited; 210 patients treated with physiotherapy for a range of MSK conditions in primary care; 150 patients undergoing hip replacement, 150 patients undergoing knee replacement and 82 undergoing shoulder surgery in secondary care.Outcome measuresPreoperative data were collected including the MSK-HQ, European Quality of Life-5D (EQ-5D) and the OHS, OKS or OSS in each joint-specific group. The same scores, together with anchor questions, were collected postintervention at 3 months for the physiotherapy group and 6 months for all others. Following COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines, responsiveness was assessed using correlation between scores and the MIC was calculated for the entire cohort using receiver operating characteristic curve analysis.ResultsThe MSK-HQ demonstrated strong correlation (R=0.73) with EQ-5D across the entire cohort and with each of the joint-specific Oxford scores (hip R=0.87, knee R=0.92 and shoulder R=0.77). Moderate correlation was seen between MSK-HQ and EQ-5D across each individual group (R value range 0.60–0.68), apart from the hip group where correlation was strong (R=0.77). The effect size with MSK-HQ was 0.93, in the entire cohort, double that measured with EQ-5D (0.43). In all subgroups, MSK-HQ measured a greater treatment effect compared with EQ-5D. The MIC is 5.5 (95% CI 2.7 to 8.3).ConclusionOur study demonstrates that the MSK-HQ questionnaire is responsive to change across a range of musculoskeletal conditions, supporting its use as a generic MSK measurement instrument.

show abstract

Intermediate Care pathways for musculoskeletal conditions – Are they working? A systematic review

Cited by 35 publications

References 27 publications

Effectiveness of Musculoskeletal Emergency Physiotherapy Practitioners

Effectiveness of Musculoskeletal Emergency Physiotherapy Practitioners

Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial

Determining responsiveness and meaningful changes for the Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways

Contact Info

Product

Resources

About