Press release issued 30 January 2013
But patient satisfaction levels unchanged
Providing access to physiotherapy has long been a problem in the NHS with waiting times of several week or months. Furthermore, waiting lists may be congested with those who will benefit from physiotherapy advice but have little to gain from a course of face-to-face appointments.
With an ageing population and rising healthcare expectations, healthcare providers need to explore new ways of delivering healthcare with one such suggestion being initial assessment by telephone. However, this has not yet been rigorously evaluated.
Researchers from around the UK therefore assessed the effectiveness of PhysioDirect, where the patient can telephone a physiotherapist for initial assessment and advice without waiting for a face-to-face appointment. Services which have already implemented PhysioDirect claim it has reduced waiting times and was popular with patients. Researchers compared PhysioDirect with usual care in a randomised controlled trial.
The study led by Professor Chris Salisbury at the University of Bristol involved 2,256 patients aged 18 or over with musculoskeletal problems who were studied between July and December 2009: 1,513 to PhysioDirect and 743 to usual care. This study has been awarded by the Efficacy and Mechanism Evaluation (EME) Programme, which is funded by the Medical Research Council and managed by the National Institute for Health Research.
Almost half the PhysioDirect patients (711) were managed entirely by telephone. They also had fewer face-to-face appointments than those in usual care and fewer physiotherapy consultations of any type. The PhysioDirect patients also had a shorter wait for physiotherapy treatment (seven days versus 34 days) and were less likely to fail to attend appointments.
The study found that care based on PhysioDirect is equally clinically effective compared with usual care and provides faster access to advice and treatment. However, no evidence was found of improved patient satisfaction.
The authors say the fact that 47 per cent of PhysioDirect patients were managed entirely on the telephone, and were almost as satisfied with their consultations as usual care patients, shows that physiotherapists are able to provide assessments and advice by telephone in a way that is reasonably acceptable to patients.
The researchers conclude that PhysioDirect “is equally clinically effective compared with usual care, provides faster access to physiotherapy, and seems to be safe” but there is no evidence that it is associated with increased patient satisfaction.
Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
1. The Efficacy and Mechanism Evaluation programme supports later-phase “science-driven” clinical trials and evaluative studies, which seek to determine whether a health intervention (e.g. a drug, diagnostic technique or device) works and in some cases how or why it works.
2. The Efficacy and Mechanism Evaluation Programme (www.eme.ac.uk ) is funded by the MRC and NIHR, with contributions from the CSO in Scotland, NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland. It is managed by the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) based at the University of Southampton.
3. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).
4. The Medical Research Council is dedicated to improving human health through excellent science. It invests on behalf of the UK taxpayer. Its work ranges from molecular level science to public health research, carried out in universities, hospitals and a network of its own units and institutes. The MRC liaises with the Health Departments, the National Health Service and industry to take account of the public's needs. The results have led to some of the most significant discoveries in medical science and benefited the health and wealth of millions of people in the UK and around the world. www.mrc.ac.uk