TY - JOUR
T1 - Substitution of doctors with physiotherapists in the management of common musculoskeletal disorders
T2 - a systematic review
AU - Marks, Darryn
AU - Comans, Tracy
AU - Bisset, Leanne
AU - Scuffham, Paul A.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background There is large variation in models-of-care involving the professional substitution of doctors with physiotherapists. Objective To establish the impact upon patients and health services, of substituting doctors with physiotherapists in the management of common musculoskeletal disorders. Data sources Medline, CINAHL and ABI Complete databases, and hand-searching of related studies. Study selection Randomised and non-randomised clinical trials, inter-rater reliability and comparative studies comparing the outcomes of usual care from doctors, with outcomes when the doctor was substituted with a physiotherapist. Study appraisal and synthesis methods Two reviewers evaluated all studies using the Downs and Black Instrument. Meta-analysis was not possible due to study heterogeneity. A descriptive review was undertaken. Results 14 studies of moderate to low quality met the inclusion criteria. Professional substitution with a physiotherapist causes no significant change to health outcomes and inconsistent variation in the use of healthcare resources. There is insufficient health economic data to determine overall efficiency. In the selected presentations studied, physiotherapists made similar diagnostic and management decisions to orthopaedic surgeons and patients are as, or more satisfied with a physiotherapist. Limitations Further high quality health and economic research is needed, in less selective patient populations, to determine the optimal role for physiotherapists. Conclusion and implications of key findings Physiotherapists provide a professional alternative to doctors for musculoskeletal disorders but the health economic implications of this model are presently unclear. Systematic Review Registration Number PROSPERO (Registration number CRD42015027671).
AB - Background There is large variation in models-of-care involving the professional substitution of doctors with physiotherapists. Objective To establish the impact upon patients and health services, of substituting doctors with physiotherapists in the management of common musculoskeletal disorders. Data sources Medline, CINAHL and ABI Complete databases, and hand-searching of related studies. Study selection Randomised and non-randomised clinical trials, inter-rater reliability and comparative studies comparing the outcomes of usual care from doctors, with outcomes when the doctor was substituted with a physiotherapist. Study appraisal and synthesis methods Two reviewers evaluated all studies using the Downs and Black Instrument. Meta-analysis was not possible due to study heterogeneity. A descriptive review was undertaken. Results 14 studies of moderate to low quality met the inclusion criteria. Professional substitution with a physiotherapist causes no significant change to health outcomes and inconsistent variation in the use of healthcare resources. There is insufficient health economic data to determine overall efficiency. In the selected presentations studied, physiotherapists made similar diagnostic and management decisions to orthopaedic surgeons and patients are as, or more satisfied with a physiotherapist. Limitations Further high quality health and economic research is needed, in less selective patient populations, to determine the optimal role for physiotherapists. Conclusion and implications of key findings Physiotherapists provide a professional alternative to doctors for musculoskeletal disorders but the health economic implications of this model are presently unclear. Systematic Review Registration Number PROSPERO (Registration number CRD42015027671).
UR - http://www.scopus.com/inward/record.url?scp=85027175203&partnerID=8YFLogxK
U2 - 10.1016/j.physio.2016.11.006
DO - 10.1016/j.physio.2016.11.006
M3 - Review article
C2 - 28801031
AN - SCOPUS:85027175203
SN - 0031-9406
VL - 103
SP - 341
EP - 351
JO - Physiotherapy (United Kingdom)
JF - Physiotherapy (United Kingdom)
IS - 4
ER -