Telephone physiotherapy reduces treatment delays

By Lucy Piper, Senior medwireNews Reporter

Providing an initial physiotherapy assessment by telephone for patients with neuromusculoskeletal problems may help reduce waiting times, say UK researchers.

They assessed the effectiveness of the PhysioDirect telephone service and found that almost half of patients studied could be managed by telephone, reducing delays for initial treatment advice. It was as clinically effective as usual care and deemed to be safe.

However, despite reducing delays for physiotherapy, PhysioDirect did not improve patient satisfaction, and in fact overall satisfaction was slightly lower compared with usual care, the team notes in the British Medical Journal.

"In the future, PhysioDirect services will probably be provided more often in conjunction with direct access for patients to physiotherapists, rather than after referral from another healthcare professional, and PhysioDirect could be offered as a choice for patients wanting quicker advice rather than as the only route to care," said Chris Salisbury (University of Bristol) and colleagues.

The study involved 2256 patients aged at least 18 years who had been referred for physiotherapy. These patients were randomly assigned to receive either assessment via PhysioDirect (n=1513) or wait for a face-to-face appointment (usual care; n=743). Primary clinical outcome data at 6 months were available for 1283 and 629 patients, respectively.

Patients in the PhysioDirect group had fewer face-to-face appointments than those in the usual care group (average 1.9 vs 3.1) and fewer physiotherapy consultations of any type (2.9 vs 3.3). Indeed, 47% of patients in the PhysioDirect group were managed entirely on the telephone.

PhysioDirect was also associated with a significantly shorter wait for physiotherapy treatment, at an average of 7 days versus 34 days with usual care. This meant that patients were less likely to miss appointments, with a mean failure rate of 0.09 versus 0.12.

At 6 months, PhysioDirect and usual care were comparable in terms of the physical component score of the Short Form-36 (version 2) questionnaire, with average patient scores of 43.50 and 44.18, respectively.

The researchers conclude: "In view of the slight reduction in patient satisfaction, our results do not provide a compelling argument in favour of PhysioDirect."

But they add that the slightly earlier advice and treatment provided by the intervention mean that the service is likely to be more cost effective than usual care.

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