Physiotherapist-led orthopaedic triage - assessment and management of musculoskeletal disorders in primary care

Abstract

The overall aim of this thesis was to evaluate physiotherapist-led orthopaedic triage of patients with musculoskeletal disorders in primary care in comparison to standard practice. The thesis comprises two studies (A and B) reported in four papers. Methods: Study A was a randomised controlled trial, where patients were randomised to either physiotherapist-led orthopaedic triage or standard practice (i.e. directly to orthopaedic surgeon consultation) with the aims; to evaluate selection accuracy for orthopaedic intervention (Paper I, n=203), to evaluate patients’ perceived quality of care (Paper II, n=163), and to report a long-term follow-up of the patient-reported out-comes (Paper III, n=203) with physiotherapist-led orthopaedic triage compared with standard practice. Study B was an exploratory qualitative study, with the aim to explore patients’ percep-tions and expectations of an upcoming orthopaedic consultation (Paper IV, n=13). Results: Study A showed that the selection accuracy was significantly higher, i.e. a significantly larger proportion of patients selected for orthopaedic surgeon consultation with physiotherapist-led orthopaedic triage was found appropriate for orthopaedic intervention compared with standard practice. Partic-ipants perceived significantly higher quality of care with physiotherapist-led orthopaedic triage than with standard practice. The long-term follow-up showed that the participants rated a signifi-cantly better health state three months after the physiotherapist-led orthopaedic triage, compared with standard practice; however, there were no other statistically significant differences in other patient-reported outcomes. The analysis in Study B resulted in five categories: Hoping for action, Meeting an expert, Having a respectful meeting, Participating in the consultation, and A belief that hard facts make evidence. Across the categories, an overarching theme was formulated: Take me seriously and do something! Conclusions: The findings in Study A suggest that physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders can provide timely access to assessment by an appropriately qualified healthcare professional who can direct patients to the most appropriate management pathway, and provide care with good perceived quality, without compromising long-term patient-reported outcomes. The main finding from Study B, that patients expect to be taken seriously and for something to happen during, or as a consequence, of the orthopaedic consultation, can serve to improve patient–clinician relationships and to inform the development of new models of care such as physiotherapist-led orthopaedic triage.