Triaging Patients With Musculoskeletal Disorders Directly to Physiotherapists at Primary Health Care Clinics.

The Effects of Triaging Patients With Musculoskeletal Disorders Directly to Physiotherapists at Primary Health Care Clinics: a Pilot Study and Randomized Controlled Trial.

The purpose of this study is to determine whether initial triaging to physiotherapists of patients with musculoskeletal disorders who seek health care from primary care clinics affects the patients health and/or health care utilization differently than initial consultation with a general practitioner.

Study Overview

• Status: Terminated
• Conditions: Musculoskeletal Disorders
• Intervention / Treatment: Other: Initially triaged to physiotherapist; Other: Initially triaged to physician

• Study Type: Interventional
• Enrollment (Actual): 55
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Gothenburg, Sweden, 417 64
    • Närhälsan Eriksberg Health centre
  • Gothenburg, Sweden, 418 33
    • Närhälsan Biskopsgården Health centre
  • Gothenburg, Sweden, 418 73
    • Närhälsan Kyrkbyn Health centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 67 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• seeking primary care clinic for musculoskeletal disorder
• age 16-67 years
• speaks enough Swedish or English to understand the patient information and complete the questionnaires
• triage nurse judges it suitable to triage participant to physiotherapist

Exclusion Criteria:

• has received treatment at the clinic by physician or physiotherapist during the preceding month for the same problem
• seeking for chronic musculoskeletal disorder with unchanged symptoms the latest 3 months and for which the patient has already tried physiotherapy
• seeking for help with medical aids other than crutches
• is in need of home care
• has been included in the study earlier

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Initially triaged to physiotherapist	Other: Initially triaged to physiotherapist
Active Comparator: Initially triaged to physician	Other: Initially triaged to physician

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of physician visits	1 year
Change in self-evaluated level of pain latest week (0-10 scale)	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of physiotherapist visits		1 year
Number of days of sick-leave		1 year
Number of referrals for external examinations and to specialists		1 year
Changes in health-related quality of life measured with EQ-5D		2 weeks
Changes in health-related quality of life measured with EQ-5D		3 months
Changes in health-related quality of life measured with EQ-5D		6 months
Changes in health-related quality of life measured with EQ-5D		1 year
Changes in attitudes regarding responsibility for musculoskeletal disorders measured with ARM scale		2 weeks
Changes in attitudes regarding responsibility for musculoskeletal disorders measured with ARM scale		3 months
Changes in attitudes regarding responsibility for musculoskeletal disorders measured with ARM scale		6 months
Changes in attitudes regarding responsibility for musculoskeletal disorders measured with ARM scale		1 year
Change in experience of functional difficulty measured with DRI scale		2 weeks
Change in experience of functional difficulty measured with DRI scale		3 months
Change in experience of functional difficulty measured with DRI scale		6 months
Change in experience of functional difficulty measured with DRI scale		1 year
Risk for developing chronic pain measured with the Örebro Musculoskeletal Pain Screening Questionnaire		2 weeks
Risk for developing chronic pain measured with the Örebro Musculoskeletal Pain Screening Questionnaire		3 months
Risk for developing chronic pain measured with the Örebro Musculoskeletal Pain Screening Questionnaire		6 months
Risk for developing chronic pain measured with the Örebro Musculoskeletal Pain Screening Questionnaire		1 year
Change in self-evaluated level of pain latest week (0-10 scale)		2 weeks
Change in self-evaluated level of pain latest week (0-10 scale)		6 months
Change in self-evaluated level of pain latest week (0-10 scale)		1 year
Prescriptions för analgesics for the actual musculoskeletal disorder	Received any prescriptions. Number of prescriptions. Number of occasions prescriptions were received. Type of prescription(s) received.	2 weeks
Prescriptions för analgesics for the actual musculoskeletal disorder	Received any prescriptions. Number of prescriptions. Number of occasions prescriptions were received. Type of prescription(s) received.	3 months
Prescriptions för analgesics for the actual musculoskeletal disorder	Received any prescriptions. Number of prescriptions. Number of occasions prescriptions were received. Type of prescription(s) received.	6 months
Prescriptions för analgesics for the actual musculoskeletal disorder	Received any prescriptions. Number of prescriptions. Number of occasions prescriptions were received. Type of prescription(s) received.	1 year

Collaborators and Investigators

• Sponsor: Göteborg University
• Collaborators: Närhälsan Primary care Research and Development
• Investigators: Principal Investigator: Lena Bornhöft, MSc, RPT, Göteborg University

Publications and helpful links

General Publications

• Bornhoft L, Thorn J, Svensson M, Nordeman L, Eggertsen R, Larsson MEH. More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment. BMC Musculoskelet Disord. 2019 May 1;20(1):186. doi: 10.1186/s12891-019-2553-9.

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2014
• Primary Completion (Actual): March 1, 2018
• Study Completion (Actual): March 1, 2019

Study Registration Dates

• First Submitted: August 15, 2014
• First Submitted That Met QC Criteria: August 15, 2014
• First Posted (Estimate): August 18, 2014

Study Record Updates

• Last Update Posted (Actual): April 26, 2019
• Last Update Submitted That Met QC Criteria: April 25, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases
• Other Study ID Numbers: 148611; VGFOUGSB-421881 (Other Grant/Funding Number: FoU primärvård Göteborg och Södra Bohuslän)