- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT07788651
Video-based First-contact Physiotherapy in Primary Care (VIPP)
Video-based First-contact Consultation With a Physiotherapist in Primary Care for Patients With Musculoskeletal Symptoms
This study aims to evaluate the effects and implications of using video-based first-contact consultation in primary care physiotherapy, compared with traditional in-person consultation for musculoskeletal symptoms. The participants with musculoskeletal symptoms will receive either a video-based first contact physiotherapy consultation or an in-person first-contact physiotherapy consultation and will be followed for up to two years. The project addresses clinical effectiveness, healthcare utilisation, cost-effectiveness, and carbon footprint, according to the following specific aims.
Objectives
- To evaluate whether a video-based first-contact consultation with a physiotherapist is not clinically inferior to an in-person first-contact consultation, using the Patient-Specific Functional Scale (PSFS) as the primary outcome measure and multiple secondary outcomes assessed over time.
- To analyse healthcare utilisation in primary and specialist care at 12 and 24 months following a video-based first-contact consultation, compared with an in-person first contact consultation.
- To evaluate whether a video-based first-contact consultation with a physiotherapist is cost-effective from a healthcare perspective and in terms of environmental impact compared with an in-person first contact consultation.
Study Overview
Status
Conditions
Detailed Description
Background The digitalisation of health care has accelerated in recent years, driven by the World Health Organisation's Global Strategy on Digital Health. Musculoskeletal conditions include diseases and disorders affecting the joints, bones, muscles and related connective tissues. These conditions can affect multiple body areas or systems. Furthermore, the conditions are often characterised by pain and limitations in mobility and activities of daily living. Globally, musculoskeletal conditions are estimated to affect 1.7 billion people. Musculoskeletal conditions represent approximately two-thirds of all adults requiring rehabilitation. Physiotherapy plays a central role in the management and rehabilitation of musculoskeletal conditions. When provided as first-line primary care, physiotherapy has proven both efficient and cost-effective . Furthermore, video-based physiotherapy has been associated with improved attendance and adherence, factors that are critical for treatment effectiveness.
Video-based assessment in physiotherapy has been shown to be partially valid and reliable, but the methods remain poorly standardised, and the use of approaches and technical tools varies considerably. Overall, the evidence is limited, and existing descriptions are insufficient to support implementation in clinical practice. The transition to video-based care is described as a paradigm shift, and the profession expresses uncertainty regarding its effectiveness.
Despite the promising potential of digital health encounters, several challenges remain. A substantial proportion of patients initially assessed via video subsequently require in-person visits. Moreover, the therapeutic relationship may be affected by the video-based format. Taken together, these factors highlight an urgent need for robust, long-term evaluations of video-based first-contact physiotherapy.
Methods Study design A pragmatic randomised controlled trial (RCT) with a non-inferiority design will be conducted. The study will evaluate whether a video-based first-contact consultation with a physiotherapy yields outcomes that are not clinically inferior to those of a standard in-person first-contact physiotherapy consultation in primary care. The study will be reported in accordance with the CONSORT 2010 Statement for non-inferiority trials.
A non-inferiority analysis will be conducted, as the study aims to determine whether video-based first-contact physiotherapy consultation is not clinically inferior to an in-person first-contact physiotherapy. The analysis will use a predefined margin (∆) based on both statistical considerations and clinical judgement. The minimal clinically important difference and change for the PSFS was considered to define the non-inferiority margin. Previous literature reports that the minimal clinically important change for the PSFS ranges from approximately 1.3 and 2.3 points, depending on the diagnostic area. To ensure that any potential difference between groups is not clinically relevant, the non-inferiority margin has been set at ∆ = 1.5 points, which is also consistent with previous research in digital physiotherapy. The standard deviation (SD) will be set to 2, based on previous studies .
Sample size calculations based on the primary outcome variable PSFS, with ∆ = 1.5, indicate that 78 participants per group are required to achieve 80% statistical power with a one-sided alpha of 2.5%. Assuming a 25 % dropout rate, 104 participants will be included in each group, for a total of 208 participants.
Participant Selection and Recruitment Participants aged 18 years or older with musculoskeletal symptoms will be recruited. The study will be conducted at approximately six regional primary care rehabilitation units in Region Västra Götaland, Sweden, representing both geographic and demographic variation.
Potential participants will be identified through advertisement via social media, through posters and telephone. Potential participants will be screened to ensure that they meet the inclusion and exclusion criteria. They will receive written participant information digitally, will have the opportunity to ask questions, and will be offered verbal information. Informed consent will be obtained digitally.
Participants will be stratified by age, randomised, and scheduled for the type of consultation (video or in-person) corresponding to their allocated group with participating physiotherapist. All collected data will be handled in accordance with the principal investigator's data management procedures and applicable legislation.
Procedures The video-based first-contact consultation and the in-person first-contact consultation will be conducted within routine care. Participating physiotherapists will undergo approximately five hours of training in a structured model for conducting video-based physiotherapeutic assessments.
Participants will complete digital questionnaires before the first consultation, immediately after the first consultation, and at 6 weeks, 3 months, 6 months, and 12 months. The estimated time required to complete the digital questionnaires is approximately 10-20 minutes. Medical records and registry data will be collected in 6, 12 and 24 months.
Statistical Analysis The analyses will be conducted using IBM SPSS Statistics for Windows, (IBM Corp., Armonk, NY, USA). Descriptive statistics will be presented as means, standard deviations, and medians for continuous variables, and as frequencies for categorical variables.
Comparisons of improvement levels will be conducted using regression models, controlling for potential confounders (e.g., age, gender, trust). Comparisons of proportions showing improvement will be performed using a two-proportion Z-test. Exploratory analyses will be conducted to identify predictors of outcomes within the video consultation group.
For the health economic analysis, QALYs will be calculated from EQ-5D-5L data, and cost data will be obtained from healthcare registers and patient records. Incremental cost-effectiveness ratios (ICERs) will be calculated, with uncertainty analyses performed using bootstrapping and cost-effectiveness acceptability curves.
Estimates of carbon dioxide emissions will be performed from a life-cycle perspective, based on patient travel and estimates from the Swedish Transport Administration, healthcare utilisation based on estimates from the National Health Service in England, and the use of digital technology.
Comparisons between groups and over time will be conducted using appropriate parametric or non-parametric tests and regression models, depending on the characteristics of the data. Matched analyses will be applied where relevant.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Elvira Lange, PhD
- Phone Number: +46 764-95 61 23
- Email: elvira.m.lange@vgregion.se
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 18 years or older.
- Musculoskeletal complaints.
- Sufficient linguistic and cognitive ability to read, understand, and complete a web-based application form and provide informed consent in Swedish.
- Willing to attend the clinic in person.
Exclusion Criteria:
- Ongoing treatment for the current condition with planned follow-up by a physiotherapist.
- Lack of access to technology capable of supporting video consultations (e.g., smartphone, computer, or tablet).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Video-based first-contact physiotherapy
Participants receive a video-based first-contact physiotherapy consultation.
Following the first-contact consultation, participants will receive standard individualised physiotherapy treatment which falls outside the scope of the study.
|
Participants receive a video-based first-contact physiotherapy consultation.
Following the assessment, individualised standard physiotherapy treatment is provided as needed.
During the video-based assessment, participants will be in a setting of their choice and will meet a physiotherapist via video.
The physiotherapists will be trained in a structured model for conducting video-based physiotherapeutic assessments.
The rehabilitation clinic's standard platform for real-time audio and video healthcare visits will be used.
The estimated time will be approximately 30-45 minutes.
|
|
Active Comparator: Traditional in-person first-contact physiotherapy
Participants receive an in-person physiotherapy consultation at a primary care rehabilitation clinic.
Following the first-contact consultation, participants will receive standard individualised physiotherapy treatment which falls outside the scope of the study.
|
Participants receive an in-person physiotherapy consultation at a primary care rehabilitation clinic.
Following the assessment, individualised standard physiotherapy treatment is provided as needed.
The traditional in-person consultation will be conducted at a rehabilitation clinic within the public healthcare system in Region Västra Götaland.
The estimated time will be approximately 30-45 minutes.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Patient-Specific Functional Scale (PSFS) at 6 weeks
Time Frame: 6 weeks
|
Evaluates treatment outcomes by having the patient identify three activities limited by their condition and rate them on a scale from 0 to 10, where 0 = "unable to perform activity" and 10 = "able to perform activity at the same level as before injury or problem" (Stratford et al., 1995).
|
6 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Patient-Specific Functional Scale (PSFS) at baseline
Time Frame: Baseline
|
Evaluates treatment outcomes by having the patient identify three activities limited by their condition and rate them on a scale from 0 to 10, where 0 = "unable to perform activity" and 10 = "able to perform activity at the same level as before injury or problem" (Stratford et al., 1995).
|
Baseline
|
|
Patient-Specific Functional Scale (PSFS) at 3 months
Time Frame: 3 months
|
Evaluates treatment outcomes by having the patient identify three activities limited by their condition and rate them on a scale from 0 to 10, where 0 = "unable to perform activity" and 10 = "able to perform activity at the same level as before injury or problem" (Stratford et al., 1995).
|
3 months
|
|
Patient-Specific Functional Scale (PSFS) at 6 months
Time Frame: 6 months
|
Evaluates treatment outcomes by having the patient identify three activities limited by their condition and rate them on a scale from 0 to 10, where 0 = "unable to perform activity" and 10 = "able to perform activity at the same level as before injury or problem" (Stratford et al., 1995).
|
6 months
|
|
Patient-Specific Functional Scale (PSFS) at 12 months
Time Frame: 12 months
|
Evaluates treatment outcomes by having the patient identify three activities limited by their condition and rate them on a scale from 0 to 10, where 0 = "unable to perform activity" and 10 = "able to perform activity at the same level as before injury or problem" (Stratford et al., 1995).
|
12 months
|
|
Pain intensity using Numeric Rating Scale (NRS) at baseline
Time Frame: Baseline
|
Current pain is rated on a numeric scale from 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain (Hjermstad et al., 2011).
|
Baseline
|
|
Pain intensity using Numeric Rating Scale (NRS) at 6 weeks
Time Frame: 6 weeks
|
Current pain is rated on a numeric scale from 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain (Hjermstad et al., 2011).
|
6 weeks
|
|
Pain intensity using Numeric Rating Scale (NRS) at 3 months
Time Frame: 3 months
|
Current pain is rated on a numeric scale from 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain (Hjermstad et al., 2011).
|
3 months
|
|
Pain intensity using Numeric Rating Scale (NRS) at 6 months
Time Frame: 6 months
|
Current pain is rated on a numeric scale from 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain (Hjermstad et al., 2011).
|
6 months
|
|
Pain intensity using Numeric Rating Scale (NRS) at 12 months
Time Frame: 12 months
|
Current pain is rated on a numeric scale from 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain (Hjermstad et al., 2011).
|
12 months
|
|
Patient's Global Impression of Change (PGIC) at 6 weeks
Time Frame: 6 weeks
|
The Patient's Global Impression of Change (PGIC) assesses the patient's perception of change.
Patients rate their change since the start of treatment on a 7-point scale, where 1 indicates "very much improved" and 7 indicates "very much worse" (Hurst & Bolton, 2004).
|
6 weeks
|
|
Patient's Global Impression of Change (PGIC) at 3 months
Time Frame: 3 months
|
The Patient's Global Impression of Change (PGIC) assesses the patient's perception of change.
Patients rate their change since the start of treatment on a 7-point scale, where 1 indicates "very much improved" and 7 indicates "very much worse" (Hurst & Bolton, 2004).
|
3 months
|
|
Perceived quality of care, Quality from the Patient's Perspective (QPP) at day 1
Time Frame: Day 1
|
Perceived quality of care will be assessed using the Quality from the Patient's Perspective (QPP) questionnaire, which measure patients 'experiences of healthcare quality from the patient's perspective across several domains/factors medical-technical competence, physical-technical conditions identity-oriented approach, socio-cultural atmosphere.
Patients first rate their experience based on "this is how it was for me", which reflects the perceived reality.
They then rate "this is how important it was for me", corresponding to subjective importance.
Responses are provided using Likert scale.
(Wilde Larsson & Larsson).
|
Day 1
|
|
Perceived quality of care, Quality from the Patient's Perspective (QPP) at 6 weeks
Time Frame: 6 weeks
|
Perceived quality of care will be assessed using the Quality from the Patient's Perspective (QPP) questionnaire, which measure patients 'experiences of healthcare quality from the patient's perspective across several domains/factors medical-technical competence, physical-technical conditions identity-oriented approach, socio-cultural atmosphere.
Patients first rate their experience based on "this is how it was for me", which reflects the perceived reality.
They then rate "this is how important it was for me", corresponding to subjective importance.
Responses are provided using Likert scale.
(Wilde Larsson & Larsson).
|
6 weeks
|
|
Quality of life measured with EuroQol Dimensions - 5 Levels (EQ-5D-5L) at Baseline
Time Frame: Baseline
|
The EQ-5D-5L is a health-related quality of life instrument consisting of two parts.
The first part is a self-assessment of quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with each dimension rated on five levels of severity.
The second part is a rating using a visual analogue scale (VAS) from 0 to 100, where 0 represents the worst imaginable health and 100 represents the best imaginable health (EuroQol Research Foundation, n.d.).
|
Baseline
|
|
Quality of life measured with EuroQol Dimensions - 5 Levels (EQ-5D-5L) at 6 weeks
Time Frame: 6 weeks
|
The EQ-5D-5L is a health-related quality of life instrument consisting of two parts.
The first part is a self-assessment of quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with each dimension rated on five levels of severity.
The second part is a rating using a visual analogue scale (VAS) from 0 to 100, where 0 represents the worst imaginable health and 100 represents the best imaginable health (EuroQol Research Foundation, n.d.).
|
6 weeks
|
|
Quality of life measured with EuroQol Dimensions - 5 Levels (EQ-5D-5L) at 3 months
Time Frame: 3 months
|
The EQ-5D-5L is a health-related quality of life instrument consisting of two parts.
The first part is a self-assessment of quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with each dimension rated on five levels of severity.
The second part is a rating using a visual analogue scale (VAS) from 0 to 100, where 0 represents the worst imaginable health and 100 represents the best imaginable health (EuroQol Research Foundation, n.d.).
|
3 months
|
|
Quality of life measured with EuroQol Dimensions - 5 Levels (EQ-5D-5L) at 6 months
Time Frame: 6 months
|
The EQ-5D-5L is a health-related quality of life instrument consisting of two parts.
The first part is a self-assessment of quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with each dimension rated on five levels of severity.
The second part is a rating using a visual analogue scale (VAS) from 0 to 100, where 0 represents the worst imaginable health and 100 represents the best imaginable health (EuroQol Research Foundation, n.d.).
|
6 months
|
|
Quality of life measured with EuroQol Dimensions - 5 Levels (EQ-5D-5L) at 12 months
Time Frame: 12 months
|
The EQ-5D-5L is a health-related quality of life instrument consisting of two parts.
The first part is a self-assessment of quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with each dimension rated on five levels of severity.
The second part is a rating using a visual analogue scale (VAS) from 0 to 100, where 0 represents the worst imaginable health and 100 represents the best imaginable health (EuroQol Research Foundation, n.d.).
|
12 months
|
|
Work Ability Index (WAI) at Baseline
Time Frame: Baseline
|
Self-rated work ability will be measured with WAI.
Questionnaire consisting of a total 10 questions of seven items, sometimes only one question is used.
The index addresses demand of work, the worker's health status and resources (Illmarinen, 2007; Svenska WAI-nätverket, n.d.).
|
Baseline
|
|
Work Ability Index (WAI) at 6 weeks
Time Frame: 6 weeks
|
Self-rated work ability will be measured with WAI.
Questionnaire consisting of a total 10 questions of seven items, sometimes only one question is used.
The index addresses demand of work, the worker's health status and resources (Illmarinen, 2007; Svenska WAI-nätverket, n.d.).
|
6 weeks
|
|
Work Ability Index (WAI) at 3 months
Time Frame: 3 months
|
Self-rated work ability will be measured with WAI.
Questionnaire consisting of a total 10 questions of seven items, sometimes only one question is used.
The index addresses demand of work, the worker's health status and resources (Illmarinen, 2007; Svenska WAI-nätverket, n.d.).
|
3 months
|
|
Work Ability Index (WAI) at 6 months
Time Frame: 6 months
|
Self-rated work ability will be measured with WAI.
Questionnaire consisting of a total 10 questions of seven items, sometimes only one question is used.
The index addresses demand of work, the worker's health status and resources (Illmarinen, 2007; Svenska WAI-nätverket, n.d.).
|
6 months
|
|
Work Ability Index (WAI) at 12 months
Time Frame: 12 months
|
Self-rated work ability will be measured with WAI.
Questionnaire consisting of a total 10 questions of seven items, sometimes only one question is used.
The index addresses demand of work, the worker's health status and resources (Illmarinen, 2007; Svenska WAI-nätverket, n.d.).
|
12 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Demographic data
Time Frame: Baseline
|
Background information such as age, sex, level of education and occupation.
|
Baseline
|
|
General self-efficacy
Time Frame: Baseline
|
One question regarding participants general self-efficacy before the first-contact consultation (Di et al., 2023).
|
Baseline
|
|
Trust in digital care using Patient Trust Assessment Tool (PATAT)
Time Frame: Baseline
|
To measure trust in telemedicine the Patient trust Assessment Tool (PATAT) will be used.
PATAT is a self-reported instrument developed to measure patients' trust in healthcare services in the context of telemedicine or digital care.
The instrument consists of 25 items, where the patient rate statements on a five-point Likert scale ranging from disagree (1) to agree (5).
The questionnaire consisting of one question in each of five domains: trust in the healthcare organization, healthcare personnel, treatment, technology, and telemedicine (Van Velsen et al., 2017).
|
Baseline
|
|
Total travel time to the clinic
Time Frame: Day 1
|
Total travel time to the clinic for the participant's first-contact consultation, or the estimated travel time to the clinic where an in-person visit would otherwise have taken place in the case of a video consultation.
For participants receiving a video consultation, the travel time represents the time they would have spent travelling to an in-person consultation.
|
Day 1
|
|
Mode of transport to the clinic
Time Frame: Day 1
|
Mode of transport used to travel to the clinic for the participant's first-contact consultation.
For participants receiving a video consultation, the mode of transport they would have used to attend an in-person consultation will be recorded.
|
Day 1
|
|
Technology used for video consultation
Time Frame: Day 1
|
Type of technology used by the participant to conduct the video consultation.
|
Day 1
|
|
Consultation duration
Time Frame: Day 1
|
Duration of the physiotherapy first-contact consultation, measured in minutes.
|
Day 1
|
|
Administrative time
Time Frame: Day 1
|
Duration of administrative activities associated with the physiotherapy consultation, measured in minutes.
|
Day 1
|
|
Number of adverse events
Time Frame: Day 1
|
Number of adverse events occurring during the first-contact consultation.
|
Day 1
|
|
Physiotherapist-rated adherence to the structured approach
Time Frame: Day 1
|
Physiotherapists rate the extent to which they followed the structured approach taught during the study training using a 0-10 numerical rating scale, where 0 = strongly disagree and 10 = strongly agree.
|
Day 1
|
|
Physiotherapist-rated sufficiency of information to proceed with treatment
Time Frame: Day 1
|
Physiotherapists rate whether they obtained sufficient information from the first-contact consultation to proceed with treatment using a 0-10 numerical rating scale, where 0 = strongly disagree and 10 = strongly agree.
|
Day 1
|
|
Participant's areas of complaint
Time Frame: Day 1
|
The participant's area of complaint as recorded by the physiotherapist at the first-contact consultation.
|
Day 1
|
|
Visit information -obtained from the physiotherapists
Time Frame: Day 1
|
|
Day 1
|
|
Diagnostic code at the first-contact consultation
Time Frame: Approximately 6 months after study start
|
ICD-10 diagnosis code from the participant´s first-contact consultation with a physiotherapist at the rehabilitation clinic where the participant attended the first study visit.
These data will be collected after all participants have been enrolled.
|
Approximately 6 months after study start
|
|
Procedure codes (KVÅ) at the first-contact consultation
Time Frame: Approximately 6 months after study start
|
Procedure codes (KVÅ) from the participant´s first-contact consultation with a physiotherapist at the rehabilitation clinic where the participant attended the first study visit.
These data will be collected after all participants have been enrolled.
|
Approximately 6 months after study start
|
|
Number of previous rehabilitation visits
Time Frame: Approximately 6 months after study start
|
All visits and visit modalities at regional primary care rehabilitation clinics during the two years before the participant´s first visit in the study.
These data will be collected after all participants have been enrolled.
|
Approximately 6 months after study start
|
|
Number of physiotherapy visits during the current episode of care, at 12 months
Time Frame: Approximately 12 months after study start
|
All physiotherapy visits related to the current episode of care, including visit modality (digital or in-person), from study start up to 12 months.
|
Approximately 12 months after study start
|
|
Number of physiotherapy visits during the current episode of care, at 24 months
Time Frame: Approximately 24 months after study start
|
All physiotherapy visits related to the current episode of care, including visit modality (digital or in-person), from study start up to 24 months.
|
Approximately 24 months after study start
|
|
Number of other Healthcare contacts, 12 months
Time Frame: Approximately 12 after study start
|
All other healthcare contacts, including visit modality, within primary care, specialized outpatient care and inpatient care during the study period.
The data will cover the period from study start until 12 months after the participant´s first-contact consultation.
|
Approximately 12 after study start
|
|
Number of other Healthcare contacts, 24 months
Time Frame: Approximately 24 months after study start
|
All other healthcare contacts, including visit modality, within primary care, specialized outpatient care and inpatient care during the study period.
The data will cover the period from study start until 24 months after the participant´s first-contact consultation.
|
Approximately 24 months after study start
|
|
Total healthcare costs during 12 months
Time Frame: Approximately 12 months after study start
|
Information on healthcare costs associated with healthcare contacts recorded during the study period, to the extent that such information is available.
Total healthcare costs will be calculated based on the recorded healthcare contacts and applicable unit costs and will be used for health economic and cost-effectiveness analyses.
|
Approximately 12 months after study start
|
|
Total healthcare costs during 24 months
Time Frame: Approximately 24 months after study start
|
Information on healthcare costs associated with healthcare contacts recorded during the study period, to the extent that such information is available.
Total healthcare costs will be calculated based on the recorded healthcare contacts and applicable unit costs and will be used for health economic and cost-effectiveness analyses.
|
Approximately 24 months after study start
|
|
Number of physiotherapy visits related to the condition
Time Frame: 12 months
|
Physiotherapy records may be reviewed during study period and up to one year after the first consultation in order to capture whether the visits were related to the current episode of care and to describe the content of assessments and treatments.
The purpose is to ensure an accurate link between healthcare utilisation and the condition for which the participant is included in the study.
|
12 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Elvira Lange, PhD, Vastra Gotaland Region
Publications and helpful links
General Publications
- Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulative Physiol Ther. 2004 Jan;27(1):26-35. doi: 10.1016/j.jmpt.2003.11.003.
- Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S; European Palliative Care Research Collaborative (EPCRC). Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011 Jun;41(6):1073-93. doi: 10.1016/j.jpainsymman.2010.08.016.
- Abbott JH, Schmitt J. Minimum important differences for the patient-specific functional scale, 4 region-specific outcome measures, and the numeric pain rating scale. J Orthop Sports Phys Ther. 2014 Aug;44(8):560-4. doi: 10.2519/jospt.2014.5248. Epub 2014 May 14.
- Piaggio G, Elbourne DR, Pocock SJ, Evans SJ, Altman DG; CONSORT Group. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA. 2012 Dec 26;308(24):2594-604. doi: 10.1001/jama.2012.87802.
- Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018 May;27(5):1147-1157. doi: 10.1007/s11136-018-1798-3. Epub 2018 Feb 12.
- Wilde Larsson B, Larsson G. Development of a short form of the Quality from the Patient's Perspective (QPP) questionnaire. J Clin Nurs. 2002 Sep;11(5):681-7. doi: 10.1046/j.1365-2702.2002.00640.x.
- Horn KK, Jennings S, Richardson G, Vliet DV, Hefford C, Abbott JH. The patient-specific functional scale: psychometrics, clinimetrics, and application as a clinical outcome measure. J Orthop Sports Phys Ther. 2012 Jan;42(1):30-42. doi: 10.2519/jospt.2012.3727. Epub 2011 Oct 25.
- Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021 Dec 19;396(10267):2006-2017. doi: 10.1016/S0140-6736(20)32340-0. Epub 2020 Dec 1.
- Artandi MK, Stewart RW. The Outpatient Physical Examination. Med Clin North Am. 2018 May;102(3):465-473. doi: 10.1016/j.mcna.2017.12.008. Epub 2018 Mar 12.
- Bernhardsson S, Larsson A, Bergenheim A, Ho-Henriksson CM, Ekhammar A, Lange E, Larsson MEH, Nordeman L, Samsson KS, Bornhoft L. Digital physiotherapy assessment vs conventional face-to-face physiotherapy assessment of patients with musculoskeletal disorders: A systematic review. PLoS One. 2023 Mar 21;18(3):e0283013. doi: 10.1371/journal.pone.0283013. eCollection 2023.
- Bornhoft L, Larsson ME, Nordeman L, Eggertsen R, Thorn J. Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial. Ther Adv Musculoskelet Dis. 2019 Feb 15;11:1759720X19827504. doi: 10.1177/1759720X19827504. eCollection 2019.
- 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.
- De Sire, A., & Invernizzi, M. (2021). Musculoskeletal rehabilitation: State-of-the-art. Applied Sciences, 11(14), 6243. https://doi.org/10.3390/app11146243
- Di, W., Nie, Y., Chua, B. L., Chye, S., & Teo, T. (2023). Developing a single-item general self-efficacy measure. Journal of Psychoeducational Assessment, 41(6). https://doi.org/10.21203/rs.3.rs-342642/v1
- EuroQol Research Foundation. (n.d.). EQ-5D-5L. Retrieved April 20, 2026, from https://euroqol.org/information-and-support/euroqol-instruments/eq-5d-5l/
- Fernando, M., & Lange, E. (2025). New ways of working as a physiotherapist in the digital era: A qualitative study. Physiotherapy Practice and Research, 46(2), 103-110.
- FHVmetodik. (n.d.). Svenska WAI-nätverket. Retrieved April 20, 2026, from https://fhvmetodik.se/arbetsmiljo-sam/kartlaggning-arbetsformaga/arbetsformaga/wai/svenska-wai-natverket/
- Gerlinger C, Schmelter T. Determining the non-inferiority margin for patient reported outcomes. Pharm Stat. 2011 Sep-Oct;10(5):410-3. doi: 10.1002/pst.507. Epub 2011 Sep 19.
- Ilmarinen, J. (2007). The work ability index (WAI). Occupational Medicine, 57(2), 160. https://doi.org/10.1093/occmed/kqm008
- Lange E, Danielsson L. Reaching for connection: a qualitative study of communication and interaction in video-based physiotherapy. Physiother Theory Pract. 2024 Dec;40(12):2865-2876. doi: 10.1080/09593985.2023.2296574. Epub 2023 Dec 25.
- NHS England. (2016). The Sustainable Development Unit for NHS England and Public Health England. https://www.england.nhs.uk/2016/06/sustainable-development/
- Pathak A, Wilson R, Sharma S, Pryymachenko Y, Ribeiro DC, Chua J, Abbott JH. Measurement Properties of the Patient-Specific Functional Scale and Its Current Uses: An Updated Systematic Review of 57 Studies Using COSMIN Guidelines. J Orthop Sports Phys Ther. 2022 May;52(5):262-275. doi: 10.2519/jospt.2022.10727. Epub 2022 Feb 5.
- Rosengren J, Brodin N. Validity and reliability of the Swedish version of the Patient Specific Functional Scale in patients treated surgically for carpometacarpal joint osteoarthritis. J Hand Ther. 2013 Jan-Mar;26(1):53-60; quiz 61. doi: 10.1016/j.jht.2012.10.007. Epub 2012 Nov 26.
- Simmich J, Ross MH, Russell T. Real-time video telerehabilitation shows comparable satisfaction and similar or better attendance and adherence compared with in-person physiotherapy: a systematic review. J Physiother. 2024 Jul;70(3):181-192. doi: 10.1016/j.jphys.2024.06.001. Epub 2024 Jun 15.
- Stratford, P., Gill, C., Westaway, M., & Binkley, J. (1995). Assessing disability and change on individual patients: A report of a patient specific measure. Physiotherapy Canada, 47(4), 258-263. https://doi.org/10.3138/ptc.47.4.258
- Taccolini Manzoni AC, Bastos de Oliveira NT, Nunes Cabral CM, Aquaroni Ricci N. The role of the therapeutic alliance on pain relief in musculoskeletal rehabilitation: A systematic review. Physiother Theory Pract. 2018 Dec;34(12):901-915. doi: 10.1080/09593985.2018.1431343. Epub 2018 Feb 5.
- Trafikverket. (2018). Kapitel 6 emissionsfaktorer bilagor 2017, 2020-2030. I Handbok för vägtrafikens luftföroreningar.
- Velsen LV, Tabak M, Hermens H. Measuring patient trust in telemedicine services: Development of a survey instrument and its validation for an anticoagulation web-service. Int J Med Inform. 2017 Jan;97:52-58. doi: 10.1016/j.ijmedinf.2016.09.009. Epub 2016 Sep 23.
- Walin, M., Hansson, O., Bernhardsson, S., & Lange, E. (2025). Video-based musculoskeletal knee examination: A scoping review. JOSPT Open, 3(3), 263-276. https://doi.org/10.2519/josptopen.2025.0094
- Walsh NE, Halls S, Thomas R, Berry A, Liddiard C, Cupples ME, Gage H, Jackson D, Cramp F, Stott H, Kersten P, Jagosh J, Foster D, Williams P. First contact physiotherapy: an evaluation of clinical effectiveness and costs. Br J Gen Pract. 2024 Sep 26;74(747):e717-e726. doi: 10.3399/BJGP.2023.0560. Print 2024 Oct.
- Withers HG, Glinsky JV, Chu J, Jennings MD, Starkey I, Parmeter R, Boulos M, Cruwys JJ, Duong K, Jordan I, Wong D, Trang S, Duong M, Liu H, Hayes AJ, Lambert TE, Zadro JR, Sherrington C, Maher C, Lucas BR, Taylor D, Ferreira ML, Harvey LA. Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial. J Physiother. 2024 Apr;70(2):124-133. doi: 10.1016/j.jphys.2024.02.016. Epub 2024 Mar 16.
- World Health Organization. (2021). Global strategy on digital health 2020-2025. World Health Organization.
- World Health Organization. (2022, July 14). Musculoskeletal conditions. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- VIPP
- 2025 (U.S. NIH Grant/Contract: Faculty of Social Sciences Scientific Grant at the University of Gdańsk)
- 2025-07915 (Other Grant/Funding Number: Swedish Research Council)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.