Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies
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2020
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Samsson, K.S.
Grimmer, K.
Larsson, M.E.H.
Morris, J.
Bernhardsson, S.
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BMC Musculoskeletal Disorders, 2020; 21(1):1-20
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Background: Physiotherapist-led (PT-led) orthopaedic triage is an evolving model of care for patients withmusculoskeletal disorders. Objectives for this study were to establish the current evidence body on the impact ofPT-led orthopaedic triage on health, quality, and service outcomes for patients referred for orthopaedicconsultation, compared with standard (orthopaedic surgeon) care.
Methods: Medline, EMBASE, Scopus and CINAHL were searched from inception until 7 May 2018; search updated 24 April 2020. Search terms (including derivatives) included physiotherapy, advanced/extended scope,musculoskeletal/orthopaedic, triage. The search was framed as Population = patients referred for orthopaedic consultation; Intervention = PT-led orthopaedic triage; Comparison = standard care; Outcomes = health, quality and process outcomes. Only randomised controlled trials (RCTs) and prospective comparative cohort studies were eligible for inclusion. Screening, study selection, data extraction, and assessment of methodological quality were performed independently by reviewer pairs. Quality was scored with the Downs and Black checklist. Certainty of evidence was determined using GRADE. PROSPERO registration number CRD42017070950.
Results: We included two RCTs and eleven cohort studies (n = 1357 participants) of variable methodological quality(range 14–23 of possible 28). Certainty of evidence was low to moderate. There was no difference between PT-ledorthopaedic triage and standard care for patient-reported outcomes (two RCTs). Perceived quality of care with PT-ledorthopaedic triage was higher (two RCTs, four cohort studies) or equal (one cohort study) compared with standardcare. PT-led orthopaedic triage had higher surgery conversion rates (one RCT, three cohort studies) (55–91% vs 22–38%), lower (two RCTs) or equal rate (two cohort studies) of referral for investigations, shorter waiting times (one RCT,one cohort study), and lower costs (one RCT). Furthermore, there was high agreement between physiotherapists’ andorthopaedic surgeons’ treatment approach (eight cohort studies), referral for investigation (five cohort studies), anddiagnosis (nine cohort studies). Study limitations were the low number of RCTs, and variable methodological quality.
Conclusions: Evidence of low to moderate certainty suggests that PT-led orthopaedic triage leads to similar diagnostic decisions as standard care, has a higher conversion-to-surgery rate, reduces waiting times, is cost effective and valued by patients, and that health outcomes are equivalent.
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Copyright 2020 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, (https://creativecommons.org/licenses/by-nc/4.0/)