Physiotherapy Assessment of Patients Referred to Orthopaedic Surgeon

Not Applicable

Completed

• Conditions: Musculoskeletal Pain
• Interventions: Procedure: Physiotherapy screening; Procedure: Standard practice

• Registration Number: NCT02265172
• Lead Sponsor: Vastra Gotaland Region

Brief Summary

Many patients with musculoskeletal pain in primary healthcare are referred to orthopaedic surgeon, however, a relatively low percentage of these patients are considered suitable for orthopaedic intervention.

Physiotherapists are suitable for musculoskeletal assessments and are used as such in many countries i.e. Advanced Practice Physiotherapists or Extended Scope Physiotherapists, however, this is not an existing model of care in Sweden. To be able to consider this model for implementation in Sweden it is necessary to evaluate it from a healthcare as well as from a patient perspective.

The study is a randomised controlled trial. Overall aim is to evaluate if a orthopaedic manual therapy assessment (physiotherapy) assessment of patients referred to orthopaedic surgeon bring any changes to referral routines, patient satisfaction and health-related variables when compared to standard practice.

Detailed Description

The study is a randomised controlled trial. Overall aim is to evaluate if a orthopaedic manual therapy assessment (physiotherapy) assessment of patients referred to orthopaedic surgeon bring any changes to referral routines, patient satisfaction and health-related variables when compared to standard practice. Patients were randomised to either physiotherapy assessment or standard practice (orthopaedic surgeon assessment).

Study Timeline

• Study Start: 2009-08
• Primary Completion: 2011-01
• Study Completion: 2012-01
• Status Verified: 2014-09
• Study First Submitted: 2014-10-06
• Study First Submitted QC: 2014-10-09
• Study First Posted: 2014-10-15
• Last Update Submitted: 2014-10-24
• Last Update Posted: 2014-10-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 208

Inclusion Criteria

• patients referred for orthopaedic surgeon with sub acute (four weeks to three months) or chronic (>three months) musculoskeletal pain who had the ability to understand written and spoken Swedish.

Exclusion Criteria

• diagnosed hallux valgus, ganglion or trigger finger.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Physiotherapy screening	Physiotherapy screening	Screening consisted of a 60-min appointment including assessment, diagnosis and management. The patients received advice regarding ergonomics, exercises and/or treatment when needed. Management options were; * Referral for orthopaedic surgeon consultation. * Referral back to the patient's General Practitioner. * Referral for further investigation. * Referral to the physiotherapy or the occupational therapy clinic.
Standard practice (orthopaedic surgeon)	Standard practice	Appointment was 15 min, including assessment, diagnosis and management. The patients received advice, prescriptions or injections when needed. Management options were; * Referral for orthopaedic intervention. * Referral back to the patient's General Practitioner. * Referral for further investigation. * Referral to the physiotherapy or the occupational therapy clinic.

Primary Outcome Measures

Name	Time	Method
Number of referrals after consultation as a measure of Management outcome	12 months

Secondary Outcome Measures

Name	Time	Method
Number of sick-leave days	12 months
Scores on the questionnaire Quality from the Patient Perspective as a measure of Patient satisfaction	30 days
Scores on the EuroQol-5D as a measure of Health-related quality of life	12 months
Scores on the Pain Disability Index as a measure of Pain-related disability	12 months
Cost per quality adjusted life year (QUALY) gained as a measure of cost-utitily	12 months	QUALYs are calculated from the EuroQol-5D
Scores on the Pain Belief Screening Instrument as a measure of risk for long-term disability	12 months