A pragmatic randomised controlled trial of PhysioDirect telephone assessment and advice services for physiotherapy
Lead Research Organisation:
University of Bristol
Department Name: Community-Based Medicine
Abstract
Muscular and joint problems are a major cause of illness, and lead to a large number of consultations with GPs. Many of these patients are referred to physiotherapy, with more than 4 million new referrals each year. The NHS has always struggled to meet the demand for physiotherapy, with waiting times of several months in many areas. During this time patients experience pain and disability and may be off work. However physiotherapy is not always helpful, so some patients experience long waits for treatment which is unlikely to be effective, while others wait for treatment which would have been more effective if delivered earlier.
In an attempt to overcome these problems, several areas have introduced telephone assessment and advice services for physiotherapy. Following the telephone assessment, patients are sent written advice by post and invited for face-to-face treatment only when necessary. These services, often known as PhysioDirect, have received awards from NHS organisations, but evidence about their costs and benefits is lacking. Good research is needed before PhysioDirect services become widespread.
This proposal is for a trial which compares PhysioDirect and usual waiting-list based care. We want to test the idea that PhysioDirect is at least as effective and provides equally good results at lower cost compared with usual face-to-face care, while also providing faster access to care and greater patient satisfaction. PhysioDirect services will be established in four PCT areas, each serving at least 25 general practices. When patients are referred by GPs for physiotherapy we will invite them to take part. Those that agree will be randomly allocated to receive either PhysioDirect or usual care. We will compare the two types of service in terms of whether patients? symptoms improved, the cost of the services, waiting times for advice or treatment, time lost from work or usual activities, satisfaction with care and which type of care patients prefer.
Using interviews with patients and staff we will examine factors associated with the success (or failure) of the service, the acceptability of PhysioDirect to patients and staff, and ways in which the service could be improved.
This trial will provide evidence to support or refute the widespread introduction of PhysioDirect. If it achieves the benefits in terms of improved effectiveness and efficiency, as well as improved convenience and satisfaction for patients, which are claimed by early PhysioDirect sites then the potential advantages for patients and the NHS are considerable.
In an attempt to overcome these problems, several areas have introduced telephone assessment and advice services for physiotherapy. Following the telephone assessment, patients are sent written advice by post and invited for face-to-face treatment only when necessary. These services, often known as PhysioDirect, have received awards from NHS organisations, but evidence about their costs and benefits is lacking. Good research is needed before PhysioDirect services become widespread.
This proposal is for a trial which compares PhysioDirect and usual waiting-list based care. We want to test the idea that PhysioDirect is at least as effective and provides equally good results at lower cost compared with usual face-to-face care, while also providing faster access to care and greater patient satisfaction. PhysioDirect services will be established in four PCT areas, each serving at least 25 general practices. When patients are referred by GPs for physiotherapy we will invite them to take part. Those that agree will be randomly allocated to receive either PhysioDirect or usual care. We will compare the two types of service in terms of whether patients? symptoms improved, the cost of the services, waiting times for advice or treatment, time lost from work or usual activities, satisfaction with care and which type of care patients prefer.
Using interviews with patients and staff we will examine factors associated with the success (or failure) of the service, the acceptability of PhysioDirect to patients and staff, and ways in which the service could be improved.
This trial will provide evidence to support or refute the widespread introduction of PhysioDirect. If it achieves the benefits in terms of improved effectiveness and efficiency, as well as improved convenience and satisfaction for patients, which are claimed by early PhysioDirect sites then the potential advantages for patients and the NHS are considerable.
Technical Summary
Musculoskeletal problems are a major cause of morbidity in the population and a leading cause of days lost from work. They account for 15% of all consultations with GPs. Many of these patients are referred to physiotherapy, with more than 4 million new referrals to physiotherapy each year. Providing timely access to physiotherapy is a long-standing problem for the NHS, with waiting times of several months in many areas. During this time patients experience pain and disability and may be unable to return to work. The value of physiotherapy varies for different conditions, so some patients experience long waits for treatment which is unlikely to be effective, while others wait for treatment which would have been more effective if delivered earlier.
In an attempt to overcome these problems, several areas have introduced telephone assessment and advice services for physiotherapy, based on computerised algorithms. Following the telephone assessment, patients are sent tailored written advice by post and invited for face-to-face treatment only when necessary. These services, often known as PhysioDirect, have been commended by NHS bodies but evidence about effectiveness, cost-effectiveness and acceptability are lacking. Robust research is needed before PhysioDirect services become widespread.
This proposal is for a pragmatic individually randomised trial comparing PhysioDirect with usual waiting-list based care. The hypothesis is that PhysioDirect will be equally effective and more cost-effective than usual care, while also providing faster access to care and greater patient satisfaction. PhysioDirect services will be newly established in four PCT areas, each serving at least 25 general practices. We will recruit patients referred by GPs for physiotherapy and randomise them individually, stratified by physiotherapy service, age and presenting problem. The primary outcome is clinical improvement; secondary outcomes include cost, waiting times, time lost from work and usual activities, patient satisfaction and preference. We will explore the impact of PhysioDirect on patients in different age-groups and with different conditions.
Using qualitative methods we will examine factors associated with the success or failure of the service, the acceptability of PhysioDirect to patients and staff, and ways in which the service could be improved.
This trial will provide evidence to support or refute the widespread introduction of PhysioDirect throughout the NHS. If it achieves the benefits in terms of improved effectiveness and efficiency, as well as improved access and satisfaction for patients, which are claimed by early PhysioDirect sites then the potential advantages for patients and the NHS are considerable.
In an attempt to overcome these problems, several areas have introduced telephone assessment and advice services for physiotherapy, based on computerised algorithms. Following the telephone assessment, patients are sent tailored written advice by post and invited for face-to-face treatment only when necessary. These services, often known as PhysioDirect, have been commended by NHS bodies but evidence about effectiveness, cost-effectiveness and acceptability are lacking. Robust research is needed before PhysioDirect services become widespread.
This proposal is for a pragmatic individually randomised trial comparing PhysioDirect with usual waiting-list based care. The hypothesis is that PhysioDirect will be equally effective and more cost-effective than usual care, while also providing faster access to care and greater patient satisfaction. PhysioDirect services will be newly established in four PCT areas, each serving at least 25 general practices. We will recruit patients referred by GPs for physiotherapy and randomise them individually, stratified by physiotherapy service, age and presenting problem. The primary outcome is clinical improvement; secondary outcomes include cost, waiting times, time lost from work and usual activities, patient satisfaction and preference. We will explore the impact of PhysioDirect on patients in different age-groups and with different conditions.
Using qualitative methods we will examine factors associated with the success or failure of the service, the acceptability of PhysioDirect to patients and staff, and ways in which the service could be improved.
This trial will provide evidence to support or refute the widespread introduction of PhysioDirect throughout the NHS. If it achieves the benefits in terms of improved effectiveness and efficiency, as well as improved access and satisfaction for patients, which are claimed by early PhysioDirect sites then the potential advantages for patients and the NHS are considerable.
