Qualitative Analysis of Physiotherapy Prescriptions From Primary Physicians for Patients With Back Musculoskeletal Disorders
Condition: Back Musculoskeletal Disorders
MeSH terms: Musculoskeletal Diseases
Study type: Observational

Summary: 
      "Prescription in France is a major act of medical activity and must be in accordance with the
      scientific evidence. The use of physiotherapy by primary physicians is becoming more and more
      frequent and involves the performance of a prescription given to the patients so that they
      can access to their care. The optimization of the use of this treatment is based on the
      respect of several legal and regulatory provisions allowing physiotherapists (PT) to offer
      the most appropriate treatment to the patient. Although these professionals can carry out a
      physiotherapy diagnosis and the objectives of care, as well as the choice of the acts and the
      techniques which seem to them the most appropriate. The performance of their treatment
      remains conditioned by the indication to physiotherapy and the anatomical region formulated
      by the prescription of the primary physicians. Primary physicians don't have the right to
      include their diagnostic hypothesis on the physiotherapy prescription. Therefore, they could
      transmit to the PT a supplementary report including all useful information for the PT which
      could influence the progress of the treatment.

      It has been reported a frequent absence of diagnostic hypothesis formulated by the primary
      physicians to the PT to justify the indication to these treatment with the prescription.
      However, PT are led to formulate one or more diagnostic hypothesis following their clinical
      assessment. This can lead to questioning the interest of prescription for referring the
      patient from the primary physician to the PT.

      The qualitative study by Panchout et al shows that 97.8% of the french private
      physiotherapists included treat patients with musculoskeletal disorders and 95.5% received
      those with back disorders. Back musculoskeletal disorders are the most common conditions
      reported from french private PT.

      No French study has yet analyzed the quality of prescriptions formulated by primary
      physicians for private physiotherapists. Much foreign health systems have a different model
      of access to physiotherapy services compared to the French system, involving direct access
      physiotherapy for patients with musculoskeletal disorders. This care pathway gives patients
      the ability to refer themselves directly to a PT without having to see another health
      professional. Patients do not need a prescription in this model of access to physiotherapy
      care to use it.

      Thus, in order to optimize the relevance of the use of physiotherapy for patients with back
      musculoskeletal disorders, we propose a prospective and cross-sectional observational study
      of 60 physiotherapists. The first aim of this study is to assess the relevance of the
      physiotherapy indication from primary care physicians for patients with back musculoskeletal
      disorders and consulting physiotherapists.
    

Detailed description: 
      The main objective is to describe the contents of the documents transmitted by the primary
      physician to the physiotherapists relating to the physiotherapy management of patients with
      back musculoskeletal disorders, as well as their conformity with the results of the initial
      assessment of the physiotherapist.

      The secondary objective is to evaluate the influence of the sociodemographic characteristics
      concerning the presence or the absence of diagnostic hypothesis on the primary physician
      documents transmitted to the physiotherapist.

      The research is broken down into 9 steps:

        1. Physiotherapists practicing in France will be randomly selected from the list of
           registered members of the National Regulatory Authority of Physiotherapists and drawn by
           region to obtain a representative selection of territories of these professionals,

        2. The sending of patients medical records indicated to the physiotherapy for the
           management of a musculoskeletal condition whose prescription has been carried out by a
           primary physician will start from the first contacted physiotherapist who has agreed to
           participate in the study,

        3. Each of the 60 physiotherapists contacted and who have agreed to participate in the
           study will meet face-to-face about the progress of the project and the anonymization of
           the files,

        4. Physiotherapists will be asked to provide 5 medical records of patients each. The file
           may include: the prescription of physiotherapy given to the patient by the primary
           physician and / or any associated medical report transmitted to the physiotherapist by
           the primary physician before the start of treatment,

        5. To avoid selection bias, physiotherapists will collect patient data, not opposing their
           participation in the study, presenting themselves consecutively with a first
           prescription of physiotherapy,

        6. Each physiotherapist will have to anonymise on the documents: first and last name and
           contact information of the prescribing physician as well as the first name and the last
           name of the patient appearing on the prescription and associated reports. Each
           physiotherapist will be assigned a number (1, 2, 3, etc ...), similarly for primary
           physicians who prescribed physiotherapy to patients the consultant and the patients seen
           in consultation.

      The statistical analysis will be carried out at the end of the study using SAS v9.3® Software
      under the responsibility of the clinical research unit.

      Qualitative data will be expressed as numbers (percentage). Percentage comparisons with a
      Chi2 test (prescriptions without diagnostic hypothesis compared to prescriptions with
      diagnostic hypothesis) on the factors studied as being able to influence this criteria will
      be made. Comparisons of means with a non-parametric Kruskal-Wallis (or Wilcoxon) test will be
      performed.
    

Intervention name(s): qualitative analysis
Intervention type(s): Other
Intervention description(s): Qualitative analysis of physiotherapy prescriptions
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients with back musculoskeletal disorders
      
Keywords: Musculoskeletal disorders; Physician; Physiotherapy; Referral