Physiotherapy Assessment of Patients Referred to Orthopaedic Surgeon

Study Overview
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Brief Summary
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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
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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).

Official Title
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Does Orthopaedic Manual Therapy Assessment of Patients Referred to Orthopaedic Surgeon Bring Any Changes to Referral Routines, Patient Satisfaction and Health-related Variables?

Conditions
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Musculoskeletal Pain

Intervention / Treatment
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* Procedure: Physiotherapy screening
* Procedure: Standard practice


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 67 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physiotherapy screening<br>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. | Procedure: Physiotherapy screening<br>* Physiotherapy screening.<br>|
| Active Comparator: Standard practice (orthopaedic surgeon)<br>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. | Procedure: Standard practice<br>* Orthopaedic surgeon assessment<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of referrals after consultation as a measure of Management outcome |  | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 
| Number of sick-leave days |  | 12 months | 
| Cost per quality adjusted life year (QUALY) gained as a measure of cost-utitily | QUALYs are calculated from the EuroQol-5D | 12 months | 
| Scores on the Pain Belief Screening Instrument as a measure of risk for long-term disability |  | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physiotherapy, Orthopaedic, Primary care