Substitution of doctors with physiotherapists in the management of common musculoskeletal disorders: a systematic review

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Marks, Darryn
Comans, Tracy
Bisset, Leanne
Scuffham, Paul A
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Background: There is large variation in models-of-care involving the professional substitution of doctors with physiotherapists. Objective To establish the impact upon patients and health services, of substituting doctors with physiotherapists in the management of common musculoskeletal disorders. Data sources: Medline, CINAHL and ABI Complete databases, and hand-searching of related studies. Study selection Randomised and non-randomised clinical trials, inter-rater reliability and comparative studies comparing the outcomes of usual care from doctors, with outcomes when the doctor was substituted with a physiotherapist. Study appraisal and synthesis methods Two reviewers evaluated all studies using the Downs and Black Instrument. Meta-analysis was not possible due to study heterogeneity. A descriptive review was undertaken. Results: 14 studies of moderate to low quality met the inclusion criteria. Professional substitution with a physiotherapist causes no significant change to health outcomes and inconsistent variation in the use of healthcare resources. There isinsufficient health economic data to determine overall efficiency. In the selected presentations studied, physiotherapists made similar diagnostic and management decisions to orthopaedic surgeons and patients are as, or more satisfied with a physiotherapist. Limitations: Further high quality health and economic research is needed, in less selective patient populations, to determine the optimal role for physiotherapists. Conclusion and implications of key findings: Physiotherapists provide a professional alternative to doctors for musculoskeletal disorders but the health economic implications of this model are presently unclear.

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