A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments.
To evaluate the effectiveness and cost effectiveness of specially trained physiotherapists in the assessment and management of defined referrals to hospital orthopaedic departments.
Design-Randomised controlled trial
Setting-Orthopaedic outpatient departments in two hospitals.
Subjects-481 patients with musculoskeletal problems referred for specialist orthopaedic opinion.
Interventions-Initial assessment and management undertaken by post-Fellowship junior orthopaedic surgeons, or by specially trained physiotherapists working in an extended role (orthopaedic physiotherapy specialists).
Main outcome measures-Patient centred measures of pain, functional disability and perceived handicap.
A total of 654 patients were eligible to join the trial, 481 (73.6%) gave their consent to be randomised.
The two arms (doctor n=244, physiotherapist n=237) were similar at baseline.
Baseline and follow up questionnaires were completed by 383 patients (79.6%). The mean time to follow up was 5.6 months after randomisation, with similar distributions of intervals to follow up in both arms.
The only outcome for which there was a statistically or clinically important difference between arms was in a measure of patient satisfaction, which favoured the physiotherapist arm.
A cost minimisation analysis showed no significant differences in direct costs to the patient or NHS primary care costs.
Direct hospital costs were lower (p<0. (...)
Mots-clés Pascal : Système ostéoarticulaire pathologie, Muscle strié pathologie, Service hospitalier, Orthopédie, Physiothérapie, Médecin, Epidémiologie, Analyse coût efficacité, Evaluation, Traitement, Homme, Economie santé, Essai thérapeutique contrôlé, Personnel sanitaire
Mots-clés Pascal anglais : Diseases of the osteoarticular system, Striated muscle disease, Hospital ward, Orthopedics, Physiotherapy, Physician, Epidemiology, Cost efficiency analysis, Evaluation, Treatment, Human, Health economy, Controlled therapeutic trial, Health staff
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0483721
Code Inist : 002B30A04B. Création : 22/03/2000.