First-Contact Physical Therapy Compared to Usual Primary Care for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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引用次数: 0
Abstract
Importance: This study aims to enhance the care provided for patients with musculoskeletal disorders (MSKDs).
Objective: The objective of this study is to compare first-contact physical therapy (FCPT) and usual primary care (UPC) for societal and clinical outcomes of patients with MSKDs.
Design: The design was a systematic review and meta-analysis of randomized controlled trials.
Setting: The study took a global perspective on FCPT compared to UPC for societal and clinical outcomes of patients with MSKDs.
Participants: The study included patients presenting with MSKDs.
Intervention(s) or exposure(s): FCPT was compared to UPC for patients with MSKDs.
Main outcomes and measures: Societal outcomes including clinical imaging rates, prescription medication rates, cost, and clinical outcomes including pain, disability, and health-related quality of life (HRQoL) were assessed.
Results: Ten randomized controlled trials were included with a sample size of 2081 patients. Very low to moderate quality of evidence showed patients achieved similar to superior societal and clinical outcomes with FCPT compared to UPC. Lower clinical imaging rates (RR = 0.55; 95% CI = 0.45 to 0.68) and prescription medication rates (RR = 0.29; 95% CI = 0.16 to 0.53) were associated with FCPT. All effects favored FCPT, including a small effect for cost (MD = -309.79; 95% CI = -678.69 to 59.12), a medium effect for pain (SMD = -0.75; 95% CI = -1.57 to 0.06), and negligible effects for disability (SMD = -0.15; 95% CI = -0.32 to 0.03) and HRQoL (SMD = -0.03; 95% CI = -0.17 to 0.11).
Conclusions: When compared to UPC, FCPT is likely to reduce clinical imaging rates, and may result in a reduction of prescription medication rates. FCPT may result in little to no difference in disability and HRQoL. Evidence is very uncertain about the effect of FCPT on pain and cost. All conclusions can be interpreted for the medium term.
Relevance: Health care organizations treating patients with MSKDs should consider integrating FCPTs to support primary care.
期刊介绍：
Physical Therapy (PTJ) engages and inspires an international readership on topics related to physical therapy. As the leading international journal for research in physical therapy and related fields, PTJ publishes innovative and highly relevant content for both clinicians and scientists and uses a variety of interactive approaches to communicate that content, with the expressed purpose of improving patient care. PTJ"s circulation in 2008 is more than 72,000. Its 2007 impact factor was 2.152. The mean time from submission to first decision is 58 days. Time from acceptance to publication online is less than or equal to 3 months and from acceptance to publication in print is less than or equal to 5 months.
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