{"title":"肌肉骨骼疾病的首次接触物理治疗与常规初级保健的比较：随机对照试验的系统回顾和荟萃分析。","authors":"Bremen Abuhl, Dallas Ehrmantraut, Mitchell Wolden","doi":"10.1093/ptj/pzaf080","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>This study aims to enhance the care provided for patients with musculoskeletal disorders (MSKDs).</p><p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>The design was a systematic review and meta-analysis of randomized controlled trials.</p><p><strong>Setting: </strong>The study took a global perspective on FCPT compared to UPC for societal and clinical outcomes of patients with MSKDs.</p><p><strong>Participants: </strong>The study included patients presenting with MSKDs.</p><p><strong>Intervention(s) or exposure(s): </strong>FCPT was compared to UPC for patients with MSKDs.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Relevance: </strong>Health care organizations treating patients with MSKDs should consider integrating FCPTs to support primary care.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"First-Contact Physical Therapy Compared to Usual Primary Care for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.\",\"authors\":\"Bremen Abuhl, Dallas Ehrmantraut, Mitchell Wolden\",\"doi\":\"10.1093/ptj/pzaf080\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>This study aims to enhance the care provided for patients with musculoskeletal disorders (MSKDs).</p><p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>The design was a systematic review and meta-analysis of randomized controlled trials.</p><p><strong>Setting: </strong>The study took a global perspective on FCPT compared to UPC for societal and clinical outcomes of patients with MSKDs.</p><p><strong>Participants: </strong>The study included patients presenting with MSKDs.</p><p><strong>Intervention(s) or exposure(s): </strong>FCPT was compared to UPC for patients with MSKDs.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Relevance: </strong>Health care organizations treating patients with MSKDs should consider integrating FCPTs to support primary care.</p>\",\"PeriodicalId\":20093,\"journal\":{\"name\":\"Physical Therapy\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-06-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Physical Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ptj/pzaf080\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Physical Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ptj/pzaf080","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
重要性：本研究旨在提高对肌肉骨骼疾病（MSKDs）患者的护理。目的：本研究的目的是比较首次接触物理治疗（FCPT）和常规初级保健（UPC）对mskd患者的社会和临床结果的影响。设计：设计为随机对照试验的系统评价和荟萃分析。背景：该研究从全球角度比较了FCPT与UPC对mskd患者社会和临床结果的影响。参与者：该研究包括mskd患者。干预或暴露：比较FCPT和UPC对mskd患者的影响。主要结局和测量：评估社会结局，包括临床显像率、处方药率、费用，以及临床结局，包括疼痛、残疾和健康相关生活质量（HRQoL）。结果：纳入10项随机对照试验，样本量为2081例。极低到中等质量的证据表明，与UPC相比，FCPT患者获得了类似的优越的社会和临床结果。较低的临床显像率(RR = 0.55；95% CI = 0.45 ~ 0.68)和处方用药率(RR = 0.29；95% CI = 0.16 ~ 0.53)与FCPT相关。所有的影响都有利于FCPT，包括对成本的小影响(MD = -309.79；95% CI = -678.69 ~ 59.12)，对疼痛有中等效果(SMD = -0.75；95% CI = -1.57至0.06)，对残疾的影响可以忽略不计(SMD = -0.15；95% CI = -0.32 ~ 0.03)和HRQoL (SMD = -0.03；95% CI = -0.17 ~ 0.11)。结论：与UPC相比，FCPT可能降低临床显像率，并可能导致处方用药率的降低。FCPT可能导致残疾和HRQoL几乎没有差异。证据非常不确定FCPT对疼痛和成本的影响。所有结论都可以从中期来解释。相关性：治疗mskd患者的卫生保健组织应考虑将FCPTs纳入初级保健。
First-Contact Physical Therapy Compared to Usual Primary Care for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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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