Physiotherapists are clinically effective and cost effective at managing and treating patients with musculoskeletal disorders (MSDs)
Patients with MSDs are the largest patient population group treated by physiotherapists.
In 2010/11 in England, physiotherapy outpatient services managed 1.9 million adults with a first appointment and 4.8 million follow up appointments for MSDs.(1)
Rapid access to musculoskeletal physiotherapists can reduce the amount of time people are off sick and is vital in preventing a new acute problem becoming chronic and long lasting.(2)
Physiotherapists have pioneered innovative ways of providing speedy and appropriate access within existing services.
The Quality, Innovation, Productivity and Prevention (QIPP) process in England has endorsed self-referral for MSDs to allow easier access to treatment.(3) It has been shown to not increase demand for physiotherapy in the long term and also reduces patient related costs; such as prescribing, X-rays, MRI and more expensive medical consultations.(2)
A Department of Health pilot showed savings of £25,207 per 100,000 of population.(2) Holdsworth et al(4) demonstrated that in Scotland, an episode of GP prompted self referral costs 10% less and full patient self referral costs 25% less than traditional GP referral for physiotherapy.
The English pilot(2) showed 41% of referrals came from the traditional GP route, 35.4% came from prompted self referral and 23.6% were full self referral.
This shows the potential for greater cost savings for three quarters of patients with MSDs if full self referral were properly promoted.
Within the UK each year, up to 9% of adults see their GP about back pain.(5)
Some patients have a simple ache which will correct itself whilst
others will have a long standing pain. The evolution of ‘risk
stratication’, where patients are screened to identify the risks which
may affect their treatment outcome, allows patients to be directed to
the treatment pathway they need rather than applying a one size fits
Keele University demonstrated that the STarT Back Tool for neck and back patients was clinically and cost effective. Signicantly improved outcomes at four months and £34.39 saving per patient was shown when comparing the STarT Back intervention group with those who received usual care.(7)
The STarT Back method asks patients to fill out a questionnaire with the GP or physiotherapist. This identies whether the risks that may affect the treatment outcome are low, medium or high. The STarT Back questionnaire takes into account the patient’s symptoms, their perception of their pain as well as how it is affecting their life. Patients can then be directed to an appropriate treatment pathway based on this assessment. The pathway may include greater emphasis on self management for low risk patients or greater management of psychological distress for high risk patients.(7)
Musculoskeletal physiotherapists support self management.
Physiotherapists provide nationally or locally produced patient information booklets. GPs and other referrers should ask local physiotherapy services about self management tools which can be provided for suitable patients in primary care.
Providing self-management resources at an early stage can help avoid the need for referral to secondary care with its associated higher costs.
Speedy access to physiotherapy for people with MSDs is clinically and cost effective for the health service, for employers and society.
It prevents unnecessary GP and secondary care appointments as well as improving patients’ quality of life.