Physiotherapy screening of patients referred for orthopaedic consultation in primary healthcare

A substantial number of patients who consult primary healthcare for musculoskeletal pain are referred for orthopaedic consultation, but orthopaedic intervention is only suitable for a small number of these patients. Experienced physiotherapists have the appropriate knowledge to manage musculoskeletal disorders. The primary aim of this randomised study was therefore to assess a screening by a physiotherapist of patients referred for orthopaedic consultation compared to standard practice in primary care. Patients referred for orthopaedic consultation (n=203) were randomised to physiotherapy screening or standard practice. Selection accuracy for orthopaedic intervention and other referrals were analysed with proportion analysis. Patient views of the quality of care were analysed with Mann-Whitney U-test, waiting time with Independent t-test. There was higher selection accuracy for orthopaedic intervention in the physiotherapy screening group (p=0.002). A smaller number of patients in the screening group were referred back to their general practitioner (GP) (p<0.001) and a greater number to the physiotherapy clinic (p<0.001) compared to standard practice. The proportion of patients referred for further investigations was significantly lower in the physiotherapy screening group (p<0.039). Waiting time was shorter in the screening group (p<0.001). A large proportion of the patients reported no hesitation to attend the clinic for future care, no difference between the groups (p<0.95).

The findings in this study indicate that an experienced physiotherapist can screen patients referred for orthopaedic consultation effectively in primary healthcare.