A pragmatic randomised controlled trial of ‘PhysioDirect’ telephone assessment and advice services for patients with musculoskeletal problems

The authors conducted this study to compare the cost-effectiveness of PhysioDirect with traditional physiotherapy care for patients with musculoskeletal problems. They evaluated cost-consequences comparing cost to the National Health Service (NHS), to patients, and the value of lost productivity with a range of outcomes and conducted a sost-utility analysis comparing cost to the NHS with Quality-Adjusted Life Years (QALYs). Adults (18+) who were referred by their general practitioner or referred themselves for physiotherapy. PhysioDirect involved telephone assessment and advice followed by face-to-face care if needed. Usual care patients were placed on a waiting list for face-to-face care. Their preliminary outcome measure was the physical component summary from the SF-36v2 at 6 months. In the cost-consequences they also included the measure Yourself Medical Outcomes Profile; a Global Improvement Score; response to treatment; patient satisfaction; waiting time. Outcome for the cost-utility analysis: QALYs. 2249 patients took part (1506 PhysioDirect; 743 usual care). Regarding cost-consequences there wasn’t any evidence of a difference between the two groups in the cost of physiotherapy, other NHS services, personal costs or value of time off work. Outcomes were also similar. Cost-utility analysis based on complete cases (n=1272). Total NHS costs, including the cost of physiotherapy were higher in the PhysioDirect group by £19.30 (95% CI -£37.60 to £76.19) and there was a QALY gain of 0.007 (95% CI -0.003 to 0.016). The incremental cost-effectiveness ratio was £2889 and the net monetary benefit at λ=£20 000 was £117 (95% CI -£86 to £310).


The authors concluded that PhysioDirect could be a cost-effective alternative to usual physiotherapy care, though only with attentiveness to the management of staff time. Adding that physiotherapists offering the service must be more fully occupied than was possible under trial conditions: consideration should be given to the scale of operation, opening times of the service and flexibility in the methods used to contact patients.

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