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Many patients with musculoskeletal pain in primary healthcare are referred to orthopaedic surgeon, however, a relatively low percentage of these patients are considered suitable for orthopaedic intervention.
Physiotherapists are suitable for musculoskeletal assessments and are used as such in many countries i.e. Advanced Practice Physiotherapists or Extended Scope Physiotherapists, however, this is not an existing model of care in Sweden. To be able to consider this model for implementation in Sweden it is necessary to evaluate it from a healthcare as well as from a patient perspective.
The study is a randomised controlled trial. Overall aim is to evaluate if a orthopaedic manual therapy assessment (physiotherapy) assessment of patients referred to orthopaedic surgeon bring any changes to referral routines, patient satisfaction and health-related variables when compared to standard practice.
The study is a randomised controlled trial. Overall aim is to evaluate if a orthopaedic manual therapy assessment (physiotherapy) assessment of patients referred to orthopaedic surgeon bring any changes to referral routines, patient satisfaction and health-related variables when compared to standard practice. Patients were randomised to either physiotherapy assessment or standard practice (orthopaedic surgeon assessment).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Physiotherapy screening | Experimental | Screening consisted of a 60-min appointment including assessment, diagnosis and management. The patients received advice regarding ergonomics, exercises and/or treatment when needed. Management options were;
|
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| Standard practice (orthopaedic surgeon) | Active Comparator | Appointment was 15 min, including assessment, diagnosis and management. The patients received advice, prescriptions or injections when needed. Management options were;
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Physiotherapy screening | Procedure | Physiotherapy screening. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Number of referrals after consultation as a measure of Management outcome | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Scores on the questionnaire Quality from the Patient Perspective as a measure of Patient satisfaction | 30 days | |
| Scores on the EuroQol-5D as a measure of Health-related quality of life | 12 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Maria Larsson, PhD | Närhalsan Research and development, Region of Västra Götaland | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24246908 | Result | Samsson K, Larsson ME. Physiotherapy screening of patients referred for orthopaedic consultation in primary healthcare - a randomised controlled trial. Man Ther. 2014 Oct;19(5):386-91. doi: 10.1016/j.math.2013.10.004. Epub 2013 Oct 29. | |
| 25088308 | Result | Samsson KS, Larsson ME. Physiotherapy triage assessment of patients referred for orthopaedic consultation - Long-term follow-up of health-related quality of life, pain-related disability and sick leave. Man Ther. 2015 Feb;20(1):38-45. doi: 10.1016/j.math.2014.06.009. Epub 2014 Jul 15. |
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| ID | Term |
|---|---|
| D059352 | Musculoskeletal Pain |
| ID | Term |
|---|---|
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
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| Standard practice |
| Procedure |
Orthopaedic surgeon assessment |
|
| Scores on the Pain Disability Index as a measure of Pain-related disability | 12 months |
| Number of sick-leave days | 12 months |
| Cost per quality adjusted life year (QUALY) gained as a measure of cost-utitily | QUALYs are calculated from the EuroQol-5D | 12 months |
| Scores on the Pain Belief Screening Instrument as a measure of risk for long-term disability | 12 months |
| 39757368 | Derived | Samsson KS, Bernhardsson S, Sandborgh M, Larsson MEH. The association between screened psychological risk for disability and appropriateness of orthopedic surgery in patients with musculoskeletal disorders - data from a Swedish RCT in primary care 2009-2011. Physiother Theory Pract. 2025 Aug;41(8):1579-1586. doi: 10.1080/09593985.2024.2448709. Epub 2025 Jan 5. |
| 27286829 | Derived | Samsson KS, Bernhardsson S, Larsson ME. Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial. BMC Musculoskelet Disord. 2016 Jun 10;17:257. doi: 10.1186/s12891-016-1112-x. |
| D012816 |
| Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |