Re: Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial
In Jonathan Field’s response, he promotes the stratified care tool for back pain that our team at the Arthritis Research UK Primary Care Centre at Keele developed and validated (the STarT Back tool; Hill et al 2008; Hill et al 2011). This tool was developed for use with low back pain patients in primary care, whereas the target population in the PhysioDirect trial was adults with any musculoskeletal pain problem, rather than back pain only. Whilst our team plan to validate a tool for a wider group of musculoskeletal pain patients, such as tool is not yet currently available.
Mr Field also makes the argument that GPs should triage or stratify patients
and only refer patients to physiotherapy if they need face to face care. In reality, we know this does not happen in a systematic fashion and the evidence suggests that patients benefit from advice from a physiotherapist. The PhysioDirect trial shows this can be delivered for many people by phone. It doesn't mean that GPs would necessarily have the skills or time to give equally effective advice.
The trial design did not favour those happy to receive advice alone. All eligible adults were invited to take part and it was clear to patients that PhysioDirect was a package of care, incorporating assessment, advice and treatment. In PhysioDirect, patients who needed face to face care were able to receive it.
The demand for physiotherapy is increasing year on year. Physiotherapy services are doing their best to meet this demand despite many services carrying vacancies. Innovative services such as PhysioDirect as tested in this trial can help to meet this demand.
Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, Hay EM. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum, 2008;59(5):632-41.
Hill JC, Whitehurst DGT, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet, 2011; 378:1560–1571.
Competing interests: One of the authors of both the PhysioDirect trial and the STarT Back screening tool.