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Physiotherapist as primary assessor for patients with suspected knee osteoarthritis in primary care-a randomised controlled pragmatic study

Journal article
Authors Chan-Mei Ho
Carina Thorstensson
Lena Margareta Nordeman
Published in Bmc Musculoskeletal Disorders
Volume 20
ISSN 1471-2474
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Language en
Links dx.doi.org/10.1186/s12891-019-2690-...
Keywords Delivery of health care, Disease management, Treatment outcome, Quality of life, Osteoarthritis, Knee, quality-of-life, health-care, joint replacement, controlled-trial, musculoskeletal disorders, eular recommendations, emergency-department, physical function, management, hip, Orthopedics, Rheumatology
Subject categories Rheumatology and Autoimmunity

Abstract

BackgroundIn Swedish primary care, the healthcare process for patients with knee osteoarthritis (KOA) can be initiated by a physician or physiotherapist assessment. However, it is unclear how the different assessments affect the healthcare processes and patient reported outcomes over time. The purpose of this study was to examine the differences in health-related quality of life (HrQoL), adjusted for pain and physical function, for patients with KOA when the healthcare process is initiated by a physiotherapist assessment compared to a physician assessment in primary care.MethodsAn assessor-blinded randomised controlled pragmatic trial. Using a computer-generated list of random numbers, patients seeking primary care during 2013-2017 with suspected KOA were randomised to either a physiotherapist or physician for primary assessment and treatment. Data was collected before randomisation and at 3, 6, and 12-month follow-ups. Primary outcome was HrQoL using EuroQol 5 dimensions 3 levels questionnaire, index (EQ-5D-3L index) and a visual analogue scale (VAS) (EQ-5D-3L VAS); pain intensity was measured with VAS (0-100) and physical function measured with the 30-s chair stand test. Mixed effect model analyses compared repeated measures of HrQoL between groups. The significance level was p<0.05 and data was applied with intention-to-treat.ResultsPatients were randomised to either a physiotherapist (n=35) or physician (n=34) for primary assessment. All 69 patients were included in the analyses. There were no significant differences in HrQoL for patients assessed by a physiotherapist or a physician as primary assessor (EQ-5D-3L index, p=0.18; EQ-5D-3L VAS, p=0.49). We found that HrQoL changed significantly 12months after baseline assessment for all patients regardless of assessor (EQ-5D-3L index, p<0.001; EQ-5D-3L VAS, p=0.0049). No adverse events or side effects were reported.ConclusionsThere were no differences in HrQoL, when adjusted for pain and physical function, for patients with KOA when the healthcare process was initiated with physiotherapist assessment compared to physician assessment in primary care. Both assessments resulted in significantly higher HrQoL at the 12-month follow-up. The results imply that physiotherapists and physicians in primary care are equally qualified as primary assessors.Trial registrationRetrospectively registered at http://clinicaltrial.gov, ID: NCT03715764.

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