TABLE 3 -.
Summary of systematic reviews (n = 5)
| First author (year of publication) | Patient perspective | Physiotherapist perspective | Societal perspective |
|---|---|---|---|
| Ojha et al (2014) (20) | Significantly less average pain was reported in DA. (VAS decreased from 5.7 to 2.7 vs. from 5.7 before treatment to 3.2 after treatment; p = 0.011.)
Higher improvement in function in DA (79% vs. 60%; p = 0.04). Higher levels of satisfaction in DA (79%-93.2% vs. 74%-84.1%; p < 0.01). DA PT is not related to any adverse events (p>0.05). |
/ | Lower costs for radiological examinations in DA PT (5.1%-13.6%; p = NR)/(4.00 vs. 7.43; p < 0.01).
Significantly fewer medication prescribed in DA PT (32.2%-48% vs. 44.1%-84%; p < 0.01). Significantly less PT visits in DA PT (5.9-20.2 vs. 7.0-33.6; p < 0.01). Decreased cost in DA (£9.55-$14.83 vs. £47.94-$63.65; p < 0.01). Mean number of days of work missed was significantly less in DA PT (10.4 vs. 27.9 days: p = NR). |
| Piscitelli et al (2018) (18) |
No significant difference between GP referral and DA PT in terms of pain reduction (64.6% vs. 66.6%; p = 0.76). DA PT has better clinical outcomes in terms of function and health-related QoL (self-reported questionnaires: 2.4 ± 2.8 vs. 4.1 ± 4.6; p = 0.03). DA PT is not related to any adverse events (p>0.05). |
DA PT provides greater treatment compliance (76%-79% vs. 58%-69%; p = 0.004). |
DA PT reduces waiting time and improves accessibility of PT (5-6 vs. 9-69 days; p < 0.001). DA PT leads to less medical imaging ($44 ± 190 vs. $175 ± 541; p < 0.01)/(47 vs. 242 patients; p < 0.001). DA PT leads to less prescribed medication ($36-163 vs. $78-873; p < 0.01)/(62-79 vs. 219-276 patients; p < 0.001). |
| Demont et al (2021) (19) |
No significant difference between DA and physician-led usual medical care for pain but tendencies to positive effects (p≥0.05). Better clinical outcomes for function in DA PT (RMQ function score 4.1 in GP referral vs. 2.4 in DA PT; p = 0.03). No significant difference in QoL, but tendencies to positive effects (p≥0.05). Significantly higher satisfaction levels in DA compared to physician-led usual medical care (74.7% vs. 53.2%; p = 0.002). DA PT is not related to any adverse events (p>0.05). |
Significantly higher treatment compliance in DA (76%-79% vs. 58%-69%; p = 0.004). |
Significantly shorter waiting time with DA PT (4-5 vs. 9-31 days; p < 0.001). Significantly less X-ray imaging described in DA PT (7.3% vs. 13.6%; p < 0.001). Significantly less medication prescribed in DA PT (32.2% vs. 44.1%; p < 0.01). Fewer or the same number of PT visits in DA PT (two to three fewer sessions; p = 0.001). Significant fewer patients required a primary care physician visit in DA (54% vs. 71%; p = 0.0113). Average cost saving per episode is significantly lower in DA PT (average saving = £36.42/patient/episode of care; p = 0.016)/(average costs £66.31 vs. £89.99; p < 0.05). |
| Babatunde et al (2020) (17) |
No significant differences between patient characteristics in DA/self-referral vs. medical triage (p≥0.05) regarding age and gender. No significant differences in pain, functional outcomes, and QoL for patients who assessed MSK care via DA compared to GP-led care. No reports of adverse effects or missed red flags. |
Less work-related absence and sick leave in DA PT. 10%-20% less total cost for DA PT compared to GP-led care. >65% less prescribed analgesics and NSAID. >70% less radiology. 2%-10% lower follow-up consults. |
|
| Gallotti et al (2023) (21) | Better management accuracy, less waiting time, and equal to higher QoL. | Higher rate of presence; shorter time to discharge (+6%). |
Higher cost-effectiveness (€−441.9 per episode of care) Imaging −28%; medication −41.2%; referral −20.7% Less sick leave (5% less prescriptions, −37 less sick leave days prescribed) |
DA = direct access; GP = general practitioner; MSK = musculoskeletal; NSAID = nonsteroidal anti-inflammatory care; PT = physiotherapy; QoL = quality of life; RMQ = Roland-Morris questionnaire; VAS = visual analogue scale.