The conclusions of the study by Hay et al1 can be paraphrased as, firstly, physiotherapy plus medication advice provides perceived benefit in patients with knee pain for up to three months and then there is no benefit. Secondly, inappropriate prescriptions of anti-inflammatory drugs can be reduced if the prescriber adheres to good practice. Thirdly, some people who are enrolled in a study and told they will be followed up for 12 months consult their general practitioners less often in the first six months than a control group.
It follows from the above that after three months, patients with knee pain receiving this treatment package are no better in terms of pain levels or functional measures than patients untreated—so why provide this treatment? If general practitioners can be encouraged to prescribe appropriately, the role of the pharmacist in this context is redundant. After six to 12 months, patients either retain or resume their old habits in terms of visits to their general practitioner.
Bottom line? There is no net gain.
I fully support the profession of physiotherapy and admire the high levels of skill demonstrated by my colleagues from this profession. However, in my opinion, the profession is done no favours by presenting these findings as “evidence” of anything. Certainly there would be no grounds to commission a service based on these findings.
Competing interests: None declared.
References
- 1.Hay EM, Foster NE, Thomas E, Peat G, Phelan M, Yates HE, et al. Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial. BMJ 2006;333:995-8. (11 November.) [DOI] [PMC free article] [PubMed] [Google Scholar]