Phone Visits Speed Time to Physical Therapy

(MedPageToday) Assessing patients with musculoskeletal problems by telephone got them into physical therapy more quickly and resulted in outcomes comparable those seen with an office visit, but patients were slightly less satisfied, according to a British study.

In a randomized controlled trial, wait times were about 70% shorter for patients in the telephone intervention compared with usual care (arm time ratio 0.32, 95% CI 0.29 to 0.35), Chris Salisbury, MD, of the University of Bristol, and colleagues reported online inBMJ.

Phone patients also had fewer face-to-face appointments than those in usual care (mean 1.91 versus 3.11, incidence rate ratio 0.59, 95% CI 0.53 to 0.65), and were more likely to keep their appointments, as evidenced by lower rates of non-attendance (IRR 0.55, 95% CI 0.41 to 0.73), they reported.

However, patients who received phone care reported slightly lower satisfaction at 6 months (P=0.031).

Although the phone intervention appears safe and effective at reducing delays, the findings “do not provide a compelling argument” in favor of the program given the differences in patient satisfaction; however, prior evidence suggests that the program is more cost-effective than usual care, they noted.

Providing timely access to physiotherapy has long been a problem in the National Health Service (NHS), according to the investigators. General practitioners refer about 1.23 million patients for physiotherapy each year in the U.K., mostly for lower limb, back, upper limb and cervical pain, respectively.

Although patients can wait weeks or months for a clinic visit in usual care, telephone interventions have increasingly been used to lessen those waits.

To compare treatment via phone assessment with the traditional route, Salisbury and colleagues randomly assigned patients to either a phone intervention (1,506 patients) or usual care (743 patients).

Those in the phone assessment group could call physiotherapists to discuss their complaints. Physiotherapists were taught a system to identify patient symptoms without seeing the patients, and referred urgent care patients for an office visit.

After receiving advice — typically an exercise regimen — the phone-assessed patients were invited to call back after 2 weeks or 1 month. All participants used the services of PhysioDirect, a commercial healthcare service in the U.K.

Patients could abandon the phone-assessment route at any point. Patients in the phone-assessment track also could receive earlier face-to-face treatment if deemed necessary by the assessor.

Patients in the control group received usual care, which typically involves referral to a physiotherapist. Waiting lists for physiotherapy services often are several weeks long. Once patients are assessed, they receive advice on specific exercises to perform, and in some cases receive further treatment, usually in the form of hands-on manual therapies, the researchers explained.

Participants ranged in age from 36 to 62, with an average age of 48 in both groups.

Salisbury and colleagues found that wait times were significantly reduced for patients in the telephone intervention compared with usual care (7 days versus 34 days), and self-reported health outcomes at 6 months were similar in both groups.

For the primary outcome of self-reported health outcomes at 6 months, as measured by the SF-36v2, the researchers saw no differences between groups (mean difference -0.01, 95% CI -0.80 to 0.79).

The difference in scores at 6 weeks suggested a trend towards slightly greater improvement in the PhysioDirect arm, but again the difference wasn’t significant.

However, PhysioDirect patients had slightly lower satisfaction overall at 6 months (difference in satisfaction -3.8%, 95% CI -7.3% to -0.3%).

They noted that the difference in satisfaction was “small and might not be meaningful,” and the “fact that patients in the PhysioDirect arm … were almost as satisfied with their consultations as patients in the usual care arm … might provide reassurance that physiotherapists are able to provide assessments and advice by telephone in a way that is reasonably acceptable to patients.”

Researchers warned that PhysioDirect services provided after the study concluded might use “less experienced physiotherapists who are not supported by computerized templates,” and that these studies are not applicable in those cases.

Still, they concluded that the phone intervention “provides faster access to physiotherapy and seems to be safe” compared with usual care.