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Direct access vs. physician-first physiotherapy

...which is most cost-effective?

Direct access to musculoskeletal spine-related physiotherapy leads to a significant reduction in both physiotherapy and total healthcare costs, as well as a lower number of required visits to practitioners. Moreover, functional outcomes improve more in the direct access model, while disability scores decreased in both models. These findings come from a systematic review with meta-analysis conducted by researchers from the University of California.

It was found that in the US musculoskeletal spine-related physiotherapy setting, direct access is more cost-effective, with less visits required to achieve a better functional outcome.

These findings provide support to the idea that direct access to musculoskeletal physiotherapy is beneficial for healthcare systems. Moreover, no episodes of adverse events due to misdiagnosis were reported. Considering these findings, the authors mention that primary care provision should be increasingly present in physiotherapists’ training.

Nevertheless, the authors state that the review only included a reduced number of retrospective studies and further robust, long-term studies remain needed.

> From: Hon et al., Phys Ther (2020) pzaa201 (Epub ahead of print). All rights reserved to Oxford University Press. Click here for the online summary.

Expert opinion

This review provides encouraging results for physiotherapists to stake their claim as primary care providers in the musculoskeletal field, since not only the costs were reduced and the functional outcomes improved, but also because no harm resulted from direct access.

Obviously, healthcare models which have been in place for decades now will not suddenly be changed; however, slowly but surely, evidence has been showing that direct access has positive implications. Hopefully healthcare stakeholders will become increasingly aware of this reality and implement this model in an increasing number of settings.

For now, the best thing to do is, as always, consistently providing quality care to patients.

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