Publication: Physiotherapists could replace physicians as primary assessors for patients with suspected knee osteoarthritis: A randomised controlled study

Physiotherapists could replace physicians as primary assessors for patients with suspected knee osteoarthritis: A randomised controlled study.
Ho C, Thorstensson C, Nordeman L.
Bangkok: 6th World Congress on Controversies, Debates & Consensus in Bone, Muscle & Joint Diseases; 2018.

Abstract

Problem statement: Common osteoarthritis (OA) symptoms such as pain and physical disability directly affect patients' social interactions, mental functioning, and sleep quality. Patients with knee OA report among the lowest health-related quality of life (HrQoL) compared with other chronic diseases. It has been estimated that consultations to healthcare will probably increase with 30-50% among patients with OA over the next 20 years. Physiotherapists are primary assessors for patients with knee OA and provide recommended treatments. However, it is unclear if physiotherapist could be the only primary assessor for this patient group. We hypothesise that all patients with suspected knee OA could be assessed by a physiotherapist first and be referred to physician only when it is acquired. The aim of this study was to explore differences in HrQoL, pain and physical function in patients with suspected knee OA after being assessed, diagnosed and treated by physiotherapist first compared with being assessed by a physician first. Methods: Patients seeking primary care with suspected knee OA were randomised to either a physiotherapist or a physician for assessment, diagnose and treatment. HrQoL (Euroqol - EQ5D-3L index, EQ5D-3L VAS), pain intensity (visual analogue scale) and physical function (30 seconds chair stand test) were measured before randomisation, and at 3-, 6- and 12 months. Mann-Whitney’s test and Chi2 test for independence were used with a significance level of p<0.05. Results: A total of 363 patients with knee pain were screened for OA, 69 patients with suspected knee OA were randomised to either a physiotherapist (n=35) or a physician (n=34). Both groups improved their HrQol, pain and physical function at all follow ups. Patients rated significantly better HrQoL (EQ5D-3L VAS) one year after physiotherapy assessment (84 (SD 11); 74 (SD 15), p=0.018). Conclusion: These results showed that physiotherapy assessment could replace physician assessment without having impact on patient reported outcome after treatment for patients with suspected knee OA. We believe that this will play a role in managing the expected increase in OA consultation in primary care.


, from FoU-rådet i Södra Älvsborg
http://researchweb.org/is/alvsborg/user/publication?ref=3060581