Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial.
Physiotherapist-led orthopaedic triage, where physiotherapists diagnose and determine management plans, aims to enhance effectiveness and provide the best care. However, scientific evidence for the effectiveness of this model of care remains limited, and there are few studies reporting on patients' perceptions of the care provided. The purpose of this study was to evaluate patients' perceived quality of care in a physiotherapist-led orthopaedic triage in primary care, compared with standard practice.



In a randomised controlled trial, patients of working age referred for orthopaedic consultation at a primary healthcare clinic in Sweden received either physiotherapist-led triage (n = 102) or standard practice (orthopaedic surgeon assessment) (n = 101). Neither subjects nor clinicians were blinded. The questionnaire Quality from the Patient's Perspective (QPP) was used to evaluate perceived quality of care focusing on the caregivers' medical-technical competence and identity-orientated approach. Also, to what extent patients' expectations were met, and their intention to follow advice was evaluated.



For this study, 163 patients (80 %) were analysed (physiotherapist-led triage (n = 83), standard practice (n = 80)). Participants perceived significantly higher quality of care with the triage than with the standard practice in regards to receiving best possible examination and treatment (medical-technical competence) (p < 0.001). This was also found in regards to receiving information about examination and treatment (p < 0.001), results (p < 0.001), and self-care (p < 0.001), the caregiver's understanding (p < 0.001), respect (p < 0.001) and commitment (p < 0.001) as well as the opportunity to participate in decision-making (p = 0.01) (identity-orientated approach). Participants in the physiotherapist-led triage group reported to a significantly higher extent that their expectations of the treatment were met (p < 0.001), as well as the intent to follow the advice and instructions received (p = 0.019).



This paper reports on patients' perceptions of quality of care in a physiotherapist-led orthopaedic triage compared with standard practice. Patients in both groups reported that they perceived good quality of care, with the patients in the physiotherapist-led triage reporting significantly higher perceived quality of care than those in the standard practice group. This model of care seems to meet patients' expectations and result in a greater intention to follow advice and instructions for self-management. Our findings are in line with existing literature that this model of care provides an opportunity to shape patient-centered care that can improve access and offer care on the most appropriate level, with maintained good quality of care.



Clinical Trials NCT02265172 . Registered 10 June 2014.
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden. karin.samsson@vgregion.se.|Närhälsan Tjörn Rehabilitation Clinic, Primary Health Care, Region Västra Götaland, Syster Ebbas väg 1, 471 94, Kållekärr, Sweden. karin.samsson@vgregion.se.
Karin S
KS
Samsson
Närhalsan Research and Development Primary Health Care, Region Västra Götaland, Kungsgatan 12, 6th floor, 411 18, Gothenburg, Sweden.
Susanne
S
Bernhardsson
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden.|Närhalsan Research and Development Primary Health Care, Region Västra Götaland, Kungsgatan 12, 6th floor, 411 18, Gothenburg, Sweden.
Maria E H
ME
Larsson
D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making / Q000379:methods*; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000628:therapy*; D000072161:Orthopedic Surgeons; D010349:Patient Compliance; D018802:Patient-Centered Care / Q000379:methods*; D010465:Perception; D059825:Physical Therapists; D011320:Primary Health Care / Q000379:methods*; D011787:Quality of Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013548:Sweden; D014218:Triage / Q000379:methods*; D055815:Young Adult
Advanced practice physiotherapy; Expectations; Patient perception; Physical therapy; Quality of care; Sweden