26 research outputs found

    Quality of physiotherapy care in primary care and prospects for evolution toward direct access physiotherapy for patients

    No full text
    Contexte : La prĂ©valence annuelle des troubles musculosquelettiques est de 77% au sein de la population mondiale, ce qui en fait la principale source de besoins en rĂ©Ă©ducation et rĂ©adaptation. En France, ces troubles reprĂ©sentent la premiĂšre cause de maladies professionnelles indemnisĂ©es. Le professionnel de santĂ© de premier recours pour les patients est le mĂ©decin gĂ©nĂ©raliste. Or les besoins de soins de la population sont en constante augmentation, de par le vieillissement de celle-ci. Le nombre de mĂ©decins gĂ©nĂ©ralistes diminue et les inĂ©galitĂ©s territoriales d’accĂšs aux soins se renforcent. Dans ce contexte, un accĂšs Ă©quitable aux soins et des soins de qualitĂ© risque de devenir plus difficiles Ă  garantir. A ce jour, aucune Ă©tude n’a Ă©valuĂ© en France l’effet de l’introduction de nouvelles pratiques masso-kinĂ©sithĂ©rapiques dans le parcours de soins des patients atteints de troubles musculosquelettiques et plus spĂ©cifiquement la place de l’accĂšs direct Ă  ces professionnels, ni la place de la pratique avancĂ©e pour cette profession. MĂ©thode : L’objectif de ce travail de thĂšse est de dĂ©crire les bĂ©nĂ©fices et les risques de proposer un modĂšle de soins intĂ©grant des masseurs-kinĂ©sithĂ©rapeutes avec un niveau supĂ©rieur d’autonomie dans la gestion de la prise en charge de ces patients en France. Pour cela, ont Ă©tĂ© rĂ©alisĂ©es : a) une revue systĂ©matique des Ă©tudes comparant le modĂšle de soins primaires dirigĂ© par un mĂ©decin gĂ©nĂ©raliste Ă  celui d’accĂšs direct Ă  un masseur-kinĂ©sithĂ©rapeute ; b) une mĂ©ta-analyse Ă©valuant l’efficacitĂ© des interventions des masseurs-kinĂ©sithĂ©rapeutes pour la prise en charge des cĂ©phalĂ©es cervicogĂ©niques, c) une Ă©tude transversale dĂ©crivant les pratiques d’orientation vers les soins masso-kinĂ©sithĂ©rapiques des mĂ©decins gĂ©nĂ©ralistes ; et d) une enquĂȘte Ă©valuant l’acceptabilitĂ© de la population Ă  recourir en accĂšs direct Ă  un masseur-kinĂ©sithĂ©rapeute. RĂ©sultats : Ce travail de thĂšse a permis de mettre en Ă©vidence des bĂ©nĂ©fices en matiĂšre d’efficacitĂ© clinique, d’utilisation des ressources en soins de santĂ© et des coĂ»ts de santĂ© pour un modĂšle d’accĂšs direct Ă  un masseur-kinĂ©sithĂ©rapeute comparativement Ă  celui orientĂ© par un mĂ©decin gĂ©nĂ©raliste. En matiĂšre d’efficacitĂ© des soins masso-kinĂ©sithĂ©rapiques, dans le cadre spĂ©cifique des cĂ©phalĂ©es cervicogĂ©niques, la thĂ©rapie manuelle Ă  court terme et les exercices cervicaux Ă  long terme ont Ă©tĂ© Ă©valuĂ©s comme efficaces. Les prescriptions de masso-kinĂ©sithĂ©rapie rĂ©digĂ©es par les mĂ©decins gĂ©nĂ©ralistes traduisent une faible connaissance des pratiques de ce corps de mĂ©tier et sont insuffisantes pour dĂ©terminer la prise en charge des patients. Les prises en charges proposĂ©es par les masseurs-kinĂ©sithĂ©rapeutes prĂ©sentent quant Ă  elles une bonne concordance aux recommandations de bonnes pratiques. Enfin, la majeure partie de la population française Ă©tudiĂ©e estime que le masseur-kinĂ©sithĂ©rapeute est compĂ©tent pour ĂȘtre un professionnel de santĂ© de premier recours et a confiance dans sa capacitĂ© Ă  diagnostiquer et traiter les patients atteints de troubles musculosquelettiques. La sous-population ayant prĂ©cĂ©demment reçu des soins de masso-kinĂ©sithĂ©rapie a globalement rapportĂ© ĂȘtre satisfaite de la qualitĂ© des soins fournis. Conclusion : Cette thĂšse suggĂšre que l’augmentation de l’autonomie des masseurs-kinĂ©sithĂ©rapeutes dans la prise en charge des patients atteints de troubles musculosquelettiques pourrait ĂȘtre une perspective innovante d’optimisation de leurs parcours. Des Ă©tudes de haute qualitĂ© mĂ©thodologique avec de grands Ă©chantillons reprĂ©sentatifs de ceux observĂ©s dans la pratique clinique doivent ĂȘtre menĂ©es pour consolider ces rĂ©sultats.Context: The annual prevalence of musculoskeletal disorders is 77% in the world population, which makes them the main source of rehabilitation needs. In France, these disorders represent the first cause of compensated occupational diseases. The primary health care professional for patients is the family physician. However, the care needs of the population are constantly increasing, due to the aging of the population. The number of family physician is decreasing and territorial inequalities in access to care are increasing. In this context, equitable access to care and quality care may become more difficult to guarantee. To date, no study has evaluated the effect of introducing new physiotherapy practices in the care pathway of patients with musculoskeletal disorders, and more specifically the role of direct access to their care, nor the role of advanced practice for this profession. Method: The objective of this thesis is to describe the benefits and risks of proposing a model of care integrating physiotherapists with a higher level of autonomy in the management of these patients in France. To do this, the following were carried out: a) a systematic review of studies comparing the family physician-led model with the direct access physiotherapy model; b) a systematic review with meta-analysis of randomized controlled trials assessing the efficacy of physiotherapy interventions for the management of cervicogenic headache; c) a cross-sectional study describing the family physicians referral to physiotherapy care; and d) a survey evaluating the acceptability of the population to use direct access to a physiotherapist. Results: This thesis work demonstrated benefits in clinical efficacy, health care resource utilization, and health care costs for a model of direct access physiotherapy compared to that referred by a family physician. In terms of efficacy of physiotherapy interventions, for the specific population with cervicogenic headache, short-term manual therapy and long-term cervical exercises were evaluated as effective. The prescriptions for physiotherapy written by family physicians reflect a poor knowledge of the practices of this profession and are insufficient to determine the management of patients. The interventions proposed by physiotherapists were broadly in line with the clinical practice guidelines. Finally, most of the French population studied felt that the masseur-physiotherapist was competent to be a primary care health professional and had confidence in his or her ability to diagnose and treat patients with musculoskeletal disorders. The subpopulation who had previously received physical therapy reported overall satisfaction with the quality of care provided. Conclusion: This thesis suggests that increasing the autonomy of physiotherapists in the management of patients with musculoskeletal disorders could be an innovative perspective for optimizing their care. Studies of high methodological quality with large samples representative of those observed in clinical practice must be conducted to consolidate these results

    Advanced practice physiotherapists can diagnose and triage patients with musculoskeletal disorders while providing effective care: a systematic review

    No full text
    Questions: What is the diagnostic and surgical triage concordance between advanced practice physiotherapists (APPTs) and physicians? What is the clinical efficacy of advanced practice physiotherapy care compared with usual medical care? Design: Systematic review with meta-analyses. Literature search: Medline, Embase, Cochrane CENTRAL and CINAHL were searched up to March 2022. Study selection criteria: Concordance studies on diagnostic or surgical triage between APPTs and physicians and randomised controlled trials comparing the clinical efficacy of an advanced practice physiotherapy (APP) model of care compared with usual medical care for participants with musculoskeletal disorders. Data synthesis: Meta-analyses were performed for concordance and clinical outcomes. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to evaluate the certainty of evidence. Results: Nineteen concordance studies (n = 1,745) and six randomised trials (n = 1,960) were included. Based on moderate-certainty evidence, the pooled Kappa for diagnostic concordance between APPTs and physicians was 0.76 (95% CI 0.68 to 0.85, n = 1,108). Based on high-certainty evidence, the pooled Kappa for surgical triage concordance was 0.71 (95% CI 0.63 to 0.78, n = 1,128). Based on moderate-certainty evidence, APP care resulted in a comparable or greater reduction in pain (MD –0.92 out of 10, 95% CI –1.75 to –0.10, n = 494) when compared with usual medical care at medium-term follow-up. Based on low-certainty evidence, APP care resulted in a comparable or greater reduction in disability (SMD –0.31, 95% CI –0.67 to 0.04, n = 535) when compared with usual medical care at medium-term follow-up. Conclusion: Concordance between APPTs and physicians is probably good to very good for diagnosis and good to very good for surgical triage of musculoskeletal disorders. Patients with musculoskeletal disorders managed in an APP model of care probably report comparable or greater pain and disability reductions when compared with usual medical care. Registration: CRD42022320950

    New models of care integrating more autonomous roles for physiotherapists: a narrative review

    No full text
    With the increased prevalence of non-communicable diseases and chronic disorders, including musculoskeletal disorders, access to care is limited in many health care systems and new multidisciplinary collaborative models of care have now been implemented in several countries in an effort to improve access to care. The paper aimed to describe the characteristics and present relevant evidence supporting different models of care that integrate physiotherapists as primary or secondary care practitioners for the management of patients with non-communicable diseases or chronic disorders. On the basis of a literature review up to August 2020 in 4 major bibliographical databases, we searched for studies of any design, including systematic reviews with or without meta-analysis and position statements, that were related to direct access physiotherapy and advanced practice physiotherapy models of care. The impact of direct access physiotherapy and advanced practice physiotherapy models of care is presented in terms of clinical outcomes, patient satisfaction, health care resource use and costs. These models appear to provide equal or better outcomes in terms of access to care, quality of care, and patients’ satisfaction. The strength of the evidence is variable, and outcomes vary depending on clinical settings, roles of physiotherapists, and characteristics of patients. This review highlights that these enhanced roles for physiotherapists, such as diagnosing, ordering diagnostic tests, or referring patients to physicians, in both primary and secondary care settings, are beneficial and may help optimize patients’ journey by providing earlier access to effective and efficient services compared with physician-led usual care models

    Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

    No full text
    International audienceBackground: The objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care. Methods: Systematic searches were conducted up to September 2021 in selected electronic bibliographical databases. Economic evaluation studies on an APP model of care were included. Economic data such as health care costs, patient costs, productivity losses were extracted. Methodological quality of included studies was assessed with the Effective Public Health Practice Project tool and the Critical Appraisal Skills Programme checklist. Meta-analyses were performed and mean differences (MD) in costs per patient were calculated using random-effect inverse variance models. Certainty of the evidence was assessed with the GRADE Approach. Results: Twelve studies (n = 14,649 participants) including four randomized controlled trials, seven analytical cohort studies and one economic modeling study were included. The clinical settings of APP models of care included primary, emergency and specialized secondary care such as orthopaedics, paediatrics and gynaecology. The majority of the included participants were adults with musculoskeletal disorders (n = 12,915). Based on low quality evidence, health system costs including salaries, diagnostic tests, medications, and follow-up visits were significantly lower with APP care than with usual medical care, at 2 to 12-month follow-up (MD: − 145.02 €/patient; 95%CI: − 251.89 to − 38.14; n = 7648). Based on low quality evidence, patient costs including travel and paid medication prescriptions, or treatments were significantly higher with APP care compared to usual medical care, at 2 to 6-month follow-up (MD: 22.18 €/patient; 95%CI: 0.40 to 43.96; n = 1485). Based on very low quality evidence, no significant differences in productivity losses per patient were reported between both types of care (MD: 450 €/patient; 95%CI: − 80 to 970; n = 819). Conclusions: This is the first systematic review and meta-analysis on the economic evaluation of APP models of care. Low quality evidence suggests that APP care might result in lower health care costs, but higher patient costs compared to usual medical care. Costs differences may vary depending on various factors such as the cost methodology used and on the clinical setting. More evidence is needed to evaluate cost benefits of APP models of care
    corecore