This case study follows the 5-step process for accessing and using evidence in response to a request from commissioners to support the work of the Musculoskeletal (MSK) programme.
Using PICO, the scope of the evidence search was defined as:
Population: Adult patients with musculoskeletal disorders (MSKD)
Intervention: Self-referral to physiotherapy (PT) / PhysioDirect/ direct access (DA) to PT
Comparison: Physician referral
Outcomes: Effectiveness, cost-effectiveness.
A Clinical Effectiveness Programme Officer was asked to conduct the search and report findings.
The following search questions were addressed:
“What recent evidence is available regarding the delivery models and effectiveness of direct access (including models such as PhysioDirect) to physiotherapy?”
The search strategy involved searching the following databases and websites:
The following search strategy was used:
((“physio direct” OR “physiodirect”) OR (“self referral” OR “self-referral”) OR (“direct access”)) AND physiotherap*
A range of study types were reviewed including systematic reviews (SRs), randomised controlled trials (RCTs) and mixed-methods studies. Appraisal was conducted according to the strengths and limitations of each piece of evidence, including issues concerning sample sizes, potential for bias, and different approaches to direct access.
Findings were reported in an evidence review. Key points of this review included:
The findings of the review were consolidated into two documents, a full evidence review and a briefing version with the headline findings. This was done to enable greater accessibility of the evidence to stakeholders and commissioners who may be limited on time. To promote sharing of learning, this review was uploaded to AHSN’s Evidence Repository on the Futures NHS platform.