Background: It has been estimated that consultations to healthcare will increase with 30-50% among patients with osteoarthritis (OA) over the next 20 years . Patients with knee OA (KOA) report among the lowest health-related quality of life (HrQoL) compared with other chronic diseases . Most patients are assessed by a physician which claims unnecessary healthcare resources since physiotherapists also are primary assessors for patients with KOA and provide recommended treatments. However, it is unclear if physiotherapists could be the first option as primary assessor for this patient group. We hypothesise that all patients with suspected KOA in primary care could be assessed by a physiotherapist first and be referred to physician only when it is required, without having a negative impact on HrQoL.
Objectives: The aim of this study was to explore differences in HrQoL, pain and physical function in patients with suspected KOA after being assessed, diagnosed and treated by physiotherapist first compared with being assessed by a physician in primary care first.
Methods: Patients seeking primary care with suspected KOA were randomised to either a physiotherapist or a physician for assessment, diagnose and treatment. Inclusion criteria were knee pain and > 38 years old. Exclusion criteria: knee pain due to traumatic cause, other systemic, somatic, mental or rheumatic diseases, pregnancy, or already been diagnosed or assessed by another healthcare giver due to current knee pain. 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-Whitneys U test and Chi2 test for independence were used with a significance level of p<0.05.
Results: 69 patients with suspected KOA 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); vs 74 (SD 15), p=0.018). No other significant differences were found between the groups.
Conclusion: Physiotherapy assessment could replace physician assessment without having negative impact on patient reported outcomes after treatment for patients with suspected KOA. This may play a role in managing the expected increase in OA consultation in primary care. However, more research is needed to clarify if this management is more cost effective, and how patients with KOA experience other primary assessors than physicians.
References  Turkiewicz A, Petersson IF, Bjrk J, Dahlberg LE, Englund M: The consultation prevalence of osteoarthritis 2030 may increase by 50%: prognosis for Sweden. Osteoarthritis and Cartilage 2013, 21(Supplement):S160-S161.
 Picavet HS, Hoeymans N: Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis 2004, 63(6):723-729.
Disclosure of Interests: None declared
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