Substituting doctors with physical therapists may lead to similar outcomes for patients with painful disorders

Increase in number of individuals with disorders will add to strain on system
Musculoskeletal disorders, which are conditions affecting the muscles and/or bones that lead to pain and impaired function, are the second largest cause of disability in the world. Most patients with musculoskeletal disorders go to their primary care doctor first, and about one-third are referred to a specialist, such as a physical therapist. In some cases, though, these musculoskeletal disorders become long-term (chronic) issues that require a higher level of care. As the number of individuals with chronic musculoskeletal disorders increases, it will add to the strain on the public health care system, giving doctors more than they can handle. One possible solution to this problem is to manage patients who have musculoskeletal disorders with physical therapists instead of doctors. Substituting doctors with physical therapists so could skip a step in the treatment process and allow these doctors to focus on other patients instead. Although this idea has been proposed, research on the topic is minimal and little is known about the outcomes of care from physical therapists compared to doctors. Therefore, a powerful study called a systematic review was conducted to evaluate the substitution of doctors with physical therapists in treating patients with musculoskeletal disorders.

Three databases searched for relevant studies
To conduct the review, investigators performed a detailed search of three major medical databases for studies with data on substituting doctors with physical therapists in the treatment of musculoskeletal disorders. This search identified 14 studies that met the necessary criteria and were therefore included in the review. The findings of each of these studies were evaluated and compared to one another with the goal of determining if there was any value in the substitution of these medical services. All 14 studies were also assessed for quality to show how reliable their information was.

Physical therapists may provide an alternative to doctors, but more research is needed
On the whole, the review produced several findings that were supportive of physical therapy. Specifically, five studies suggested that there was no significant difference in outcomes of patients being treated with either doctors or physical therapists. Eight studies also suggested that patients were equally or more satisfied with consulting a physical therapist than a doctor, while seven studies showed inconsistent and conflicting changes in the amount of healthcare used by patients when substituting a doctor with a physical therapist. Finally, it was found that substituting a doctor with a physical therapist may be less costly, but this was only drawn from one study. Based on these findings, it appears that physical therapy may be a safe substitution to doctors for treating patients with musculoskeletal disorders, and that it results in no significant change to patients’ health outcomes. Unfortunately, the quality of the included studies was rated as low to moderate, which means that additional research is needed to investigate this topic further. Still, this review provides evidence that physical therapy may be a reasonable alternative to doctors, and this approach may hold promise in the healthcare system moving forward.

-Summarized by Greg Gargiulo

-As reported in the November ’16 issue of the Physiotherapy