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#JEANETTE J. HOPPER TRIAL#

There was no difference in time lost from work. Health outcome measures suggested a trend towards slightly greater improvement in the PhysioDirect arm at six week follow-up and no difference at six months. After six months’ follow-up, the SF-36v2 physical component score was equivalent between groups (adjusted difference in means −0.01 (−0.80 to 0.79)). PhysioDirect patients had fewer face-to-face appointments than usual care patients (mean 1.91 v 3.11 incidence rate ratio 0.59 (95% confidence interval 0.53 to 0.65)), a shorter waiting time (median 7 days v 34 days arm time ratio 0.32 (0.29 to 0.35)), and lower rates of non-attendance (incidence rate ratio 0.55 (0.41 to 0.73)). Results Of 1506 patients allocated to PhysioDirect and 743 to usual care, 85% provided primary outcome data at six months (1283 and 629 patients, respectively). Participants were not blind to allocation, but outcome data were collected blind to allocation. Secondary outcomes included four other measures of health outcome, mental component score and scales from the SF-36v2, time lost from work, and patient satisfaction and preference. Primary outcome was physical health (SF-36v2 physical component score) at six months. Main outcome measures Numbers of appointments, waiting time for treatment, and non-attendance rates. Usual care involved patients joining a waiting list for face-to-face treatment. Interventions PhysioDirect services invited patients to telephone a physiotherapist for initial assessment and advice, followed by face-to-face physiotherapy if necessary. Participants Adults (aged ≥18 years) referred by general practitioners or self referred for musculoskeletal physiotherapy. Setting Four physiotherapy services in England. Patients were individually randomised in a 2:1 ratio to PhysioDirect or usual care.

#JEANETTE J. HOPPER TRIAL#

Objectives To assess the clinical effectiveness, effect on waiting times, and patient acceptability of PhysioDirect services in patients with musculoskeletal problems, compared with usual care.ĭesign Pragmatic randomised controlled trial to assess equivalence in clinical effectiveness.

Correspondence to: C Salisbury c.salisburybristol.ac.uk.

5Musculoskeletal Outpatient Department, Bristol Community Health, Bristol, UK.

4Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.

3Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK.

2Bristol Randomised Controlled Trials Collaboration, University of Bristol, UK.

1Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.

Nadine E Foster, professor of musculoskeletal health in primary care 3.

Sean Grove, clinical lead physiotherapy 5,.

Jeanette Hall, operational lead for outpatient physiotherapy 5,.Joanna Coast, professor of health economics 4,.Angelo Franchini, research methods training fellow 2,.Sandra Hollinghurst, senior lecturer in health economics 1,.Alan A Montgomery, reader in health services research 2,.

Chris Salisbury, professor of primary healthcare 1,.