Background: Grooving evidence suggests that patients could have Direct Access (DA) to physiotherapy. It represents a new model of care, which might lead to improve patients' health status and decrease cost services for healthcare compared with a secondary care referral pathway. The aim of this study is to explore the evidence regarding feasibility, effectiveness, costs, safety and patient satisfaction through DA compared to other organizational models.
Methods: A systematic review was carried out through MEDLINE, CINAHL, and EMBASE databases from their inceptions until March 2018 using keywords related with DA. All articles in English, Italian or Polish comparing the modality of DA with any other organizational modality were included. Two reviewers independently selected eligible studies, extracted the data, and assessed methodological quality using the Newcastle-Ottawa Scale for cohort studies.
Results: 1593 articles were initially identified, and thirteen studies met the inclusion criteria. The mean NOS score for study quality was 6.4 ± 1.4 out of a possible total score of nine points. Patients impairments and health care status, were similar through all studies. DA showed less number of physiotherapy treatments, visits to physician, imaging performed and required fewer non-steroidal anti-inflammatory drugs and secondary care. Patients were more satisfied with the service in comparison to the group referred by the physician. and costs per subject were lower. DA patients were younger, with a higher level of education; mostly, they presented a less severe clinical condition and a more acute pathologies related to the spine. No harms were reported. Only one study assessed the clinical safety of the DA.
Conclusion: The findings suggest that DA to physiotherapy is feasible considering the clinical and economic point of view. However, more research is still needed due to the low evidence of the reviewed studies and to explore the clinical safety of DA.
Keywords: Physical Therapy Modalities; Primary Health Care; Referral and Consultation.
Gallotti M, Campagnola B, Cocchieri A, Mourad F, Heick JD, Maselli F. Gallotti M, et al. J Clin Med. 2023 Sep 7;12(18):5832. doi: 10.3390/jcm12185832. J Clin Med. 2023. PMID: 37762773 Free PMC article. Review.
Ojha HA, Snyder RS, Davenport TE. Ojha HA, et al. Phys Ther. 2014 Jan;94(1):14-30. doi: 10.2522/ptj.20130096. Epub 2013 Sep 12. Phys Ther. 2014. PMID: 24029295 Review.
Demont A, Quentin J, Bourmaud A. Demont A, et al. Rev Epidemiol Sante Publique. 2020 Sep;68(5):306-313. doi: 10.1016/j.respe.2020.08.001. Epub 2020 Sep 3. Rev Epidemiol Sante Publique. 2020. PMID: 32893028 Review. French.
Xi S. Xi S. Int J Evid Based Healthc. 2010 Dec;8(4):256-8. doi: 10.1111/j.1744-1609.2010.00177.x. Int J Evid Based Healthc. 2010. PMID: 21091891 Review.
Hon S, Ritter R, Allen DD. Hon S, et al. Phys Ther. 2021 Jan 4;101(1):pzaa201. doi: 10.1093/ptj/pzaa201. Phys Ther. 2021. PMID: 33245117
Gallotti M, Campagnola B, Cocchieri A, Mourad F, Heick JD, Maselli F. Gallotti M, et al. J Clin Med. 2023 Sep 7;12(18):5832. doi: 10.3390/jcm12185832. J Clin Med. 2023. PMID: 37762773 Free PMC article. Review.
Salvalaggio S, Turolla A, Andò M, Barresi R, Burgio F, Busan P, Cortese AM, D'Imperio D, Danesin L, Ferrazzi G, Maistrello L, Mascotto E, Parrotta I, Pezzetta R, Rigon E, Vedovato A, Zago S, Zorzi M, Arcara G, Mantini D, Filippini N. Salvalaggio S, et al. Front Aging Neurosci. 2023 Jul 4;15:1205063. doi: 10.3389/fnagi.2023.1205063. eCollection 2023. Front Aging Neurosci. 2023. PMID: 37469951 Free PMC article.
Feller D, Giudice A, Maritati G, Maselli F, Rossettini G, Meroni R, Lullo G, Hutting N, Mourad F. Feller D, et al. Healthcare (Basel). 2023 May 24;11(11):1527. doi: 10.3390/healthcare11111527. Healthcare (Basel). 2023. PMID: 37297667 Free PMC article.
Mourad F, Milella C, Lullo G, Zangari F, Meroni R, Taylor A, Kerry R, Hutting N, Maselli F. Mourad F, et al. Healthcare (Basel). 2023 May 7;11(9):1342. doi: 10.3390/healthcare11091342. Healthcare (Basel). 2023. PMID: 37174884 Free PMC article.
Lopez G, Cataldi F, Bellin G, Dunning J, Fernández-de-Las-Peñas C, Galeno E, Meroni R, Maselli F, Mourad F. Lopez G, et al. Healthcare (Basel). 2023 Apr 18;11(8):1165. doi: 10.3390/healthcare11081165. Healthcare (Basel). 2023. PMID: 37107999 Free PMC article.