Abstract
Objective
To explore factors that might be relevant when designing a triage tool.
Design
A mixed-methods study using multivariable logistic regression analysis to identify
significant factors associated with requiring different levels of care, and qualitative
focus groups exploring views of patients and physiotherapy clinicians regarding case
complexity.
Setting
A community-based adult musculoskeletal service delivering tier 1 (standard physiotherapy)
and tier 2 care (complex care beyond the scope of standard physiotherapy) and providing
onward referral to orthopedic clinics (tier 3).
Participants
Quantitative data were extracted from a random sample of patients (N=484) who had
received treatment for musculoskeletal conditions. Patients and physiotherapists who
had received care or who worked in the service participated in focus groups.
Interventions
Not applicable.
Main Outcome Measures
Themes that emerged from focus groups were compared against predictors of requiring
complex care found to be significant (P<.05) after quantitative data analysis.
Results
A total of 184 patients (38.0%; 95% confidence interval, 33.8–42.4) received complex
care. Peripheral joint problems, unclear diagnosis, and symptoms affecting sleep were
significant independent predictors of requiring complex care. These data supported
some of the main themes raised at focus groups.
Conclusions
A substantial proportion of patients receive tier 2 complex care. Further studies
are needed to evaluate whether the predictive factors found to be significant in our
study might be useful for developing a tool for more effective triage to the most
appropriate tier of musculoskeletal care.
Keywords
List of abbreviations:
CI (confidence interval), GP (general practitioner), MSK (musculoskeletal), UK (United Kingdom)To read this article in full you will need to make a payment
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References
- Sports Injury Prevention Taskforce final report.Sport and Recreation Victoria, Melbourne2013
- Morbidity statistics from general practice: fourth national study 1991-1992.HMSO, London1995
- International comparisons of the consultation prevalence of musculoskeletal conditions using population-based healthcare data from England and Sweden.Ann Rheum Dis. 2014; 73: 212-218
- Fit for purpose. Absence and workplace health survey.(Available at:) (Accessed June 7, 2015)
- Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study.BMC Musculoskelet Disord. 2010; 11: 144
- A joint responsibility: doing it differently.Department of Health, London2006 (Available at:)http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4138412.pdf(Accessed June 11, 2014)
- Evaluating the public health impact of health promotion interventions: the RE-AIM framework.Am J Public Health. 1999; 89: 1322-1327
- A controlled study of the effects of an early intervention on acute musculoskeletal pain problems.Pain. 1993; 54: 353-359
- Early identification of patients at risk of developing a persistent back problem: the predictive validity of the Orebro Musculoskeletal Pain Questionnaire.Clin J Pain. 2003; 19: 80-86
- The updated Cochrane review of bed rest for low back pain and sciatica.Spine (Phila Pa 1976). 2005; 30: 542-546
- Musculoskeletal triage: a mixed methods study, integrating systematic review with expert and patient perspectives.Physiotherapy. 2014; 100: 277-289
- “INTERMED”: a method to assess health service needs. I. Development and reliability.Gen Hosp Psychiatry. 1999; 21: 39-48
- Weights for waits: lessons from Salisbury.J Health Serv Res Policy. 2000; 5: 83-88
- Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain.Clin J Pain. 1998; 14: 209-215
- A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study.Ann Intern Med. 2004; 141: 920-928
- Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program.Arch Phys Med Rehabil. 2005; 86: 1753-1762
- A clinical return-to-work rule for patients with back pain.CMAJ. 2005; 172: 1559-1567
- Predictive validity of the Chronic Pain Coping Inventory in subacute low back pain.Pain. 2005; 116: 205-212
- Musculoskeletal pain in primary health care: subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables.J Pain. 2007; 8: 67-74
- Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial.Lancet. 2011; 378: 1560-1571
- Predictive value of the Acute Low Back Pain Screening Questionnaire and the Orebro Musculoskeletal Pain Screening Questionnaire for persisting problems.Eur Spine J. 2012; 21: S773-S784
- Commentary: prognostic models: clinically useful or quickly forgotten?.BMJ. 1995; 311: 1539-1541
- Chronic musculoskeletal pain rarely presents in a single body site: results from a UK population study.Rheumatology (Oxford). 2007; 46: 1168-1170
- Carpa Study Group. Course of functional status and pain in osteoarthritis of the hip or knee: a systematic review of the literature.Arthritis Rheum. 2006; 55: 779-785
- The assessment of the prognosis of musculoskeletal conditions in older adults presenting to general practice: a research protocol.BMC Musculoskelet Disord. 2006; 7: 84
- A primary care back pain screening tool: identifying patient subgroups for initial treatment.Arthritis Rheum. 2008; 59: 632-641
- The Staffordshire Arthritis, Musculoskeletal, and Back Assessment (SAMBA) study: a prospective observational study of patient outcome following referral to a primary-secondary care musculoskeletal interface service.BMC Musculoskelet Disord. 2010; 11: 67
- A goodness-of-fit test for the multiple logistic regression model.Commun Stat. 1980; A10: 1043-1069
- The use of focus groups to define patient needs.J Pediatr Gastroenterol Nutr. 1999; 28: S19-S22
- The methodology of focus groups: the importance of interaction between research participants.Sociol Health Illn. 1994; 16: 103-121
- Beginning qualitative research: a philosophic and practical guide.Falmer Pr, London, Washington (DC)1994
- Research design: qualitative and quantitative approaches.Sage, London1994
Article info
Publication history
Published online: December 29, 2015
Footnotes
Supported by Leeds Community Healthcare Trust Research Capability Funding.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
