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Abstract：
Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists\' characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261.
摘要：
背景。当患者有能力在没有医生转诊的情况下自我参考物理治疗时，就会发生直接物理治疗（DAPT）。这种肌肉骨骼疾病（MSD）的护理模式比传统的医疗护理模式显示出更好的结果，传统的医疗护理模式需要医生转诊才能获得物理治疗师服务。这种传统的医生转诊通常会导致护理延迟。不幸的是,DAPT在许多国家仍然不允许。Objectives.这项系统评价的主要目的是比较有效性，安全,以及DAPT与医生主导的肌肉骨骼疾病患者治疗模式相比的准确性。本研究的次要目的是确定DAPT涉及的物理治疗师的特征或资格。材料和方法。搜索的数据库包括：Medline，Scopus和WebofScience从数据库开始到2022年7月进行了搜索。研究字符串是根据临床问题的PICO模型开发的(患者，干预，比较,和结果）。自由术语或同义词(例如，物理治疗；初级卫生保健；直接获取；肌肉骨骼疾病；成本效益），并在可能的情况下使用MeSH（医学主题词）术语并与布尔运算符（AND，OR,NOT).通过用于随机对照试验（RCT）的Cochrane偏见风险工具（ROB-2）的第2版和用于观察性研究的纽卡斯尔渥太华量表（NOS）进行偏见风险评估。作者通过叙事分析和叙事综合对结果进行了定性分析。提供了叙事分析，以提取不同研究的关键概念和共同含义，而摘要叙述提供了数据的文本组合。此外,进行了定量分析，比较了平均值和平均值之间的差异。结果。28篇文章符合纳入标准并进行了分析。结果表明，DAPT具有较高的转诊准确性和回访率的降低。医学模型对成像的使用率较高，毒品,并转诊给另一位专家.发现DAPT比医学模式更具成本效益。DAPT导致更好的工作相关结果，并且在考虑患者满意度时更优越。在任何研究中都没有发现不良事件。关于健康结果，模型之间没有差异。ROB-2显示RCT偏倚风险的中等风险，观察性研究的NOS量表平均为6/9分。结论。DAPT是个保险箱,更便宜，可靠的分诊和护理管理模式，与传统医学模式相比，患者满意度更高。Prospero注册号：CRD42022349261。
