OBJECTIVE: To compare single and multiple physiotherapy sessions to improve pain, function, and quality of life (QoL) in patients with musculoskeletal disorders (MSKDs).
DATA SOURCES: AMED, Cinahl, SportsDiscus, Medline, Cochrane Register of Clinical Trials, Physiotherapy Evidence Database, and reference lists.
STUDY SELECTION: Randomized controlled trials (RCTs) comparing single and multiple physiotherapy sessions for MSKDs.
DATA EXTRACTION: Two reviewers extracted data and assessed risk of bias and certainty of evidence using Cochrane Risk of Bias tool 2.0 and Grading of Recommendation Assessment, Development, and Evaluation.
DATA SYNTHESIS: Six RCTs (n=2090) were included (conditions studied: osteoporotic vertebral fracture, neck, knee, and shoulder pain). Meta-analyses with low-certainty evidence showed a significant pain improvement at 6 months in favor of multiple sessions compared with single session interventions (3 RCTs; n=1035; standardized mean difference [SMD]: 0.29; 95% CI: 0.05 to 0.53; P=.02) but this significant difference in pain improvement was not observed at 3 months (4 RCTs; n=1312; SMD: 0.39; 95% CI: -0.11 to 0.89; P=.13) and at 12 months (4 RCTs; n=1266; SMD: -0.05; 95% CI: -0.49 to 0.39; P=.82). Meta-analyses with low-certainty evidence showed no significant differences in function at 3 (4 RCTs; n=1583; SMD: 0.05; 95% CI: -0.11 to 0.21; P=.56), 6 (4 RCTs; n=1538; SMD: 0.06; 95% CI: -0.12 to 0.23; P=.53) and 12 months (4 RCTs; n=1528; SMD: 0.08; 95% CI: -0.08 to 0.25; P=.30) and QoL at 3 (4 RCTs; n=1779; SMD: 0.08; 95% CI: -0.02 to 0.17; P=.12), 6 (3 RCTs; n=1206; SMD: 0.03; 95% CI: -0.08 to 0.14; P=.59), and 12 months (4 RCTs; n=1729; SMD: -0.03; 95% CI: -0.12 to 0.07; P=.58).
CONCLUSIONS: Low certainty meta-analyses found no clinically significant differences in pain, function, and QoL between single and multiple physiotherapy sessions for MSKD management for the conditions studied. Future research should compare the cost-effectiveness of those different models of care.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Nurse |  |
| Rehab Clinician (OT/PT) | |
Nurse rater
As an educator, I found that this article beneficial as it looked at the importance of looking at the individual as a whole and the importance of providing education to the patient. It was also interesting to see that more is not "better" and looking at the importance of the patient-partners relationship and supporting the patients educational needs.
Nurse rater
One and done is a great idea, regarding cost savings, but how is the intervention evaluated? Would two and done better serve the client?
Rehab Clinician (OT/PT) rater
The most relevant aspect of this review is the recommendation that future research should compare the cost-effectiveness of those different models of care and assess patients’ satisfaction with an intervention comprising only 1 session with a health care professional. In addition, it would be relevant that researchers and clinicians develop educational content jointly with patient-partners to ensure acceptability and understanding by its users.
Rehab Clinician (OT/PT) rater
This is a useless study. As a colleague once said, "comparing all PT in all MSK problems is a bit like asking whether medical intervention improves abdominal pain. How can any one tell with such broad terms!"
Rehab Clinician (OT/PT) rater
This is not in relation to Occupational Therapy, so it will not be so interesting for us. It will probably be of more interest to physical therapists, but they also know this.
Rehab Clinician (OT/PT) rater
The low certainty of evidence and small number of clinical trials included in this meta-analytic review limit the usefulness of the results.
Rehab Clinician (OT/PT) rater
This is a clear and helpful review with strong clinical message.
Rehab Clinician (OT/PT) rater
The low number of studies involved and low quality in the research make it difficult to draw any helpful conclusions. More research is needed. It will be interesting to watch this space!
, McMaster University