IMPORTANCE: This study aims to enhance the care provided for patients with musculoskeletal disorders (MSKDs).
OBJECTIVE: The objective of this study is to compare first-contact physical therapy (FCPT) and usual primary care (UPC) for societal and clinical outcomes of patients with MSKDs.
DESIGN: The design was a systematic review and meta-analysis of randomized controlled trials.
SETTING: The study took a global perspective on FCPT compared to UPC for societal and clinical outcomes of patients with MSKDs.
PARTICIPANTS: The study included patients presenting with MSKDs.
INTERVENTION(S) OR EXPOSURE(S): FCPT was compared to UPC for patients with MSKDs.
MAIN OUTCOMES AND MEASURES: Societal outcomes including clinical imaging rates, prescription medication rates, cost, and clinical outcomes including pain, disability, and health-related quality of life (HRQoL) were assessed.
RESULTS: Ten randomized controlled trials were included with a sample size of 2081 patients. Very low to moderate quality of evidence showed patients achieved similar to superior societal and clinical outcomes with FCPT compared to UPC. Lower clinical imaging rates (risk ratio [RR] = 0.55; 95% CI, 0.45-0.68) and prescription medication rates (RR = 0.29; 95% CI, 0.16-0.53) were associated with FCPT. All effects favored FCPT, including a small effect for cost (mean difference = -309.79; 95% CI, -678.69 to 59.12), a medium effect for pain (standardized mean difference [SMD] = -0.75; 95% CI, -1.57 to 0.06), and negligible effects for disability (SMD = -0.15; 95% CI, -0.32 to 0.03) and HRQoL (SMD = -0.03; 95% CI, -0.17 to 0.11).
CONCLUSIONS: When compared to UPC, FCPT is likely to reduce clinical imaging rates and may result in a reduction of prescription medication rates. FCPT may result in little to no difference in disability and HRQoL. Evidence is very uncertain about the effect of FCPT on pain and cost. All conclusions can be interpreted for the medium term.
RELEVANCE: Health care organizations treating patients with MSKDs should consider integrating FCPTs to support primary care.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
| Physician |  |
Physician rater
My ratings are lower because insurers typically require an order from a physician or similar professional. Thus, these findings are most relevant to payers, rather than of direct clinical relevance.
Rehab Clinician (OT/PT) rater
This study suggests that direct access to physiotherapy for musculoskeletal disorders may reduce the use of diagnostic imaging and medication, while providing similar clinical outcomes to those of usual care. For countries like Türkiye, where legal frameworks currently require a physician's referral, these findings offer a valuable perspective on the potential benefits of autonomous practice. Hopefully, such evidence will encourage regulatory updates to support more efficient, patient-centered healthcare models.
Rehab Clinician (OT/PT) rater
This article offers a timely and meaningful contribution to the literature on care models for musculoskeletal disorders. The authors synthesize the available evidence clearly, demonstrating that FCPT can achieve clinical and societal outcomes comparable to, or better than, usual physician-led care. The discussion thoughtfully acknowledges the strength of the evidence while highlighting its practical implications. Overall, the article presents FCPT as a promising approach to address growing healthcare system demands and improve access to high-quality MSKD care.
, McMaster University