Physio findings: triage and women's health

Janet Wright looks at new research of interest to physiotherapy staff.

Practice: Triage cuts costs and speeds treatment

Referring people for surgical consultations they don’t need is a waste of time for everyone including those patients stuck on the ever-lengthening waiting list.

That’s why triage, or early assessment, is increasingly valued as a way of directing patients along the most helpful pathway from the start.

New research shows that physio-led triage can cut costs while improving patients’ experience.

In Walsall, CSP member Damon Burn and colleagues studied an orthopaedic clinical assessment service run by extended scope practitioners (ESPs).

The physios provide treatment including injections, request X-rays and magnetic resonance imaging (MRI) scans, and make referrals to orthopaedic services if necessary.

The researchers found that 86.1 per cent of patients had their entire treatment managed by the ESPs, with the rest being referred for orthopaedic consultation.

More than 80 per cent of the ESPs’ referrals were considered appropriate and three quarters led to surgery, showing that the physios were referring the right people. The service cut NHS costs by 27.3 per cent, compared with the pre-triage route.

‘The cost savings indicate clearly that there are a significant number of patients being referred to orthopaedic consultant services that do not require surgical intervention and could be seen by other health professionals,’ the authors conclude.

A second study investigated GPs’ feelings about the service. Interviews revealed that some had difficulty in understanding all the different available services, including the various professional roles.

The authors say that’s ‘not surprising considering the large increase in role extension in various professions including physiotherapy’.

To clarify their options, some GPs asked for clinicians to advertise their services. Others suggested streamlining processes to have a single point of access for patients with orthopaedic conditions.

Given that GPs took on responsibility for commissioning services last year, the authors call for more research ‘to investigate GPs’ thoughts and behaviours in relation to referral patterns’.Burn D & Beeson E. Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates. Clinical Governance Burn D et al.  General Practitioners’ views about an Orthopaedic Clinical Assessment Service. Physiotherapy Research International 2014

Women's health: Lax joints and large families lead to long-term back pain

Many women suffer back ache during pregnancy, but some are still plagued with it after the baby has been born.

Researchers in Sweden set out to see whether this continuing pain was linked with joint hypermobility, which can mean problems with connective tissue.

They gave questionnaires and clinical assessments to 200 volunteers from antenatal clinics, during their pregnancies and 13 weeks after each birth. The assessments included a simple test of joint mobility, measuring how far the women’s left little fingers bent back.

Joints normally become more mobile during pregnancy, so even the average woman’s fingers became slightly more flexible during pregancy.

However, the team found that those with hypermobile joints were more likely to have pain continuing after the birth, especially if they had already had several pregnancies.  

Women whose fingers bent back farthest and who had had the most pregnancies were most likely to have back pain continuing after the birth.

‘These factors may provide a foundation for development of targeted prevention strategies,’ say the authors.Lindgren A & Kristiansson P. Finger joint laxity, number of previous pregnancies and pregnancy-induced back pain in a cohort studyBMC Pregnancy and Childbirth 2014 

Comments and conclusions

More than half the 95 professional rugby players who took part in a recent study were found to have had at least one spinal fracture, mostly in the thoracic spine (T8 to T10). In total, 51 players had 120 fractures, including 46 rated as moderate to severe. All the men were still playing – five of them having had four moderate or severe fractures each.  Hind K et al. PLoS ONE 2014 
Common cancers such as skin, thyroid and testicular cancer occur most often in affluent US neighbourhoods, a new study reports. Those cancers have a relatively low death rate. Although the risk of developing cancer is similar in rich and poor areas, the poor areas have less common but more deadly cancers: Kaposi sarcoma and cancers of the larynx, cervix, penis and liver. ‘When it comes to cancer, the poor are more likely to die of the disease while the affluent are more likely to die with the disease,’ say the authors. Boscoe FP et al. Cancer 2014

Over-anxious parents can reduce their children’s ability to cope with pain. So assessing parents’ ability to deal constructively with their own ‘catastrophising’ thoughts, and offering counselling or training if needed, could be helpful to the children, say US researchers.Langer SL et al. Pain Research and Treatment 2014 

Recent research shows that two doses of vaccine against Human Papillomavirus (HPV) are as effective as three in girls under 15, says Public Health England, which from September will reduce the school vaccination regime to two doses.

Troubled teenagers who play sports are less likely to drink alcohol excessively, a new study shows. Young offenders drank more and played less sport than non-offending teenagers – but reduced their drinking if they took up sport. The authors call for more access to organised sports for young offenders.
Hallingberg B et al. Criminal Behaviour and Mental Health 2014

Janet Wright

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