Realistic Medicine and Musculoskeletal Physiotherapy


Drivers for this change were the need to implement more shared decision-making in our practice and more clearly identify our patients’ goals and expectations, whilst reducing wait times for physiotherapy. Previously, approaches to patient care have often been directed by the physiotherapists’ perceptions of what the patient needs, with less focus on shared decision-making. This project aimed to establish if implementing Realistic Medicine Principles within musculoskeletal physiotherapy would improve capacity, reduce Did Not Attend rates and result in an overall reduction in the waiting list.


Realistic Medicine roadshows were delivered to cover all outpatient staff in groups of 10.The roadshows comprised a presentation of Realistic Medicine’s key principles and an opportunity for staff to discuss how these principles could be implemented within daily practice, thus maximising staff engagement.

· Physiotherapists aimed to increase emphasis on establishing the patient’s expectation of the consultation and offering the choice of a further appointment using an options-based approach.

· Evaluation was carried out for the period pre and post roadshows. No additional resources or staffing was required to implement this change


Results: Key benefits over current practice:

· Fewer wasted appointments, with a 22% reduction in the number of review appointment Did Not Attends.

· We achieved an 8% increase in new patient capacity (despite the fact that staffing levels were lower)

· We achieved a reduction in the waiting list of 2.65 weeks, with improved patient choice.

· Reduced staff stress levels.

Conclusion(s): In light of ever-increasing demands on the NHS, this project reflects an innovative yet simple approach to delivering Realistic Medicine principles within physiotherapy practice, benefiting patients, staff and the service as a whole

Cost and savings

No additional costs to run this project


This work has been shared with multiple health professionals across different disciplines both within Lothian and more widely. The findings have been well received with other services looking to implement similar approaches with their services. The next steps involve looking at ways to further implement Realistic Medicine principles into our practice, thus ensuring we are truly listening to our patients and engaging them in their care

Top three learning points

No further information.

Funding acknowledgements

Not funded