Effectiveness of a rapid access musculoskeletal service in rural primary care

Abstract

Introduction: Facing a crippling scarcity of community physiotherapists, a family doctor clinic in rural Canada collaborated with a highly skilled and experienced physiotherapist to provide rapid access to musculoskeletal (MSK) assessment for patients presenting to the doctor or practice nurses. Methods: The physiotherapist saw six patients for 30 minutes each in a weekly session. He did an expert assessment and frequently found a home programme of exercises was the appropriate treatment with onward referral and/or investigation for more complex cases. Results: Rapid access was provided in a convenient location. The alternative was a 12-15 month wait for physiotherapy at least 1 hour's drive away. Outcomes were good. The results of two audits will be presented. Practice use of lab tests and X-rays was reduced. MSK knowledge and skills of doctor and nurses was improved. Discussion: We hypothesised that rapid access to a physiotherapist would lead to improved outcomes compared with the above-noted long wait times. We limited contact to two or, at most, three sessions - ideally just one - to safeguard our goal of rapid access. What we did not expect, and were very surprised to see, was the number of patients - approximately 75% of the total - who had good to excellent outcomes following one or two visits. We postulate that hard-pressed physiotherapy services need a new practice paradigm, using this community-based model. We recommend establishment of further pilot projects with very careful selection of practitioners and detailed evaluation of outcomes.