June/July 2015 (vol. 12/1)

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Research Plus

Musculoskeletal conditions – intermediate care

Most musculoskeletal (MSK) conditions can be managed with intermediate care – including by physiotherapist-led triage and treatment – without the need for referral to orthopaedic services, this systematic review finds. The NHS MSK Clinical Assessment Treatment Service (MSK CATS) is designed to reduce the reliance on secondary care interventions and reduce waiting times. It is typically delivered by physiotherapists and GPs with a special interest in MSK medicine, and provides rapid assessment and treatment, with secondary referrals only when necessary. It included 23 three papers, 14 exploring MSK CATS, and nine examining referral pathways in intermediate care. Between 72% and 97% of MSK patients were managed entirely by intermediate care, leading to a 20%–60% reduction in orthopaedic referrals. Clinical decisions and referral accuracy by physiotherapists was comparable to those of doctors in 68%–96% of cases. Reduced waiting times and patient satisfaction is reported. Most studies were of low quality – only one was a randomised controlled trial. 

  1. Intermediate care pathways for musculoskeletal conditions – Are they working? A systematic review. Physiotherapy 2015; 101(1): 13–24. doi: 10.1016/j.physio.2014.08.004


Occupational Health at Work June/July 2015 (vol. 12/1) pp36