Evaluation of a primary care musculoskeletal clinical assessment service: a preliminary study

Abstract 

Objectives

To evaluate the clinical effectiveness of a primary care musculoskeletal clinical assessment service (MCAS). The MCAS is a triage and treatment service for the management of patients with musculoskeletal conditions.

Design

Prospective observational cohort study.

Participants

Consecutive patients with musculoskeletal disorders referred to the MCAS from primary care over a 6-month period.

Interventions

Patients were managed within the service in accordance with usual MCAS management/treatment pathways.

Main outcome measures

Previously validated self-administered questionnaires were selected as outcome measures in order to facilitate the use of postal responses. These comprised two generic health status questionnaires (Short Form 36, EuroQol EQ-5D), a pain assessment using a visual analogue scale and two measures of patient satisfaction (Perceived Improvement Evaluation, Deyo and Diehl satisfaction questionnaire). Outcome measures were taken at baseline, and 3 and 12 months after recruitment.

Results

In total, 217 patients were recruited into the study. Significant improvement was demonstrated with EuroQol at 3 and 12 months (P=0.043 and 0.035, respectively) and the pain visual analogue scale at 3 and 12 months (P=0.001 and 0.002, respectively). No significant differences were demonstrated with Short Form 36 (P=0.73 and 0.87). The mean patient-perceived improvement was 33% at 3 months and 46% at 12 months. Results showed high levels of patient satisfaction, with 72% of patients indicating total satisfaction with all aspects of the MCAS.

Conclusions

Nationally, models similar to the MCAS have been developed to help improve care for patients and achieve the 18-week access target. This preliminary study shows the possible benefits of adopting this model of care, and identifies the need for further research.

Keywords: Physiotherapy, Musculoskeletal, Triage, Clinical assessment service, Access