Evidence map›Paper›PMID 10616677›Full record

Trial reportJournal of epidemiology and community health1999

A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments.

G Daker-White, A J Carr, I Harvey, G Woolhead, G Bannister, I Nelson, M Kammerling

Open access · bronzeAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of epidemiology and community health, 1999. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
70citing papers in PubMed, 7 pooled it
3.9field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

70 citing papers in PubMed, 7 syntheses or guidelines pooled it, 240 citations in OpenAlex.

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  4. Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2021
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  6. What is orthopaedic triage? A systematic review.Journal of evaluation in clinical practice · 2015
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10 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

G Daker-WhiteDepartment of Social Medicine, University of Bristol.
A J Carr
I Harvey
G Woolhead
G Bannister
I Nelson
M Kammerling
University of Bristol · GB

Funding

VALIDATION OF SELF REPORTED OSTEOARTHRITIS IN THE NURSES HEALTH STUDY COHORTP60AR036308 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI LEBOFF, MERYL S · 1986 to 2000
$1.5M
NIAMS NIH HHS AR36308
6 · The paper itself

Abstract

objectiveTo evaluate the effectiveness and cost effectiveness of specially trained physiotherapists in the assessment and management of defined referrals to hospital orthopaedic departments.

designRandomised controlled trial.

settingOrthopaedic outpatient departments in two hospitals. SUBJECTS: 481 patients with musculoskeletal problems referred for specialist orthopaedic opinion.

interventionsInitial assessment and management undertaken by post-Fellowship junior orthopaedic surgeons, or by specially trained physiotherapists working in an extended role (orthopaedic physiotherapy specialists).

main outcome measuresPatient centred measures of pain, functional disability and perceived handicap.

resultsA total of 654 patients were eligible to join the trial, 481 (73.6%) gave their consent to be randomised. The two arms (doctor n = 244, physiotherapist n = 237) were similar at baseline. Baseline and follow up questionnaires were completed by 383 patients (79.6%). The mean time to follow up was 5.6 months after randomisation, with similar distributions of intervals to follow up in both arms. The only outcome for which there was a statistically or clinically important difference between arms was in a measure of patient satisfaction, which favoured the physiotherapist arm. A cost minimisation analysis showed no significant differences in direct costs to the patient or NHS primary care costs. Direct hospital costs were lower (p < 0.00001) in the physiotherapist arm (mean cost per patient = 256 Pounds, n = 232), as they were less likely to order radiographs and to refer patients for orthopaedic surgery than were the junior doctors (mean cost per patient in arm = 498 Pounds, n = 238).

conclusionsOn the basis of the patient centred outcomes measured in this randomised trial, orthopaedic physiotherapy specialists are as effective as post-Fellowship junior staff and clinical assistant orthopaedic surgeons in the initial assessment and management of new referrals to outpatient orthopaedic departments, and generate lower initial direct hospital costs.

Indexed as

OrthopedicsOutpatient Clinics, HospitalPhysical Therapy ModalitiesAdolescentAdultAgedAged, 80 and overCost-Benefit AnalysisFemaleHumansMaleMiddle AgedOutcome Assessment, Health CarePatient SatisfactionPhysical Therapy Department, HospitalUnited Kingdom

Identifiers

PMID10616677
PMCPMC1756791
OpenAlexW2170066319

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.