Trial reportBMJ open2017
STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain.
Trial report in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 4 of them syntheses that pooled 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.
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.
Who cites it
28 citing papers in PubMed, 4 syntheses or guidelines pooled it, 62 citations in OpenAlex.
- Systematic review of direct access physiotherapy for musculoskeletal conditions in primary care: consequences for general practitioner workload, resource use, and organisation of care.BMC primary care · 2026Pooled it
- Interventions to improve referrals from primary care to outpatient specialist services for chronic conditions: a systematic review and framework synthesis update.Systematic reviews · 2025Pooled it
- Models of care for managing non-specific low back pain.The Cochrane database of systematic reviews · 2025Pooled it
- Do recommended interventions widen or narrow inequalities in musculoskeletal health? An equity-focussed systematic review of differential effectiveness.Journal of public health (Oxford, England) · 2022Pooled it
- Trial
- Trial
- How direct access to physiotherapy reshapes GP gatekeeping for musculoskeletal care in primary care: an exploratory organisational typology across health systems.Family medicine and community health · 2026Article
- The value of integrating physical therapists into primary care, including patient outcomes and health care costs: a scoping review.Physical therapy · 2026Article
- Factors that influence the use of direct access to allied health professionals in the Netherlands.Primary health care research & development · 2025Article
- Musculoskeletal Health and Work: Development and Internal-External Cross-Validation of a Model to Predict Risk of Work Absence and Presenteeism in People Seeking Primary Healthcare.Journal of occupational rehabilitation · 2025Article
- Advanced Practice Physiotherapy in Canada: A Survey of Canadian Physiotherapists.Physiotherapy Canada. Physiotherapie Canada · 2025Article
- Proactive clinical review of patients taking opioid medicines long term for persistent pain led by clinical pharmacists in primary care teams (PROMPPT): a non-randomised mixed methods feasibility study.Pilot and feasibility studies · 2025Article
- Barriers to the use of direct access according to allied health professionals; an exploration among Dutch physiotherapists, dietitians, and health insurers.BMC primary care · 2025Article
- First contact physiotherapy: an evaluation of clinical effectiveness and costs.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Article
- Reducing strain on primary healthcare systems through innovative models of care: the impact of direct access physiotherapy for musculoskeletal conditions-an interrupted time series analysis.Family medicine and community health · 2024Article
- Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review.Journal of clinical medicine · 2023Review
- Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development: the EASIER study.BMC musculoskeletal disorders · 2023Article
- Influence of Initial Health Care Provider on Subsequent Health Care Utilization for Patients With a New Onset of Low Back Pain: A Scoping Review.Physical therapy · 2022Article
- Strategies to Increase Access to Outpatient Physiotherapy Services: A Scoping Review.Physiotherapy Canada. Physiotherapie Canada · 2022Article
- Reply to Moretti et al. Would Moving Forward Mean Going Back? Comment on "Maselli et al. Direct Access to Physical Therapy: Should Italy Move Forward?International journal of environmental research and public health · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
introductionAround 17% of general practitioner (GP) consultations are for musculoskeletal conditions, which will rise as the population ages. Patient direct access to physiotherapy provides one solution, yet adoption in the National Health Service (NHS) has been slow.
settingA pilot, pragmatic, non-inferiority, cluster randomised controlled trial (RCT) in general practice and physiotherapy services in the UK.
objectivesInvestigate feasibility of a main RCT.
participantsAdult patients registered in participating practices and consulting with a musculoskeletal problem.
interventions4 general practices (clusters) randomised to provide GP-led care as usual or the addition of a patient direct access to physiotherapy pathway. OUTCOMES: Process outcomes and exploratory analyses of clinical and cost outcomes. DATA COLLECTION: Participant-level data were collected via questionnaires at identification, 2, 6 and 12 months and through medical records. BLINDING: The study statistician and research nurses were blinded to practice allocation.
resultsOf 2696 patients invited to complete study questionnaires, 978 participated (intervention group n=425, control arm n=553) and were analysed. Participant recruitment was completed in 6 months. Follow-up rates were 78% (6 months) and 71% (12 months). No evidence of selection bias was observed. The direct access pathway was used by 90% of patients in intervention practices needing physiotherapy. Some increase in referrals to physiotherapy occurred from one practice, although waiting times for physiotherapy did not increase (28 days before, 26 days after introduction of direct access). No safety issues were identified. Clinical and cost outcomes were similar in both groups. Exploratory estimates of between group effect (using 36-item Short Form Health Survey (SF-36) Physical Component Summary (PCS)) at 6 months was -0.28 (95% CI -1.35 to 0.79) and at 12 months 0.12 (95% CI -1.27 to 1.51).
conclusionsA full RCT is feasible and will provide trial evidence about the clinical and cost-effectiveness of patient direct access to physiotherapy. TRIAL REGISTRATION NUMBER: ISRCTN23378642.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.