Elsevier

Physiotherapy

Volume 88, Issue 11, November 2002, Pages 645-657
Physiotherapy

Research report
Patient Satisfaction with a New Physiotherapy Telephone Service for Back Pain Patients

https://doi.org/10.1016/S0031-9406(05)60107-1Get rights and content

Summary

Background and Purpose

Telephone triage and advice are increasingly important ways of managing primary care workload and improving patient access to healthcare services. The role of telephone advice in physiotherapy has not been explored in detail. The purpose of this study was to investigate patient satisfaction with physiotherapy telephone advice in addition to standard management for back pain.

Methods

A randomised controlled trial was conducted in two urban general practices (population 10,500 and 11,500) over five months. Patients with back pain who were referred by their general practitioner to physiotherapy were randomised into a control group who received usual care or an experimental group who received physiotherapy telephone advice before their usual care. Satisfaction levels were measured at the point of discharge from physiotherapy using the Patient Satisfaction with Healthcare Provider Scale.

Results

The experimental group expressed more satisfaction than the control group with the physiotherapy service received (p < 0.05). Physiotherapy telephone advice reduced reported symptoms associated with back pain and was easily remembered by the recipients.

Conclusions

Telephone advice for back pain improves patient satisfaction with physiotherapy. It offers a ‘new way’ of providing physiotherapy care to patients in line with current NHS plans.

Section snippets

Background and Purpose

Back pain is a very common complaint. A comparison of two prevalence surveys at an interval of ten years demonstrated that the one-year prevalence of back pain rose from 36.4% to 49.1%. The trend was consistent across all ages in both men and women, and also within social classes and regions (Palmer et al, 2000). In 1995 back pain was estimated to cost the National Health Service up to £400 million a year (Klaber-Moffett et al, 1995). However, five years later these costs were reported as being

Aims and Objectives

The aim of the study was to test the hypothesis: ‘Providing telephone advice to people with back pain improves satisfaction with a physiotherapy service.’

Objectives were:

  • 1.

    To provide a telephone advice service to patients with back pain.

  • 2.

    To determine the usefulness of this service in terms of patient satisfaction.

Pilot Study

A pilot study was conducted before the main study. This included pre-pilot interviews with consumers (people who had used healthcare services for back pain) to establish issues, related to satisfaction, that were deemed important. This information was used when selecting a patient satisfaction questionnaire to improve content validity. A small pilot study (n = 15) was then conducted to refine the details and design of the pro-posed protocol for the main study.

Main Study

Patients from two practices who

Data Analysis

The computer software Statistical Package for the Social Sciences (SPSS) version 8.0 was used for all the data analysis. Data were double-entered by a second person to ensure accuracy and therefore reliability of data entry.

Results Descriptive Statistics

Of 295 questionnaires distributed, 223 were returned; a response rate of 75.6%. Of the respondents, 34.5% were men (mean age 51.2 years) and 65.5% were women (mean age 50.4 years).

Seven subjects telephoned the surgery and stated that they no longer required assessment as their symptoms had resolved. Six of these subjects were in the experimental group and had received the telephone advice and one was in the control group. Twenty-two subjects either failed to attend their first appointment or

Satisfaction Scores

Descriptive data of satisfaction scores may be seen in table 1.

The mean satisfaction score was higher in the experimental group (74.16) than in the control group (63.39). This difference was significant (p < 0.001). The lowest score in the experimental group was 61 (range 61-80) which was higher than that of the control group (lowest score 33, range 33-80).

This information is demonstrated in figure 3 and clearly supports the experimental hypothesis.

Subjects' Opinions

Responses to the statement ‘The tel-ephone advice the physiotherapist gave me has helped me get better’ are illustrated in figure 4, to ‘I felt very much better after talking to the physiotherapist on the telephone’ in figure 5, and to ‘I followed every detail of the physio-therapist's telephone advice’ in figure 6.

Subjects' Recollection

Table 2 illustrates the responses to the question:

‘When the physiotherapist telephoned you, did you receive any of the following advice?’

Reliability

Cronbach's alpha in this case was 0.94.

Representativeness of the Sample

The sample and population were the same, as no subject met the exclusion criteria.

The sample and ‘pre-study population’ demonstrated very similar age and sex distributions (table 3). It may be conclud-ed from these descriptive statistics that the sample did not differ in terms of age and sex from usual patients who are referred to physiotherapy with back pain.

Table 4 illustrates the age and sex distributions of the wider population. There is a pattern of similarity between this and the sample.

Discussion

The final sample size of 223 gave the statistical analysis a 90% power to detect a difference between the results of the two groups. The return rate of the quest-ionnaires was 75.6%.

Seven patients informed the practice that they did not require physiotherapy assessment as their symptoms had resolved. This may have been due to natural resolution, the medication or advice the general practitioner issued, receipt of another form of treatment – eg home remedies or private healthcare – or as a

Extraneous Variables

It is recognised, however, that other factors may have been of influence. The satisfaction data collected do not isolate satisfaction with the content of infor-mation given from the manner in which it was delivered. The satisfaction may not have been related only to the telephone advice. Other issues that may have in-fluenced the outcome are:

  • The relationship between subjects and their physiotherapists, eg if the relationship was good but the treatment techniques were poor, respondents may

Conclusion

Telephone consulting is an increasingly popular means of healthcare inter-vention. It provides an accessible, con-venient and rapid response service to meet increasing patient demand (DoH, 2000a). The current Labour Government is encouraging its use, but so far no experimental studies have been reported that investigate telephone consulting in physiotherapy.

Findings from this study clearly showed that patients who received telephone advice for their back pain were more satisfied with the

Acknowledgements

Our thanks go to Hilda O'Flanigan, David Rhodes and David Merrick for statistical advice; to Professor Gene Marsh for permission to use the PSHCPS and to the staff and patients of the two general practices involved in this study.

The study was funded by the Royal College of General Practitioners, Connect Physical Health Centres Limited, Newcastle, and Central Surgery, Tyne and Wear.

References (33)

  • N Maniadakis et al.

    ‘The economic burden of back pain in the UK’

    Pain

    (2000)
  • JE Ware et al.

    ‘Behavioral consequences of consumer dissatisfaction with medical care’

    Evaluation and Program Planning

    (1983)
  • A Bryman et al.

    Quantitative Data Analysis with SPSS Release 8 for Windows: A Guide for Social Scientists

    (1999)
  • DC Cherkin et al.

    ‘Patient satisfaction with family physicians and general internists: Is there a difference?’

    Journal of Family Practice

    (1988)
  • Clinical Standards Advisory Group

    ‘Epidemiology review: The epidemiology and cost of back pain’, annex to CSAG Report on Back Pain

    (1994)
  • Clinical Standards Advisory Group

    Back Pain: Report of a CSAG Committee on Back Pain, chairman Professor Michael Rosen

    (1994)
  • J Dale et al.

    ‘Development of telephone advice in A&E: Establishing the views of staff’

    Nursing Standard

    (1995)
  • J Dale et al.

    ‘A study of out-of-hours telephone advice from an A&E department’

    British Journal of Nursing

    (1997)
  • Department of Health

    The NHS Plan: A plan for investment: A plan for reform

    (2000)
  • Department of Health

    Meeting the Challenge: A strategy for the allied health professions

    (2000)
  • CV Egleston et al.

    ‘Use of a telephone advice line in an accident and emergency department’

    British Medical Journal

    (1994)
  • RJ Evans et al.

    ‘Telephone advice in the accident and emergency department: A survey of current practice’

    Archives of Emergency Medicine

    (1993)
  • JL Fleiss

    Statistical Methods for Rates and Proportions

    (1981)
  • M Gallagher et al.

    ‘Telephone triage of acute illness by a practice nurse in general practice: Outcomes of care’

    British Journal of General Practice

    (1998)
  • A Glasper

    ‘Telephone triage: A step forward for nursing practice?’ (editorial)

    British Journal of Nursing

    (1993)
  • C Grbich

    Qualitative Research in Health: Introduction

    (1999)
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    1

    Siobhan Taylor MSc MCSP is a senior physiotherapist at Scarborough General Hospital. She is the lead author of the paper, which records an MSc project.

    2

    Ieuan Ellis MREd CertEd(FE) MCSP DipTP is head of physiotherapy in the School of Health and Professional Practice Studies at the University of Northumbria. He was academic supervisor of the project conducted as an MSc thesis, and co-author of the paper.

    3

    Morris Gallagher MB BS FRCGP is a general practitioner in South Sheilds. He was an external academic and clinical superviser of the project and a co-author of the paper.

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