Article Text

Download PDFPDF

A pragmatic randomised controlled trial of ‘PhysioDirect’ telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation
  1. Sandra Hollinghurst1,
  2. Joanna Coast2,
  3. John Busby1,
  4. Annette Bishop3,
  5. Nadine E Foster3,
  6. Angelo Franchini4,
  7. Sean Grove5,
  8. Jeanette Hall5,
  9. Cherida Hopper1,
  10. Surinder Kaur1,
  11. Alan A Montgomery6,
  12. Chris Salisbury1
  1. 1Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
  2. 2Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK
  3. 3Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
  4. 4Imperial Clinical Trials Unit, School of Public Health Medicine, Imperial College, London, UK
  5. 5Musculoskeletal Outpatient Department, Bristol Community Health, Bristol, UK
  6. 6Nottingham Clinical Trials Unit, Queen's Medical Centre, Nottingham, UK
  1. Correspondence to Sandra Hollinghurst; s.p.hollinghurst{at}


Objectives To compare the cost-effectiveness of PhysioDirect with usual physiotherapy care for patients with musculoskeletal problems.

Design (1) Cost-consequences comparing cost to the National Health Service (NHS), to patients, and the value of lost productivity with a range of outcomes. (2) Cost-utility analysis comparing cost to the NHS with Quality-Adjusted Life Years (QALYs).

Setting Four physiotherapy services in England.

Participants Adults (18+) referred by their general practitioner or self-referred for physiotherapy.

Interventions PhysioDirect involved telephone assessment and advice followed by face-to-face care if needed. Usual care patients were placed on a waiting list for face-to-face care.

Primary and secondary outcomes Primary clinical outcome: physical component summary from the SF-36v2 at 6 months. Also included in the cost-consequences: Measure Yourself Medical Outcomes Profile; a Global Improvement Score; response to treatment; patient satisfaction; waiting time. Outcome for the cost-utility analysis: QALYs.

Results 2249 patients took part (1506 PhysioDirect; 743 usual care). (1) Cost-consequences: there was no evidence of a difference between the two groups in the cost of physiotherapy, other NHS services, personal costs or value of time off work. Outcomes were also similar. (2) Cost-utility analysis based on complete cases (n=1272). Total NHS costs, including the cost of physiotherapy were higher in the PhysioDirect group by £19.30 (95% CI −£37.60 to £76.19) and there was a QALY gain of 0.007 (95% CI −0.003 to 0.016). The incremental cost-effectiveness ratio was £2889 and the net monetary benefit at λ=£20 000 was £117 (95% CI −£86 to £310).

Conclusions PhysioDirect may be a cost-effective alternative to usual physiotherapy care, though only with careful management of staff time. Physiotherapists providing the service must be more fully occupied than was possible under trial conditions: consideration should be given to the scale of operation, opening times of the service and flexibility in the methods used to contact patients.

  • economic evaluation
  • physiotherapy
  • telehealth
  • costs & cost analysis

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.