{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:15:17Z","timestamp":1753877717050,"version":"3.41.2"},"reference-count":65,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011698","name":"Chartered Society of Physiotherapy Charitable Trust","doi-asserted-by":"publisher","award":["SRP (11)2"],"award-info":[{"award-number":["SRP (11)2"]}],"id":[{"id":"10.13039\/100011698","id-type":"DOI","asserted-by":"publisher"}]},{"name":"GP and Physiotherapy Research Facilitators"},{"name":"Australian National Health and Medical Research Council","award":["2018182"],"award-info":[{"award-number":["2018182"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The aims of the study were to identify prognostic factors associated with health care outcomes in patients with musculoskeletal (MSK) conditions in primary care and to determine whether characteristics associated with choice of care modify treatment effects of a direct-access physical therapist\u2013led pathway in addition to general practitioner (GP)\u2013led care compared to GP-led care alone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A secondary analysis of a 2-parallel-arm, cluster randomized controlled trial involving general practices in the United Kingdom was conducted. Practices were randomized to continue offering GP-led care or to also offer a direct-access physical therapist\u2013led pathway. Data from adults with MSK conditions who completed the 6-month follow-up questionnaire were analyzed. Outcomes included physical health, opioid prescription, and self-reported health care utilization over 6\u00a0months. Treatment effect modifiers were selected a priori from associations in observational studies. Multivariable regression models identified potential prognostic factors, and interaction analysis tested for potential treatment effect modifiers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Analysis of 767 participants indicated that baseline pain self-efficacy, pain severity, and having low back pain statistically predicted outcomes at 6\u00a0months. Higher pain self-efficacy scores at baseline were associated with improved physical health scores, reduced opioid prescription, and less health care utilization. Higher bodily pain at baseline and having low back pain were associated with worse physical health scores and increased opioid prescription. Main interaction analyses did not reveal that patients\u2019 age, level of education, duration of symptoms, or MSK presentation influenced response to treatment, but visual trends suggested those in the older age group proceeded to fewer opioid prescriptions and utilized less health care when offered direct access to physical therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients with MSK conditions with lower levels of pain self-efficacy, higher pain severity, and presenting with low back pain have less favorable clinical and health care outcomes in primary care. Prespecified characteristics did not modify the treatment effect of the offer of a direct-access physical therapist\u2013led pathway compared to GP-led care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact<\/jats:title>\n                  <jats:p>Patients with MSK conditions receiving primary care in the form of direct-access physical therapist\u2013led or GP-led care who have lower levels of self-efficacy, higher pain severity, and low back pain are likely to have a less favorable prognosis. Age and duration of symptoms should be explored as potential patient characteristics that modify the treatment response to a direct-access physical therapist\u2013led model of care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzae066","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T17:23:09Z","timestamp":1714670589000},"source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Factors and Treatment Effect Modifiers for Physical Health, Opioid Prescription, and Health Care Utilization in Patients With Musculoskeletal Disorders in Primary Care: Exploratory Secondary Analysis of the STEMS Randomized Trial of Direct Access to Physical Therapist\u2013Led Care"],"prefix":"10.1093","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5596-1923","authenticated-orcid":false,"given":"James","family":"Zouch","sequence":"first","affiliation":[{"name":"The University of Sydney Faculty of Medicine and Health, , Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazim","family":"Bhimani","sequence":"additional","affiliation":[{"name":"The University of Sydney Faculty of Medicine and Health, , Sydney, New South Wales, Australia"},{"name":"Royal North Shore Hospital Upper Gastrointestinal Surgical Unit, , Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9","family":"Bussi\u00e8res","sequence":"additional","affiliation":[{"name":"Universit\u00e9 du Qu\u00e9bec \u00e0 Trois-Rivi\u00e8res D\u00e9partement de Chiropratique, , Trois-Rivi\u00e8res, Quebec, Canada"},{"name":"McGill University School of Physical & Occupational Therapy, , Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela L","family":"Ferreira","sequence":"additional","affiliation":[{"name":"The University of Sydney Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, , Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine E","family":"Foster","sequence":"additional","affiliation":[{"name":"The University of Queensland and Metro North Hospital and Health Service Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, , Herston, Queensland, Australia"},{"name":"Keele University Primary Care Centre Versus Arthritis, School of Medicine, , Newcastle-under-Lyme, Staffordshire, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo","family":"Ferreira","sequence":"additional","affiliation":[{"name":"The University of Sydney Faculty of Medicine and Health, Musculoskeletal Pain Hub, Charles Perkins Centre, Sydney Musculoskeletal Health, , Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"key":"2024090100064359600_ref1","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: a systematic analysis for the global burden of disease study 2017","volume":"392","author":"James","year":"2018","journal-title":"Lancet"},{"key":"2024090100064359600_ref2","doi-asserted-by":"crossref","first-page":"372","DOI":"10.3399\/bjgp14X680749","article-title":"Research into practice: improving musculoskeletal care in general practice","volume":"64","author":"Helliwell","year":"2014","journal-title":"Br J Gen Pract"},{"year":"2019","journal-title":"Australian Institute of Health and Welfare. 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