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Background <p>Musculoskeletal disorders (MSDs) are frequent and disabling conditions in primary care and contribute substantially to general practitioners’ (GPs) workload. Direct access (DA) to physiotherapy, allowing patients to consult physiotherapists without prior medical referral, has been proposed to streamline care, reduce delays, and optimise resource use. This systematic review synthesized the effects of DA on GPs’ practice and the organisation of primary care for adults with MSDs.</p> Methods <p>Following PRISMA 2020, we systematically searched 12 databases/platforms (MEDLINE/PubMed, Embase, Cochrane Library, CINAHL, PEDro, Web of Science, Scopus, Cairn.info, Érudit, ClinicalTrials.gov) and discovery platforms (ScienceDirect, Google Scholar), plus grey literature, from 15 July 2024 to 4 November 2025 (initial search 15 July–15 October 2024; updated search 1 January 2024–4 November 2025). Eligible studies assessed the consequences of DA to physiotherapy for MSDs in primary care versus GP-referred pathways (referral-based usual care). Two reviewers independently screened, extracted data, as well as appraised quality using the Newcastle–Ottawa Scale (observational studies), ROB 2.0 (RCTs), and graded certainty using GRADE at the study level. Outcomes included GP workload, imaging and medication prescriptions, clinical results, costs, and safety.</p> Results <p>We included 21 studies (7 RCTs, 14 observational) totaling 90 401 patients (15 017 DA; 75 384 GP-referred). Across 15 studies, DA was associated with 10–30% fewer GP consultations. 14 studies reported reduced imaging and medication use under DA; effects on prescriptions were context-dependent. 14 studies showed non-inferior clinical outcomes, with small early advantages in some RCTs. 13 studies assessed costs, indicating neutral to reduced per-episode costs; two RCT-linked economic analyses were comparable or favorable to DA. No serious adverse events attributable to DA were reported (5 studies). GRADE certainty was moderate in 2, low in 12, and very low in 5 studies, limited by observational predominance and small RCT samples. Totals refer to study-level GRADE assessments (<i>n</i> = 19), as two economic evaluations were linked to their parent RCTs.</p> Conclusions <p>In adults with MSDs, DA to physiotherapy appears to lessen GP workload and resource use with clinical outcomes similar to GP-referred pathways and no consistent signal of increased harms. Given methodological limitations, further robust comparative studies are warranted to inform large-scale implementation and policy in primary care.</p> Trial registration <p> OSF (ID 897ub; registered 15 August 2024; <a href="https://osf.io/897ub/">https://osf.io/897ub/</a>).</p>

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Systematic review of direct access physiotherapy for musculoskeletal conditions in primary care: consequences for general practitioner workload, resource use, and organisation of care

  • 期刊论文

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  • 发表日期：

    2026年1月30日

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  • Matthieu Fischer,
  • Emilie Bui,
  • Laure Besombes,
  • Mathilde François

摘要

Background

Musculoskeletal disorders (MSDs) are frequent and disabling conditions in primary care and contribute substantially to general practitioners’ (GPs) workload. Direct access (DA) to physiotherapy, allowing patients to consult physiotherapists without prior medical referral, has been proposed to streamline care, reduce delays, and optimise resource use. This systematic review synthesized the effects of DA on GPs’ practice and the organisation of primary care for adults with MSDs.

Methods

Following PRISMA 2020, we systematically searched 12 databases/platforms (MEDLINE/PubMed, Embase, Cochrane Library, CINAHL, PEDro, Web of Science, Scopus, Cairn.info, Érudit, ClinicalTrials.gov) and discovery platforms (ScienceDirect, Google Scholar), plus grey literature, from 15 July 2024 to 4 November 2025 (initial search 15 July–15 October 2024; updated search 1 January 2024–4 November 2025). Eligible studies assessed the consequences of DA to physiotherapy for MSDs in primary care versus GP-referred pathways (referral-based usual care). Two reviewers independently screened, extracted data, as well as appraised quality using the Newcastle–Ottawa Scale (observational studies), ROB 2.0 (RCTs), and graded certainty using GRADE at the study level. Outcomes included GP workload, imaging and medication prescriptions, clinical results, costs, and safety.

Results

We included 21 studies (7 RCTs, 14 observational) totaling 90 401 patients (15 017 DA; 75 384 GP-referred). Across 15 studies, DA was associated with 10–30% fewer GP consultations. 14 studies reported reduced imaging and medication use under DA; effects on prescriptions were context-dependent. 14 studies showed non-inferior clinical outcomes, with small early advantages in some RCTs. 13 studies assessed costs, indicating neutral to reduced per-episode costs; two RCT-linked economic analyses were comparable or favorable to DA. No serious adverse events attributable to DA were reported (5 studies). GRADE certainty was moderate in 2, low in 12, and very low in 5 studies, limited by observational predominance and small RCT samples. Totals refer to study-level GRADE assessments (n = 19), as two economic evaluations were linked to their parent RCTs.

Conclusions

In adults with MSDs, DA to physiotherapy appears to lessen GP workload and resource use with clinical outcomes similar to GP-referred pathways and no consistent signal of increased harms. Given methodological limitations, further robust comparative studies are warranted to inform large-scale implementation and policy in primary care.

Trial registration

OSF (ID 897ub; registered 15 August 2024; https://osf.io/897ub/).