Résumé :
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[BDSP. Notice produite par INIST A71oR0xb. Diffusion soumise à autorisation]. Objective-To evaluate the effectiveness and cost effectiveness of specially trained physiotherapists in the assessment and management of defined referrals to hospital orthopaedic departments. Design-Randomised controlled trial. Setting-Orthopaedic outpatient departments in two hospitals. Subjects-481 patients with musculoskeletal problems referred for specialist orthopaedic opinion. Interventions-Initial assessment and management undertaken by post-Fellowship junior orthopaedic surgeons, or by specially trained physiotherapists working in an extended role (orthopaedic physiotherapy specialists). Main outcome measures-Patient centred measures of pain, functional disability and perceived handicap. Results-A total of 654 patients were eligible to join the trial, 481 (73.6%) gave their consent to be randomised. The two arms (doctor n=244, physiotherapist n=237) were similar at baseline. Baseline and follow up questionnaires were completed by 383 patients (79.6%). The mean time to follow up was 5.6 months after randomisation, with similar distributions of intervals to follow up in both arms. The only outcome for which there was a statistically or clinically important difference between arms was in a measure of patient satisfaction, which favoured the physiotherapist arm. A cost minimisation analysis showed no significant differences in direct costs to the patient or NHS primary care costs. Direct hospital costs were lower (p
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