Integration of Musculoskeletal Physical Therapy Care in the Patient Centered Medical Home

NCT03110211 | Completed

• 1 other identifier: Pro00081069
• Study Type: interventional
• Target: 146
• Locations: 1 country
• Sites: 1

Brief Summary

Purpose and Objective: To determine the effectiveness of a physical therapist first versus a primary care physician first for patients entering a primary care setting with a musculoskeletal complaint on the outcomes of costs/charges, utilization and healthcare satisfaction. Study activities and population group: This will be a randomized clinical trial enrolling patients who are seeking care to the Duke Outpatient Clinic with a musculoskeletal complaint. Patients, adults aged 18 years or greater, that agree to be part of the study will be randomized to see a physical therapist first or primary care physician first. All aspects of the evaluation and treatment by both providers will be standard care for musculoskeletal conditions. Data analysis and risk/safety issues: Descriptive data including means and standard deviations and counts and proportions of baseline scores will be conducted. Differences in total costs/charges, opioid prescriptions, emergency department visits will be calculated and tested across groups. Participants may not personally be helped by taking part in this study. Participants may experience improvements in pain, function, or other symptoms from physical therapy program in this study. There is a minimal risk of loss of confidentiality. If a patient chooses not to participate, there will be no effect on their medical treatment and the study team will cease contact.

Conditions

Musculoskeletal Pain Disorder

Outcome Measures

Primary Outcomes (2)

• Total patient costs accrued for musculoskeletal care during the 3 month study period

  Total costs accrued for musculoskeletal care will be aggregated and abstracted by revenue code by the Duke University Health System Department of Finance

  3 months

• Total patient charges submitted for musculoskeletal care during the 3 month study period

  Total charges submitted for musculoskeletal care will be aggregated and abstracted by revenue code by the Duke University Health System Department of Finance

  3 months

Secondary Outcomes (7)

• Patient Satisfaction with Healthcare

  3 months

• Opioid prescriptions

  3 months

• Emergency Room Visits

  3 months

• Imaging received

  3 months

• Physical Therapy Missed Appointments

  3 months

Study Arms (2)

Physical Therapist Evaluation

EXPERIMENTAL

Patients are randomized to have an initial appointment with a physical therapist for a musculoskeletal complaint. The intervention is an initial evaluation and treatment recommendations by a physical therapist.

Procedure: Physical Therapist Evaluation

Primary Care Physician Evaluation

EXPERIMENTAL

Patients are randomized to have an initial appointment with a primary care physician for a musculoskeletal complaint. The intervention is an initial evaluation and treatment recommendations by a primary care physician.

Procedure: Primary Care Physician

Interventions

Physical Therapist Evaluation PROCEDURE

Participants assigned to this group will receive an initial evaluation and treatment recommendations by a physical therapist.

Also known as: PT First

Physical Therapist Evaluation

Primary Care Physician PROCEDURE

Participants assigned to this group will receive an initial evaluation and treatment recommendations by a primary care physician.

Also known as: PCP First

Primary Care Physician Evaluation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients seeking care to the Duke Outpatient Clinic for a musculoskeletal complaint
• Patients speak English

You may not qualify if:

• Physical Therapist determines inappropriate for study due to medical reasons
• Patient does not speak English

Sponsors & Collaborators

• Duke University: lead

Study Sites (1)

Duke Outpatient Clinic

Durham, North Carolina, 27704, United States

Location

Related Publications (8)

• Storheim K, Zwart JA. Musculoskeletal disorders and the Global Burden of Disease study. Ann Rheum Dis. 2014 Jun;73(6):949-50. doi: 10.1136/annrheumdis-2014-205327. No abstract available.

  PMID: 24790065 BACKGROUND

• Goode AP, Freburger JK, Carey TS. The influence of rural versus urban residence on utilization and receipt of care for chronic low back pain. J Rural Health. 2013 Spring;29(2):205-14. doi: 10.1111/j.1748-0361.2012.00436.x. Epub 2012 Sep 27.

  PMID: 23551651 BACKGROUND

• Carey TS, Freburger JK. Exercise and the Prevention of Low Back Pain: Ready for Implementation. JAMA Intern Med. 2016 Feb;176(2):208-9. doi: 10.1001/jamainternmed.2015.7636. No abstract available.

  PMID: 26752108 BACKGROUND

• Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS. The rising prevalence of chronic low back pain. Arch Intern Med. 2009 Feb 9;169(3):251-8. doi: 10.1001/archinternmed.2008.543.

  PMID: 19204216 BACKGROUND

• Carey TS, Freburger JK, Holmes GM, Castel L, Darter J, Agans R, Kalsbeek W, Jackman A. A long way to go: practice patterns and evidence in chronic low back pain care. Spine (Phila Pa 1976). 2009 Apr 1;34(7):718-24. doi: 10.1097/BRS.0b013e31819792b0.

  PMID: 19282797 BACKGROUND

• Katon W. Health reform, research pave way for collaborative care for mental illness. Interview by Bridge M. Kuehn. JAMA. 2013 Jun 19;309(23):2425-6. doi: 10.1001/jama.2013.6494. No abstract available.

  PMID: 23780435 BACKGROUND

• Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012 Aug;169(8):790-804. doi: 10.1176/appi.ajp.2012.11111616.

  PMID: 22772364 BACKGROUND

• Carvalho E, Bettger JP, Bowlby L, Carvalho M, Dore D, Corcoran MW, Harris AA, Bond J, Goode AP. Integration of musculoskeletal physical therapy care in the patient-centred medical home (IMPaC): protocol for a single-site randomised clinical trial. BMJ Open. 2018 Aug 8;8(8):e022953. doi: 10.1136/bmjopen-2018-022953.

  PMID: 30093522 DERIVED

MeSH Terms

Conditions

Collagen Diseases

Interventions

Physicians, Primary Care

Condition Hierarchy (Ancestors)

Connective Tissue Diseases; Skin and Connective Tissue Diseases

Intervention Hierarchy (Ancestors)

Physicians; Health Personnel; Health Care Facilities Workforce and Services

Study Officials

• Adam P Goode, DPT, PhD

  Associate Professor

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 31, 2017
• First Posted: April 12, 2017
• Study Start: August 14, 2017
• Primary Completion: January 1, 2019
• Study Completion: January 1, 2019
• Last Updated: February 15, 2019

Record last verified: 2018-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)