Use of primary care physiotherapy and its associations with clinical and socioeconomic outcomes in musculoskeletal disorders: a cohort study

OBJECTIVES: To assess how physiotherapy contact frequency relates to clinical outcomes in patients with musculoskeletal disorders across prognostic groups, and how outcomes are associated with future healthcare costs and disability pension. DESIGN AND SETTING: Cohort study linking clinical data from the FYSIOPRIM primary care physiotherapy cohort (12-month follow-up) with national registry data on healthcare use, costs, and socioeconomic factors. PARTICIPANTS: 1475 patients were included in FYSIOPRIM at baseline, 671 provided data on all covariates and 12-month outcomes and were included in the analysis. METHOD: Comparing low and high physiotherapy use during a 12 month follow-up period (High use: Median or higher (9+ contacts)). Patients were categorized into good, medium, and poor clinical prognosis based on seven baseline clinical factors. MAIN OUTCOME MEASURES: Global Perceived Effect (GPE) at 12 months, high healthcare costs (≥95th percentile two years post-FYSIOPRIM), and disability pension (1-3 years post-FYSIOPRIM). RESULTS: High physiotherapy use was associated with improvement in GPE in patients with poor prognosis (OR 4.04, 95%CI 1.56-10.50) but not for good or medium prognosis. Improvement on GPE was associated with lower odds of high future healthcare costs (OR 0.27, 95%CI 0.13-0.58) and disability pension (OR 0.06, 95%CI 0.01-0.53). CONCLUSIONS: Patients with poor prognosis may benefit from more physiotherapy contacts, while those with better prognosis may require fewer contacts. Tailoring treatment intensity to prognosis may support more efficient resource allocation and support long-term societal benefits through reduced healthcare costs and disability risk.