An exploratory study of physiotherapy telephone assessment

Aims The popular adoption of self referral to physiotherapy across the United Kingdom has increased the use of the telephone as a means of accessing the service. This relies on the physiotherapist's ability to make an accurate diagnosis, leading to an appropriate management decision and thus facilitating the best possible outcome for the patient. This study examined the agreement between telephone and face-to-face management of musculoskeletal conditions and assessed the accuracy of diagnosis over the telephone. Methods 55 patients with musculoskeletal conditions were assessed over the telephone and then face to face. Patients were assigned to either a physiotherapist with less than 2 years of experience (n=33) or to a physiotherapist with over 4 years of experience (n=22). The physiotherapist on the telephone and the physiotherapist in the department made independent diagnoses (clinical impression) and management decisions. Inter-examiner agreement between the telephone and face-to-face management decisions was measured (Kappa coefficient values), and the Fisher's Exact test was used to measure agreement between the provisional telephone diagnosis and the final department diagnosis. Findings Kappa values showed poor agreement for junior staff for the management decision (64% agreement; κ-value of 0.27) and fair to good agreement for experienced staff (91% agreement; κ-value of 0.70). Agreement on diagnosis was good and there was not a significant difference between the junior staff (85%) and experienced staff (91%) (Fisher's Exact test 0.30). Conclusions Findings indicate that diagnosis over the telephone appears to be comparable with face-to-face diagnosis. However, management of musculoskeletal conditions by telephone, particularly by less experienced members of staff, was found to compare less favourably with face-to-face management. Given the growth of telephone assessment in physiotherapy, it is suggested that further research is required to explore its ability to provide an effective and efficient service.