SynthesisBMC primary care2026
Systematic review of direct access physiotherapy for musculoskeletal conditions in primary care: consequences for general practitioner workload, resource use, and organisation of care.
Synthesis in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Social Determinants of Healthcare Access: Horizontal Inequity in Rehabilitation Utilization and the Limits of Care in Mediating the Income-Depression Gradient in Türkiye.Healthcare (Basel, Switzerland) · 2026Article
- How direct access to physiotherapy reshapes GP gatekeeping for musculoskeletal care in primary care: an exploratory organisational typology across health systems.Family medicine and community health · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMusculoskeletal 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.
methodsFollowing 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.
resultsWe 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.
conclusionsIn 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 registrationOSF (ID 897ub; registered 15 August 2024; https://osf.io/897ub/ ).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.