Impact of direct access on the quality of primary care musculoskeletal physiotherapy: a scoping review from a patient, provider, and societal perspective.

This is a scoping review, not a single controlled trial, so it maps the evidence rather than proving that direct access causes any outcome. Only one of the five systematic reviews had an overall low risk of bias, and for every risk-of-bias domain, at least one included study was scored high risk. The search was limited to English, Dutch, and French and to MEDLINE and Web of Science, so relevant work may have been missed. Four primary studies were included, but three were retrospective cohort studies and one was a pilot RCT. Primary studies had relatively short follow-up of about 1 month, so longer-term effects may not be captured. No results were reported on physiotherapist responsibility, liability, status, prestige, or job satisfaction. Return-to-work findings were inconsistent, so the review does not settle whether direct access reliably helps people work.

The authors declare no conflict of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Do not conclude that direct-access physiotherapy improves pain, quality of life, or function. The review reports no significant differences for those patient outcomes, with benefits seen mainly in waiting time, medication, imaging, and costs.