The evidence for and against 'PhysioDirect' telephone assessment and advice services

Patients have experienced inadequate access to physiotherapy since the inception of the National Health Service (NHS). Over the last 50 years, many initiatives have been introduced to address this problem, the most recent being a new patient management pathway known as 'PhysioDirect'. Within these services, physiotherapists offer initial assessment and advice by telephone, sometimes supported by computerised algorithms, and patients are sent written self-management and exercise advice by post. For some patients, face-to-face physiotherapy care will be offered where this is considered to be more appropriate. Although several such services have been developed across the UK, there is no robust evidence about clinical and cost-effectiveness, nor the acceptability of PhysioDirect to patients, physiotherapists or primary care organisations. This debate article summarises models of PhysioDirect, the links to other healthcare developments and relevant evidence to date about this type of service. By providing a summary of the arguments for, and key concerns about, PhysioDirect, this article stresses the need for more definitive evidence from high-quality randomised controlled trials before widespread roll-out across the NHS.