Exploring repeated re-referral of chronic pain patients into musculoskeletal physiotherapy outpatient departments: a scoping review

Background:
Physiotherapists anecdotally describe repeated re-referral of patients with chronic pain into musculoskeletal physiotherapy outpatient departments, stimulating concerns regarding potential unmet needs for these patients.

Objective:
To investigate current understanding of repeated re-referral into musculoskeletal physiotherapy and other secondary care services, and the extent of investigation to date.

Data sources:
Cochrane, PubMed, and OvidSP databases – AMED, Embase, and Medline.

Study selection:
Inclusion criteria: all literature was included if directly or indirectly relevant to repeated re-referral into musculoskeletal outpatient physiotherapy or other secondary care pathways.

Study appraisal and synthesis:
Studies directly dealing with repeated re-referral of patients into the same secondary care pathway are discussed, observing methods used. Studies relating to initial referral into outpatient physiotherapy are discussed separately. A narrative synthesis of the data has been presented.

Results:
A gap exists in knowledge regarding re-referral into musculoskeletal outpatient physiotherapy, despite a body of evidence relating to initial referral decisions and processes. A paucity of results meant that aspects of re-referral, such as outcomes or costs involved were not addressed. Analysis/synthesis of similar study types is limited due to a lack in high-quality evidence, and of studies with corresponding methodology. Few audits were identified.

Conclusion and implications of key findings:
This scoping review identified a significant gap in knowledge regarding re-referral into musculoskeletal outpatient physiotherapy, despite anecdotal evidence reporting the occurrence, and the existence of a body of evidence relating to the initial referral decision and process. Considering the gap in knowledge, and issues arising around the characteristics of current referrals, it is concluded that further investigation into repeated re-referral to musculoskeletal physiotherapy is warranted.