Guideline-based physiotherapy for non-communicable diseases (NCDs)
What role does physiotherapy play in the treatment of non-communicable diseases in Switzerland? Through a systematic literature search of clinical guidelines, we aim to identify physiotherapeutic interventions.
Factsheet
- Schools involved School of Health Professions
- Institute(s) Physiotherapy
- Research unit(s) Public Health und physiotherapiebezogene Gesundheitsökonomie
- Funding organisation Others
- Duration 01.06.2024 - 30.09.2024
- Head of project Prof. Dr. Nathanael Lutz
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Project staff
Alexander Philipp Schurz
Prof. Dr. Nathanael Lutz
Prof. Dr. Jan Taeymans - Partner Physioswiss
Situation
Non-communicable diseases (NCDs) account for the majority of the disease burden in Switzerland, with approximately 80% of direct healthcare costs attributable to NCDs. Physiotherapy is an essential component of primary healthcare and plays
Course of action
In the first phase, NCDs of particular relevance in the Swiss context were prioritized using prevalence data and disease burden measured by Disability Adjusted Life Years (DALYs). Based on this prioritization, a systematic search for CGs was conducted in databases and guideline repositories in the second phase. Recommendations within these guidelines relevant to the physiotherapy scope of practice were extracted and categorized as “strong recommendation,” “moderate recommendation,” or “recommendation against.” The “recommendation against” category refers to interventions that should not be performed according to the guidelines. In the final phase, for selected NCDs where physiotherapy was identified as a key component of care, health economic studies were reviewed to evaluate cost-effectiveness.
Result
A total of 21 NCDs were included and grouped into nine categories: cancer, cardiovascular diseases, digestive diseases, diabetes and kidney diseases, mental disorders, musculoskeletal diseases, neurological disorders, chronic respiratory diseases, and falls. For each of these 21 NCDs, at least one CG was identified. For 11 NCDs, at least one physiotherapy intervention was strongly recommended. For 13 NCDs, at least one moderate recommendation was identified, while for 5 NCDs, no physiotherapy recommendations were provided. Over half of the strong and moderate recommendations involved exercise therapy and the promotion of physical activity. Additionally, approximately 10% of strong and moderate recommendations included educational or counseling interventions, while 5% of strong and 7% of moderate recommendations involved passive interventions, such as manual therapy or soft tissue techniques. Three systematic reviews and one model-based study were identified that evaluated the cost-effectiveness of the recommended physiotherapy interventions. These studies covered ischemic heart disease, type 2 diabetes mellitus, low back pain, and knee osteoarthritis, and in all cases, the implementation of the recommended interventions was found to be cost-effective.
Looking ahead
The reviewed CGs recommend the use of physiotherapy interventions for the majority of NCDs. Physiotherapy plays a particularly important role in managing musculoskeletal conditions such as osteoarthritis and low back pain, in the rehabilitation of cardiovascular diseases, in type 2 diabetes management, and in the prevention and rehabilitation of falls. The primary focus of these recommendations lies in exercise therapy, the promotion of physical activity, and educational and counseling interventions. Health economic evaluations further demonstrate that implementing these recommendations is cost-effective. To fully leverage the benefits of physiotherapy in the management of NCDs, coordinated efforts from all stakeholders are required. Universities of applied sciences need to align their curricula accordingly, policymakers must establish frameworks that support the implementation of guideline-based recommendations with fair reimbursement structures and appropriate treatment duration and intensity, and physiotherapists and their professional associations must adapt to the evolving healthcare landscape by reconsidering outdated practices and embracing evidence-based practice.
