A combination of increasing demand from primary care and limitations on the capacity of NHS physiotherapy services to respond is likely to re-open the debate about the appropriateness of referred cases. Musculoskeletal symptoms are the commonest, and an increasing, reason for direct referral from primary care to physiotherapy. However, evidence suggests that in primary care such symptoms often ... [Show full abstract] reflect somatisation of patients’ unrecognised mental illness.
In a study of primary care patients with persistent physical symptoms due to somatisation of mental illness, we found a substantial minority (45%) who had been referred for one or more courses of physiotherapy. We present case histories from a number of patients who had received physiotherapy to illustrate patterns of somatisation of mental illness. Physiotherapy does not appear to benefit and may harm such patients by reinforcing their somatic orientation and delaying access to more appropriate interventions.
The absence of recent published accounts of inappropriate referral from general practice to physiotherapy suggests that the problem of somatisation is either not recognised or not acknowledged by the two professions. We consider approaches to reducing this type of inappropriate demand on physiotherapy services.