Feasibility trial tests giving physiotherapists individual feedback to standardise MSK referral decisions

A UK cluster randomised feasibility trial across four primary care sites tested PRISM, a clinician-facing dashboard that gives First Contact Physiotherapists individualised social-norms feedback — for example, how their referral and social-prescribing rates compare with their peers — with the aim of reducing unwarranted variation in musculoskeletal (MSK) referral decisions [Primary Study].

As a feasibility trial, the study is designed to test whether the dashboard and trial methods work, not to demonstrate a definitive effect on referral variation or patient outcomes; a full-scale trial would be needed to establish whether the feedback changes referral behaviour or outcomes at scale.

Unwarranted variation in MSK referral decisions between similar patients seeing different clinicians is a well-recognised but rarely directly addressed problem in primary care musculoskeletal pathways. This trial offers a low-cost, scalable candidate tool — individualised feedback rather than new treatment — for services seeking to standardise First Contact Physiotherapy referral decisions, pending confirmatory trial results.