Chief Investigator:

Principal Investigator:

Study Co-ordinator:

Funder name / reference number: The Chartered Society of Physiotherapy Charitable Trust (CSP) Charitable Trust/ Reference SRP(11)2
UKCRN Study portfolio: 14803, ISRCTN23378642, CSP Ref: 116679
Year 2010-2012, 2013-2015

Study design

A pilot pragmatic non-inferiority cluster randomised controlled trial.

GP practices were the unit of randomisation and thus patients followed the care pathways to which the practice was randomised. Four GP practices were recruited each was randomised to one of two groups: either to continue with usual GP-led primary care for musculoskeletal patients with the addition of the offer of self-referral to physiotherapy (intervention group) or to continue with usual GP-led primary care alone (usual care control group).

Adults who consulted participating GP practices or physiotherapy services with musculoskeletal problems were recruited into the STEMS trial. Participants completed questionnaires at baseline, 2, 6 and 12 months.

Primary objective

The overall aim of the STEMS pilot trial is to assess the feasibility of a future larger trial to compare the clinical and cost-effectiveness of the additional offer of self-referral to physiotherapy versus continuing with usual GP-led care alone for adults with common musculoskeletal problems.


Usual care in GP practices; allocated to the control arm patients will continue to be managed according to usual GP-led care. Intervention: In practices allocated to the intervention arm patients will continue to be able to access care via usual GP-led care pathways in addition to a new self-referral physiotherapy pathway for musculoskeletal patients. The self-referral pathway will allow adults with musculoskeletal problems to refer themselves directly to the physiotherapy service.