Most MSK conditions need time to heal and resolve and early review has not been shown to be useful. Evidence suggests a review period of 12 weeks is optimal.

If you are considering booking a scheduled review for your patient, evidence suggests this should be at 12 weeks unless there is clear clinical justification to review sooner.

Reviews can be:

• Patient initiated – patient is instructed to contact the service within an agreed period if symptoms get worse to arrange face to face review.
• Virtual (telephone/video) - all patients seen in one week can be targeted via a virtual review session.
• Scheduled – where a further appointment is agreed with patient before they leave or an appointment is posted to the patient.

If patient does not request review within agreed timescale it can be assumed the problem has resolved and the patient may be discharged.

If the patient has attended a return appointment and there is no improvement in their condition, escalation should be considered if poor compliance can be ruled out.

It is important to explain to the patient that escalated treatment may not be considered until there is evidence that they have complied with the advice given in the 1st line intervention.

Patients should not attend for 3 or more return appointments without clear clinical justification.

If the patient’s symptoms are persisting due to lack of compliance with self- management advice then you should consider discharging the patient with advice on how to re-access the service once they have followed advice given and symptoms still persist.

Reinforce initial self-management advice, check compliance and technique and advise to continue rehabilitation advice.

Give reassurance that symptoms will continue to improve if rehabilitation package is adhered to.

Arrange to review as appropriate.

Continued Symptoms; No improvement; or unsatisfactory improvement.

Reinforce initial advice, check compliance and technique and advise to continue rehabilitation advice.

Escalate to next appropriate line of treatment or make a referral to the appropriate service if this is outside of the initial clinician’s scope of skills and competency.

Reasons for discharge.

Patient has reached satisfactory level of improvement; Patient goals have been met; No further treatment options available within scope of service.

Advise the patient if they are not yet fully recovered, the likely timescale to full recovery and give clear information on how to re access MSK AHP services if needed and when to seek further input.

Discharge with advice on continued management to reduce likelihood of early recurrence.