Changes to healthcare design and delivery involving advanced physiotherapy roles may help health systems to meet challenges imposed by ageing populations, long-term conditions and unsustainable healthcare costs. This narrative literature review examined recent peer-reviewed literature (2010-2017), including primary studies and systematic reviews, that investigated the impact of advanced physiotherapy on healthcare efficacy, efficiency, service design or perceptions (consumers or health professionals) of these advanced roles. Thirty-five studies were included that investigated advanced physiotherapy roles in primary care, emergency department, orthopaedic outpatient and rheumatology clinic contexts. Implementation of these roles was found to reduce waiting times for appointments, reduce length of stay, improve access to care, reduce other clinicians' workload in primary care and emergency departments, streamline orthopaedic surgeons' caseload, and improve patient satisfaction. Some studies observed patient recovery outcomes following advanced practice physiotherapist care, but none compared these to existing models of care. In addition, few studies explored non-musculoskeletal physiotherapy fields or the New Zealand context, and no studies investigated the impact on consumer choice. More clearly defined and consistent use of advanced physiotherapy roles within the literature would enable a better understanding of the potential impact on health care. Overall, evidence suggested that advanced physiotherapy roles may provide benefits to the public and health system when implemented in innovative, interdisciplinary and non-traditional ways.

Suitable execution of moderation policy is challenging but crucial for the trustworthiness and credibility of internal high-stakes assessment systems. In formal education, policies are rarely implemented as intended. Instead, they are enacted in ways influenced by mediating factors including the internal and external contexts of organisations. Ball, Maguire and Braun’s (2012) contextual-dimensions heuristic provides a conceptualisation of organisation-specific contexts, which is useful when the organisation is the unit of analysis. However, comprehensive analysis of policy enactment—including that relating to moderation—warrants consideration of contexts narrower in scope than whole organisations and wider in scope than individual organisations. In this article, we modify Ball and colleagues’ heuristic, incorporating Biggs’ (1993) application of systems theory, to develop a new contextual framework for moderation that is applicable on multiple scales and enables such analysis. This framework is applied to a selection of contemporary moderation studies with scopes that vary from one course, to jurisdiction-wide, to illustrate its utility. Our framework captures the hierarchy of embedded, interacting systems within which moderation is enacted and makes contextual relationships visible, allowing consideration of perspectives between units of analysis. Our framework provides a nuanced conceptualisation of context that distinguishes between material and human factors, and intrinsic and extrinsic contexts. We present potential uses of the framework for education organisations, central agencies and researchers including as a tool for identifying contextual factors involved in executing moderation initiatives and identifying possible pressures, tensions and enablers.