The aim of this study is to investigate the clinical effectiveness of an advanced practice physiotherapist triaging patients referred from primary care to the orthopaedic clinic with chronic hip and knee pain. An exploratory study design was used to assess 87 consecutive patients referred from general practice in Northern Tasmania. Patients were assessed by both an advanced practice physiotherapist and a consultant orthopaedic surgeon. Diagnostic and treatment decisions were compared, with the orthopaedic consultant decision defined as the gold standard. By using these decisions, over and under referral rates to orthopaedics could be calculated, as well as the surgical conversion rate. Conservative care of patients referred to the orthopaedic clinic with hip and knee pain was limited. The diagnostic agreement between the advanced scope physiotherapist and the orthopaedic surgeon was almost perfect (weighted kappa 0.93 (95% CI 0.87–1.00)), with treatment agreement substantial (weighted kappa 0.75 (95% CI 0.62–0.89)). Under a physiotherapist-led triage service, the surgical conversion rate doubled from 38% to 78%. An advanced physiotherapist assessing and treating patients with chronic hip and knee pain made decisions that match substantially with decisions made by an orthopaedic consultant. A model of care utilising an advanced physiotherapist in this way has the potential to support high-quality orthopaedic care in regional centres.

ObjectiveTo assess the potential impact of the Shetty test over Ottawa ankle foot rules (OAFR) on plain imaging utilisation in the ED.MethodsNursing and medical staff assessed both Shetty test and OAFR in ED. All patients received ankle and foot radiographs.ResultsFifty‐four participants were assessed. Shetty test specificity at triage was 0.40 (95% CI 0.25–0.57), compared to OAFR 0.10 (95% CI 0.03–0.24), McNemar's P < 0.01. Shetty test and OAFR sensitivity at triage was 0.92 (95% CI 0.64–0.99), McNemar's P = 1.00.ConclusionShetty test may safely reduce unneeded radiographs in ED. Further research is warranted.