No abstract

Purpose: To examine the role of an advanced-practice physiotherapist (APP) with respect to (1) agreement with an orthopaedic surgeon on diagnosis and management of patients with shoulder problems; (2) wait times; and (3) satisfaction with care. Methods: This prospective study involved patients with shoulder complaints who were referred to a shoulder specialist in a tertiary care centre. Agreement was examined on seven major diagnostic categories, need for further examination and surgery, and type of surgical procedure. Wait times were compared between the APP-and surgeon-led clinics from referral date to date of initial consultation, date of final diagnostic test, and date of confirmed diagnosis and planned treatment. A modified and validated version of the Visit-Specific Satisfaction Instrument assessed satisfaction in seven domains. Kappa (k) coefficients and bias-and prevalence-adjusted kappa (PABAK) values were calculated, and strength of agreement was categorized. Wait time and satisfaction data were examined using non-parametric statistics. Results: Agreement on major diagnostic categories varied from 0.68 (good) to 0.96 (excellent). Agreement with respect to indication for surgery was k ¼ 0.75, p < 0.001; 95% CI, 0.62-0.88 (good). Wait time for APP assessment was significantly shorter than wait time for surgeon consultation at all time points (p < 0.001); the surgeon's wait time was significantly reduced over 3 years. High satisfaction was reported in all components of care received from both health care providers. Conclusions: Using experienced physiotherapists in an extended role reduces wait times without compromising patient clinical management and overall satisfaction.Key Words: advanced practice; diagnosis; physiotherapist; shoulder. RÉ SUMÉObjectif : Examiner le rô le du physiothé rapeute en pratique avancé e en ce qui a trait (1) aux accords avec un chirurgien orthopé dique sur le diagnostic et la gestion de patients aux prises avec des problè mes à l'é paule; (2) au temps d'attente; (3) à la satisfaction par rapport aux soins. Mé thode : Cette é tude prospective a fait appel à des patients avec des douleurs à l'é paule qui ont é té dirigé s vers des spé cialistes de l'é paule dans un centre de soins tertiaires. Les accords ont é té examiné s pour sept caté gories de diagnostics, en fonction de la né cessité d'examens plus poussé s ou de chirurgie et du type d'intervention chirurgicale projeté . On a comparé les temps d'attente pour le physiothé rapeute en pratique avancé e et les cliniques dirigé es par un chirurgien à partir de la date où le patient a é té redirigé à la consultation initiale, jusqu'à la date de diagnostic dé finitif, jusqu'à la date de diagnostic confirmé et jusqu'au traitement planifié . Une version modifié e et validé e de l'instrument d'é valuation de la satisfaction à la suite d'une consultation (VisitSpecific Satisfaction Instrument ) a permis de mesurer la satisfaction dans sept domaines. Les coefficients kappa (k) et les valeurs kappa ajusté es pour la pré valence...