Advanced musculoskeletal physiotherapy practice in Ireland: A National Survey

Fennelly, Orna; Blake, Catherine; FitzGerald, Oliver; Breen, Rachel; O’Sullivan, Cliona; O'Mir, Marie; Desmeules, François; Cunningham, Caitríona

doi:10.1002/msc.1351

Cited by 12 publications

(16 citation statements)

References 26 publications

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“…Furthermore, it could be argued that costs might increase, due to many patients being referred for further physiotherapy after PT-led triage [24]. Another issue with this model of care is the PTs' advanced role, allowing professional development but also entailing greater responsibility [77]. This increased responsibility should be reflected in salaries, and with that, costs might increase.…”

Section: Discussionmentioning

confidence: 99%

Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

Samsson

Grimmer

Larsson

et al. 2020

BMC Musculoskelet Disord

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Background Physiotherapist-led (PT-led) orthopaedic triage is an evolving model of care for patients with musculoskeletal disorders. Objectives for this study were to establish the current evidence body on the impact of PT-led orthopaedic triage on health, quality, and service outcomes for patients referred for orthopaedic consultation, compared with standard (orthopaedic surgeon) care. Methods Medline, EMBASE, Scopus and CINAHL were searched from inception until 7 May 2018; search updated 24 April 2020. Search terms (including derivatives) included physiotherapy, advanced/extended scope, musculoskeletal/orthopaedic, triage. The search was framed as Population = patients referred for orthopaedic consultation; Intervention = PT-led orthopaedic triage; Comparison = standard care; Outcomes = health, quality and process outcomes. Only randomised controlled trials (RCTs) and prospective comparative cohort studies were eligible for inclusion. Screening, study selection, data extraction, and assessment of methodological quality were performed independently by reviewer pairs. Quality was scored with the Downs and Black checklist. Certainty of evidence was determined using GRADE. PROSPERO registration number CRD42017070950. Results We included two RCTs and eleven cohort studies (n = 1357 participants) of variable methodological quality (range 14–23 of possible 28). Certainty of evidence was low to moderate. There was no difference between PT-led orthopaedic triage and standard care for patient-reported outcomes (two RCTs). Perceived quality of care with PT-led orthopaedic triage was higher (two RCTs, four cohort studies) or equal (one cohort study) compared with standard care. PT-led orthopaedic triage had higher surgery conversion rates (one RCT, three cohort studies) (55–91% vs 22–38%), lower (two RCTs) or equal rate (two cohort studies) of referral for investigations, shorter waiting times (one RCT, one cohort study), and lower costs (one RCT). Furthermore, there was high agreement between physiotherapists’ and orthopaedic surgeons’ treatment approach (eight cohort studies), referral for investigation (five cohort studies), and diagnosis (nine cohort studies). Study limitations were the low number of RCTs, and variable methodological quality. Conclusions Evidence of low to moderate certainty suggests that PT-led orthopaedic triage leads to similar diagnostic decisions as standard care, has a higher conversion-to-surgery rate, reduces waiting times, is cost effective and valued by patients, and that health outcomes are equivalent.

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Section: Discussionmentioning

confidence: 99%

Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

Samsson

Grimmer

Larsson

et al. 2020

BMC Musculoskelet Disord

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“…The international physiotherapy literature provides many examples of ACPs delivering new models of care, particularly in musculoskeletal services, and across different settings, including emergency, primary and secondary care. [20][21][22][23][24][25][26][27] Many of these examples involved the physiotherapy ACPs assessing and treating patients for musculoskeletal conditions, instead of medical practitioners, both in routine clinics and emergency care. These models consistently evaluate well, providing not only an equivalent quality but also additional benefits, such as increased accessibility and wider range of strategies.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In a previous study in physiotherapy, ACPs were found to be committed to further training and there were positive experiences reported, though opportunities varied. 25 Similarly, in a study in radiography, barriers to implementation of ACP roles included funding and backfill for training. 36 Within nursing, the availability of education has been identified as an enabler for the ACP role.…”

Section: Discussionmentioning

confidence: 99%

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<p>The Role and Development of Advanced Clinical Practice Within Allied Health Professions: A Mixed Method Study</p>

Stewart-Lord¹,

Beanlands²,

Khine³

et al. 2020

JMDH

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Objective: To investigate the profiles of advanced clinical practitioners (ACPs) in the allied health professions (AHPs) and their skills, attributes, experiences and involvement in new models of care. Methods: A 2 phase, cross sectional, mixed method survey of AHP ACPs across London was conducted in 2018-2019. Online questionnaires were completed by 127 AHP ACPs and then semi-structured interviews were conducted with 15 AHP ACPs. Results: The survey results gave a comprehensive overview of the attributes of AHPs in ACP roles across London. There was considerable variability between role titles, types and levels of qualification, and evolution of the roles. The respondents predominately worked in clinical practice, and less frequently in other ACP domains (research, leadership and management, education). The interview findings provided in-depth insights into the AHP ACP roles within four themes: being advanced, career pathways, outcomes of the advanced practitioner role and influencing and transforming. The "Being advanced" theme highlighted that expert practice comprised confident and autonomous practice, leadership, and applying specialist and expert decision-making skills. "Career pathways" highlighted the diversity within the participants' roles, titles, career opportunities and development. In the "Outcomes of the advanced clinical practitioner role" theme, the ACPs described their services as prompter, more accessible and providing an improved patient journey. The "Influencing and transforming" theme highlighted networking and dissemination and ideas for innovation, influencing and transforming services. Conclusion: This is the first comprehensive profile of ACP roles across AHPs and indicates that these roles are already having a positive impact on healthcare services and supporting new models of care. However, establishing the necessary infrastructure, standardization and governance for ACP roles across sectors, along with the career pathways, funding, sustainability and education, could increase impact in the future.

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“…Healthcare transformation, designed to improve access and quality of care while containing cost, is a worldwide priority [ [93] , [94] , [95] ], aligned with value-based care and enabled through MoCs. Many countries have responded by enabling existing healthcare professionals to work to their maximum scope (advanced scope of practice [ [96] , [97] , [98] , [99] , [100] , [101] ], which has also been articulated as an enabler to implementing MoCs [ 102 ]. Historically, this approach has worked to address shortages in available healthcare practitioners in remote and rural areas and on the front line to triage injured soldiers during wartime.…”

Section: Implementing Models Of Care To Support Value-based Carementioning

confidence: 99%

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

Speerin

Needs

Chua

et al. 2020

Best Practice & Research Clinical Rheumatology

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Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems.

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Advanced musculoskeletal physiotherapy practice in Ireland: A National Survey

Cited by 12 publications

References 26 publications

Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

<p>The Role and Development of Advanced Clinical Practice Within Allied Health Professions: A Mixed Method Study</p>

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

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