Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis

Lafrance, Simon; Lapalme, Jean-Gabriel; Méquignon, Marianne; Santaguida, Carlo; Fernandes, Julio C.; Desmeules, François

doi:10.1007/s00586-020-06648-5

Cited by 14 publications

(12 citation statements)

References 38 publications

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“…Several authors report that MSKDs often lead to significant productivity losses among workers [ 50 – 52 ]. Therefore, as APP care may facilitate earlier return to work by decreasing wait time for an initial consultation or by providing better rehabilitation care [ 12 , 19 , 32 , 53 , 54 ], the cost saving could be important, but this as yet to be formally confirmed in future studies on APP.…”

Section: Discussionmentioning

confidence: 99%

“…Previous systematic reviews could not conclude on the economic benefits of APP MoC. Indeed, these reviews reported that APP MoC improve health care access while providing at least comparable quality of care than UMC [ 12 – 17 , 19 ]. As our results suggest health care system cost saving with APP MoC compared to UMC, the development and implementation of these models is further supported, especially for MSKDs care.…”

Section: Discussionmentioning

confidence: 99%

“…Previous systematic reviews report that APP MoC improves access to care by reducing waiting time for an initial consultation while providing at least comparable quality of care and retaining high patient satisfaction for adults with musculoskeletal disorders (MSKDs) [ 12 – 15 , 17 , 19 ]. Three systematic reviews, evaluating several outcomes and not only economic evaluations of APP MoC have been published.…”

Section: Introductionmentioning

confidence: 99%

“…For acute and chronic physical disorders, the use of advanced practice physiotherapy (APP) models of care (MoC) has been proposed as a potential solution to improve health care access [12][13][14][15][16][17]. The ultimate goals of these MoC are to provide best practice care while improving health care access in a cost-effective manner.…”

Section: Introductionmentioning

confidence: 99%

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Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

Lafrance

Demont

Thavorn

et al. 2021

BMC Health Serv Res

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Background The objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care. Methods Systematic searches were conducted up to September 2021 in selected electronic bibliographical databases. Economic evaluation studies on an APP model of care were included. Economic data such as health care costs, patient costs, productivity losses were extracted. Methodological quality of included studies was assessed with the Effective Public Health Practice Project tool and the Critical Appraisal Skills Programme checklist. Meta-analyses were performed and mean differences (MD) in costs per patient were calculated using random-effect inverse variance models. Certainty of the evidence was assessed with the GRADE Approach. Results Twelve studies (n = 14,649 participants) including four randomized controlled trials, seven analytical cohort studies and one economic modeling study were included. The clinical settings of APP models of care included primary, emergency and specialized secondary care such as orthopaedics, paediatrics and gynaecology. The majority of the included participants were adults with musculoskeletal disorders (n = 12,915). Based on low quality evidence, health system costs including salaries, diagnostic tests, medications, and follow-up visits were significantly lower with APP care than with usual medical care, at 2 to 12-month follow-up (MD: − 145.02 €/patient; 95%CI: − 251.89 to − 38.14; n = 7648). Based on low quality evidence, patient costs including travel and paid medication prescriptions, or treatments were significantly higher with APP care compared to usual medical care, at 2 to 6-month follow-up (MD: 22.18 €/patient; 95%CI: 0.40 to 43.96; n = 1485). Based on very low quality evidence, no significant differences in productivity losses per patient were reported between both types of care (MD: 450 €/patient; 95%CI: − 80 to 970; n = 819). Conclusions This is the first systematic review and meta-analysis on the economic evaluation of APP models of care. Low quality evidence suggests that APP care might result in lower health care costs, but higher patient costs compared to usual medical care. Costs differences may vary depending on various factors such as the cost methodology used and on the clinical setting. More evidence is needed to evaluate cost benefits of APP models of care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

Lafrance

Demont

Thavorn

et al. 2021

BMC Health Serv Res

Self Cite

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“…15,53 The authors hypothesized that the decrease of waiting times for services could be a factor indirectly explaining these positive impacts on other outcomes, as long waiting times are known to impact quality of life and psychological health, further supporting the importance of taking action to reduce waiting times. 4,11,49,53,54…”

Section: Discussionmentioning

confidence: 99%

Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review

Dupuis

Déry

Oliveira

et al. 2022

J Health Serv Res Policy

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Objective Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy ( n = 11), occupational therapy ( n = 2), prosthetics ( n = 1), exercise physiology ( n = 1) and multidisciplinary ( n = 4) services. The methodological quality varied ( n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.

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Was the impact of COVID‐19 on a spinal triage service as significant as expected? A retrospective service evaluation: Results and evaluation

Wood

Eveleigh

Dixon

et al. 2022

Musculoskeletal Care

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Objectives The aim of this evaluation was to review service outcomes for a spinal advanced practitioner physiotherapy (APP) triage service during COVID‐19. The evaluation compares outcomes gathered against pre‐pandemic data and evaluates the impact of the pandemic on service delivery. Design Service‐level data were extracted between 2019 and 2021 including: total referrals, new and follow‐up appointments, telehealth consultation rates, discharges at first appointment, magnetic resonance imaging and injection request rates. Multidisciplinary‐team (MDT) meeting notes with Spinal Surgeons were reviewed and surgical conversion calculated. Patient satisfaction data were collated using: Friends and Family test, specific questionnaires, individual and formal complaints and compliments, and telephone surveys. Analysis was performed by the lead author and results were compared between years using analysis of variance, as well as with previously reported data. Setting ‘Nottingham University Hospitals’ National Health Services Trust is a secondary care spinal unit, using APPs to triage, assess and manage spinal conditions. Results In 2020, 407 (22%; p = 0.02) less patients were referred to the service, however, there was a significant increase in the number of telehealth attendances (mean = 50% in 2020 from 2019, p = 0.005). Only 13% (n = 1342) patients were discussed at MDT, of which 8% (n = 808) were discussed for surgical consideration, and 36% (n = 268) were directly listed. High levels of patient satisfaction were reported by 89% (n = 1028 of 1160) patients. Conclusion This service evaluation demonstrates a statistically significant change in numbers of patients referred and telehealth attendances in the year of the pandemic (2020). Surgical conversion declined during the pandemic, and did not recover post‐pandemic.

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Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis

Cited by 14 publications

References 38 publications

Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review

Was the impact of COVID‐19 on a spinal triage service as significant as expected? A retrospective service evaluation: Results and evaluation

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