Evaluation of an Advanced-Practice Physical Therapist in a Specialty Shoulder Clinic: Diagnostic Agreement and Effect on Wait Times

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...

Intermediate Care pathways for musculoskeletal conditions – Are they working? A systematic review

“…The search revealed one pragmatic randomised control trial [17], 14 observational retrospective studies [10,15,16,18,[21][22][23][24][25][26][28][29][30][31], five observational prospective studies [13,14,19,20,27], one prospective quasi-experimental study [12], and two audits [11,32]. Two studies used a low sample size (e.g.…”

“…This included seven studies that assessed triage services in reducing waiting times [10][11][12], diagnostic agreement [13,14], patient satisfaction [15] and appropriateness of triage referral [16]. The other seven studies evaluated musculoskeletal assessment services in the patient management and referral [17,18] and the overall outcome and characteristics of the services [19][20][21][22][23] -here defined as referral procedures, interventions, investigations, patient satisfaction and reduction in waiting times.…”

“…The modified checklist ranked the observational studies into three sub-levels of evidence; high (score = 13 to 16), medium (score = 9 to 12) and low (score ≤ 8). The modified checklist revealed 11 low [10,12,18,20,21,[25][26][27][28][29][30], eight medium [11,15,16,19,22,23,31,32], and four high quality studies [13,14,17,24].…”

Evaluation of an advanced-practice physiotherapist in triaging patients with lumbar spine pain: surgeon–physiotherapist level of agreement and patient satisfaction

“…13,14 In several countries, physiotherapists trained by orthopedic surgeons have shown high clinical diagnostic accuracy, making similar triage recommendations to those of surgeon colleagues. [15][16][17][18] In the United Kingdom, care teams using physiotherapists with an extended scope of practice have reduced wait times, lowered direct hospital costs owing to a reduction in diagnostic tests, provided more advice and reassurance than physician counterparts, and had high levels of patient satisfaction. 19,20 At our centre, we have employed advanced-practice physiotherapists (APPs) in the arthroplasty program for 10 years and in the shoulder clinic for 5 years, with reliable triage and high levels of patient satisfaction.…”

“…19,20 At our centre, we have employed advanced-practice physiotherapists (APPs) in the arthroplasty program for 10 years and in the shoulder clinic for 5 years, with reliable triage and high levels of patient satisfaction. 18,21,22 Using physiotherapists to perform spinal triage is not a new concept. In 1994, Hourigan and Weatherley 23 described the role of a physiotherapist in assessing 100 consecutive patients together with a surgeon.…”