Extended scope physiotherapy roles for orthopedic outpatients: an update systematic review of the literature

Abstract

PurposeThis systematic review updates one conducted in 2008 into extended scope practice (ESP) in physiotherapy in orthopedics.MethodsA comprehensive open-ended search was conducted using electronic library data-bases and Google Scholar to identify any primary study design reporting on physiotherapists working in ESP roles within orthopedic settings. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, although only studies in levels I, II, or III_1 were critically appraised using a purpose-built critical appraisal tool. Information was extracted on the country of origin, ESP tasks, relevant training, patient types, health, process, and cost measures.Results1071 studies were identified, and twelve were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from II to IV, from which only two diagnostic studies met the criteria for critical appraisal. ESP tasks included injection therapy, removing k-wires, and requesting investigations. The education of ESP physiotherapists varied widely, and included formal and informal training. The positive outcomes of ESP initiatives were reported, in diagnostic ability, reduced costs and waiting times, and improved health outcomes.ConclusionDespite the positive results, the generally low level of evidence and the range of outcome measures reported, constrained clear conclusions regarding the health, process, and cost implications of ESP physiotherapy roles in orthopedic settings. The need for formalized, widely recognized training was highlighted, to give ESP physiotherapy roles credibility.

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“…Many foci for improvements around these issues have been reported in the literature, such as standardization of discharge and transition processes, 2 technological innovations and their correlation with level of health care, 7 , 8 and extended scope roles for non-medical practitioners. 9 – 18 …”

Surgery or Consultation: A Population-Based Cohort Study of Use of Orthopaedic Surgeon Services

“…Such teams frequently include physiotherapists working in extended practice/roles and may also include primary care physicians and other health professions. Evaluation of these models has shown them to be acceptable to patients, [38], [41] and to have reduced wait times from referral to first appointment, [41], [45] lower costs [45] and an increased surgical conversion rate for those patients who were triaged to surgeons [21], [42]. In cases where the teams are located at the intersection of primary and secondary care a further benefit has been reduced referrals to secondary care with many patients being treated with conservative management [42].…”

“…In cases where the teams are located at the intersection of primary and secondary care a further benefit has been reduced referrals to secondary care with many patients being treated with conservative management [42]. Evaluation of the performance of extended scope physiotherapists in such roles have good agreement with surgeons about diagnosis and/or need for surgery[45]–[47].…”

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