Impacts of advanced physiotherapy: A narrative literature review

Abstract

Changes to healthcare design and delivery involving advanced physiotherapy roles may help health systems to meet challenges imposed by ageing populations, long-term conditions and unsustainable healthcare costs. This narrative literature review examined recent peer-reviewed literature (2010-2017), including primary studies and systematic reviews, that investigated the impact of advanced physiotherapy on healthcare efficacy, efficiency, service design or perceptions (consumers or health professionals) of these advanced roles. Thirty-five studies were included that investigated advanced physiotherapy roles in primary care, emergency department, orthopaedic outpatient and rheumatology clinic contexts. Implementation of these roles was found to reduce waiting times for appointments, reduce length of stay, improve access to care, reduce other clinicians' workload in primary care and emergency departments, streamline orthopaedic surgeons' caseload, and improve patient satisfaction. Some studies observed patient recovery outcomes following advanced practice physiotherapist care, but none compared these to existing models of care. In addition, few studies explored non-musculoskeletal physiotherapy fields or the New Zealand context, and no studies investigated the impact on consumer choice. More clearly defined and consistent use of advanced physiotherapy roles within the literature would enable a better understanding of the potential impact on health care. Overall, evidence suggested that advanced physiotherapy roles may provide benefits to the public and health system when implemented in innovative, interdisciplinary and non-traditional ways.

Advanced practice physiotherapists in primary health care: stakeholders’ views of a new scope of practice

“…This is consistent with the impact of advanced physiotherapy roles observed internationally. 10 Participants agreed a formal post-graduate qualification was necessary to qualify as an APP but were uncertain about whether this needed to be a Master's degree. Subsequent to the conduct of this research, the Physiotherapy Board has changed the requirement from a Master's to a post-graduate diploma.…”

“…[6][7][8][9] These roles have included advanced practice (such as triage of complex cases) and extended practice (such as referring for high-tech imaging, administering injections or limited prescribing rights). 10 Internationally, advanced roles have not been regulated within scopes of practice, in contrast to the APP scope in NZ. Overall, it has been shown that models of service delivery that include physiotherapists practising at a higher level (advanced practice) improve health care access, reduce waiting times, improve onward referral for physiotherapy treatment or medical specialist assessment, enhance selfmanagement strategies, improve patient outcomes and boost patient satisfaction.…”

“…Overall, it has been shown that models of service delivery that include physiotherapists practising at a higher level (advanced practice) improve health care access, reduce waiting times, improve onward referral for physiotherapy treatment or medical specialist assessment, enhance selfmanagement strategies, improve patient outcomes and boost patient satisfaction. 6,[10][11][12][13] In NZ, the public have been able to self-refer to physiotherapists since the 1970s and in 1989 physiotherapists were formally recognised as a first-contact profession. This often occurs in primary care in owner-operated private physiotherapy practices.…”