The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics

Abstract

BackgroundThe demand for paediatric orthopaedic care is growing, and providing the service required is an increasingly challenging task. Physiotherapist-led triage clinics are utilised in adult orthopaedics to enable the provision of care to patients who may not require a surgical consult. The Physiotherapy Orthopaedic Triage Clinic (POTC) was established in Our Lady’s Children’s Hospital Crumlin in response to increasing demands on the paediatric orthopaedic service. The clinic is run by physiotherapists working in an advanced practice role (APP), and is the first paediatric clinic of its type and scale in the Republic of Ireland.PurposeTo evaluate the efficacy of the service over the 3-year period from January 2011 to December 2013.MethodsA review of the prospectively gathered database was performed in order to establish the demographic profile of patients, investigate clinic outcomes, and evaluate the reduction in patient waiting times.Results2650 patients were managed by the clinic over the 3-year period. A total of 77 % of patients were managed without consultant intervention. Fifty-three percent of patients were diagnosed as having a normal presentation. The mean waiting time reduced from 101.9 weeks pre-2010 to 15.4 weeks in 2013 for those patients managed by the POTC.ConclusionSince its inception, the clinic has significantly reduced waiting times for routine elective paediatric orthopaedic patients while managing the majority of patients independent of surgical opinion. This study shows that the APP can deliver high-quality care in the paediatric orthopaedic setting, benefitting both patients and service.

An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints

“…A total of 147 patients, referred by the APPs, attended the orthopaedic consultant clinic during 2013, accounting for 21% of all patients who attended the APP clinic that year (Mir et al, ). Thirty‐two nonattenders and two patients with incomplete notes were excluded from the study, leaving n = 113 patient records for analysis.…”

“…It should be noted that diagnosis by the consultant was based on clinical examination combined with the results of relevant investigations that are not always available to the physiotherapist. The APPs in this service manage 79% of the patients seen completely independently (Mir et al, ) and this figure would improve further if appropriate legislative changes were made to allow APPs independent radiology prescription rights.…”

“…To date, evaluation of paediatric APP clinics has, in the main, focused on patient outcomes and waiting time reductions. Independent management rates of up to 80% of patients with musculoskeletal complaints (Mir et al, ), and 94% of normal variant patients (Belthur, Clegg, & Strange, ; Lipscombe, Saville, James, & Bruce, ; Mir et al, ) have been demonstrated. Normal variants or physiological referrals (Molony, Heffernan, Dodds, & McCormack, ; Moraleda & Castellote, ) are identified in the literature as conditions that resolve spontaneously with the normal growth and development of the child, and do not require treatment or intervention (Johnston, Eastwood, & Jacobs, ; Jones, Khandekar, & Tolessa, ; Staheli, ).…”

“…The APP can refer directly to the orthopaedic consultant and a number of other clinical specialities in the hospital. It was the first paediatric clinic of its type nationally, demonstrating marked waiting time reduction and good care‐pathway outcomes for patients (Mir et al, ).…”

Advanced musculoskeletal physiotherapy practice in Ireland: A National Survey

“…Enhancement in scope of practice sees physiotherapists conducting tasks that are traditionally more aligned with a medical scope of practice, with increased autonomy (Desmeules et al, ). These advanced practice physiotherapists (APPs), formerly known as extended‐scope practitioners in the UK (Chartered Society of Physiotherapy, ), most commonly operate as part of adult orthopaedic services, but are also found in emergency departments (McClellan, Cramp, Powell, & Benger, ), primary care (Goodwin & Hendrick, ) and paediatrics (O Mir et al, ).…”