Is Advanced practice physiotherapy equal or better care to physicians in patients with musculoskeletal disorders?

Can you imagine how frustrating for patients it must be to wait for a surgical consultation only to be told you don’t need surgery and then be sent away. Then enter the Advanced Physiotherapy Practitioner whose roles beyond those of a regular physiotherapist include activities traditionally the role of medical staff such as; screening patients pre- and post-operatively, triaging patients for surgery, prescribing conservative management and monitor patients on an ongoing basis. These roles provide an ideal opportunity to educate patients on treatment options and how to manage their symptoms. The purpose of this role is to improve patient access to timely surgical care by reducing wait times for surgery.

Advanced Physiotherapy Practitioners roles include activities traditionally the role of medical staff.

Extended scope or advanced practice roles for physiotherapists arose in the United States following the Vietnam War and have been established for over 20 years in the United Kingdom. These shifts in traditional roles are responses to the high demand and costs for healthcare. But how effective are these roles compared with traditional healthcare provision in patients with musculoskeletal disorders? This was the purpose of a recent systematic review by authors from Canada.

Here’s what they did

The authors searched 3 databases (Medline, Cinahl and Embase) for articles published between 1980 and 2011. Sixteen studies were included and were assessed by pairs of raters and were of variable methodological quality.

Here’s what they found

Included studies varied in designs and objectives and were categorized in four areas:

diagnostic agreement or accuracy compared to medical providers,
treatment effectiveness,
economic efficiency
patient satisfaction.
Their findings of the studies were consistent and suggest that Advanced Physiotherapy Practitioner care may be as (or more) beneficial than usual care by physicians for patients with musculoskeletal disorders across all categories

The authors concluded

“Physiotherapists in Advance Physiotherapy Practitioner roles provide equal or better usual care in comparison to physicians in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction.”

The Musculoskeletal Elf’s view

It was interesting to see the variability of settings in which advanced practitioners work. The settings in which these studies took place included: orthopaedic clinics, emergency departments, a military hospital clinic, a specialized outpatient musculoskeletal clinic, a physical therapy department, and a paediatric rheumatology clinic. The roles included; communicating a medical diagnosis; triaging patients to be seen by physicians
or specialists for consultation or surgery; ordering of diagnostic tests (imaging or laboratory); conservative treatment recommendations that may include medication prescription and/or injection; referral to other health care providers including to
physiotherapists.

Are you an Extended Scope or Advanced Physiotherapy Practitioner? Are you working in any of these settings and providing these roles? Perhaps you have some other role to share with the community.

The Musculoskeletal Elf