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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...

Background: Disease-specific Quality Of Life (QOL) measures are devised to assess the impact of a specific disease across a spectrum of important domains of life. The purpose of this study was to examine the cross-sectional and longitudinal construct validity (sensitivity to change) of two rotator cuff diseasespecific measures, the Rotator Cuff-Quality Of Life (RC-QOL) and the Western Ontario Rotator Cuff (WORC) index, in relation to one another and to other joint and limb specific measures in the same population of the patients suffering from rotator cuff pathology.

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BackgroundRotator-cuff pathology is the most common cause of pain and disability in the shoulder. Examining the combined effect of biological and societal factors on disability would potentially identify existing differences between men and women with rotator cuff pathology which would help to provide suggestions for better models of care. Purpose of this study was to determine the overall differences in disability between men and women and to examine the relationship between factors that represent sex (biological factors) and gender (non-biological factors) with disability and satisfaction with surgical outcome 6 months after rotator cuff surgery.MethodsPatients with impingement syndrome and/or rotator cuff tear who underwent rotator cuff surgery completed the Western Ontario Rotator Cuff (WORC) index, the American Shoulder & Elbow Surgeons (ASES) assessment form, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measures prior to surgery and 6 months post-operatively. They also rated their satisfaction with surgery at their follow-up appointment.Results and DiscussionOne hundred and seventy patients entered into the study (85 men and 85 women). One hundred and sixty patients (94%) completed the 6-month assessment. Women reported more disability both prior to and after surgery. Disability at 6 months was associated with pain-limited range of motion, participation limitation, age and strength. Satisfaction with surgery was associated with level of reported disability, expectations for improved pain, pain-limited range of motion and strength.ConclusionsThe results of this study indicate that women with rotator cuff pathology suffer from higher levels of pre- and post-operative disability and sex and gender qualities contribute to these differences. Gender-sensitive approach will help to identify existing differences between men and women which will help to promote more effective and tailored care by health professionals.

Study Design: Prospective intertester reliability study investigating the ability of 2 therapists to agree on a low back pain diagnosis using examination techniques and the classification system described by McKenzie. Objectives: To investigate intertester agreement in determining McKenzie diagnostic syndromes, subsyndromes, presence, and relevance of the spinal deformities. Background: Reliability of the McKenzie approach for determining diagnostic categories is unclear. Previous studies have been characterized by inconsistency of test protocols, criterion measures, and level of training of the examiners, which confounds the interpretation of results. Methods: htients were assessed simultaneously by 2 physical therapists trained in the McKenzie evaluation system. The therapists were randomly assigned as examiner and observer. Agreement was estimated by Kappa statistics. Results: Forty-five subjects (47 2 14 years), composed of 25 women and 20 men with acute, subacute, or chronic low back pain were examined. The agreement between raters for selection of the McKenzie syndromes was K = 0.70, and for the derangement subsyndromes was K = 0.96. Interrater agreement for presence of lateral shift, relevance of lateral shift, relevance of lateral component, and deformity in sagittal plane was K = 0.52, 0.85, 0.95, and 1.00, respectively. lntertester agreement on syndrome categories in 17 patients under 55 years of age was excellent, with K = 1.00. Conclusions: A form of low back evaluation, using patterns of pain response to repeated end range spinal test movements, was highly reliable when performed by 2 properly trained physical therapists. patterns that are based on clinical signs and the locations of symptoms.22 The first 4 categories of the QTF are very similar to the derangement subsyndromes described by McKenzie.IS Recent studies have addressed the reliability and benefits of an assessment method that identifies the location and the intensity of the patient's symptoms in relation to movements and p o s i t i~n s .~J~J~ Physical therapists using the McKenzie system classify the patient's symptoms as "nonmechanical" or "me~hanical."~~ Symptoms associated with inflammatory conditions, medical conditions, and nonorganic pain may be classified as "nonmechanical." Mechanical symptoms in the McKenzie classification system are those that are consistently influenced by movements and positions. These symptoms are then classified into one of the 3 syndromes: postural, dysfunction, or derangement (Appendix A). Postural syndrome is pain caused only by prolonged end-range stretch of structures in the back and can occur in sitting, standing, or lying. Dysfunction syndrome is thought to be caused by the stretching of sensitive, adaptively shortened structures and has subsyndre mes based upon the end-range direction that elicits this pain: flexion, extension, side-glide, and multidirectional subsyndromes. Adherent nerve root syndrome and nerve root entrapment syndrome are also considered to be subsets of dysfunction (Appendix A)....

Patients who have undergone total knee replacement demonstrate a response shift in the measurement of their outcome at six months postoperatively. Although the response shift effect in the present study did not affect the interpretation of clinical results, we have highlighted the different patterns of individuals' psychological adaptation to a change in health status. This is an essential component of assessing the success or failure of surgical interventions as quantified with self-administered quality-of-life measures.

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