Evaluation of an advanced-practice physiotherapist in triaging patients with lumbar spine pain: surgeon–physiotherapist level of agreement and patient satisfaction

Abstract

Background: Surgery for lumbar spine pain is indicated for specific etiologies. Given the majority of individuals referred to spine surgeons are not surgical candidates, care delivery is inefficient, with consultations being of limited value for most. Using specially trained physiotherapists in triage is a human resource strategy that may optimize surgeons' time and the patient experience.Methods: An advanced-practice physiotherapist (APP) and a surgeon assessed consecutive patients with lumbar spine pain presenting at an academic health centre's spine surgery clinic. The second assessor was blinded to the outcome of the first. We used the κ statistic to evaluate surgeon-APP level of chance-corrected agreement concerning patients' need for a surgical consultation. To assess satisfaction with the APP, patients completed a modified version of the validated Visit-specific Questionnaire. Results:The sample included 102 participants (54 women) with a mean age of 54.3 ± 14.3 years and a mean Oswestry Disability Index score of 35.4 ± 16.6. The assessors' overall agreement was 86%. The κ coefficient for the need for a surgical consultation was 0.69 (95% confidence interval 0.54-0.84). The APP identified that 77% of patients did not require a surgical consultation. Twenty-one patients underwent surgery. Satisfaction scores for the APP were very high (mean score 92 out of 100). Conclusion:In triaging patients with lumbar spine pain, the APP and surgeon had a high level of agreement. An APP performing triage at a surgical centre can effectively reduce wait lists by 70%, reserving surgical consultations for those patients in whom they are indicated.

Can a physiotherapy student assume the role of an advanced practice physiotherapist in Orthopaedic surgery triage? A prospective observational study

“…The PS was capable of differentiating between more nuanced orthopaedic entities such as “knee osteoarthritis vs. uni-compartmental knee osteoarthritis” and “glenohumeral osteoarthritis vs. rotator cuff arthropathy”. The PS’s ability to correctly diagnose orthopaedic entities was similar to that of APPs in the current literature which reported diagnostic raw percent agreement varying between 69 and 98% [10, 11, 13, 14]. Furthermore, compared to similar studies, a greater variety of orthopaedic problems, spanning three joints, was seen by the PS.…”

“…APPs, though scarce, have been successfully implemented in numerous countries [7–13]. Several studies examining agreement of clinical diagnosis and surgical triage between APPs and OSs show that APPs can establish similar diagnoses as OSs for a variety of musculoskeletal problems, with raw percent agreement ranging from 75 to 92% [10, 11, 13, 14]. Strong agreement (86–92%; κ = 0.69–0.80) has also been shown for triaging surgical patients [10–14].…”

“…Several studies examining agreement of clinical diagnosis and surgical triage between APPs and OSs show that APPs can establish similar diagnoses as OSs for a variety of musculoskeletal problems, with raw percent agreement ranging from 75 to 92% [10, 11, 13, 14]. Strong agreement (86–92%; κ = 0.69–0.80) has also been shown for triaging surgical patients [10–14]. Furthermore, orthopaedic clinics involving APPs have generated high satisfaction [8–11, 13, 15].…”

An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment

“…The majority of cases have low levels of disability, but combined with the minority of highly disabled LBP-patients, LBP causes high societal and economic burden [3], comparable to cardio-vascular disease in high-income countries [4]. Less than 20% of the LBP patients seen by a surgeon typically need a surgical solution [5], but the challenge is the reliable identification of surgical indications [6]. Thus, close collaboration between spine surgeons and non-surgical spine experts, such as chiropractors, is crucial.…”

A quasi-randomised, controlled, feasibility trial of GLITtER (Green Light Imaging Interpretation to Enhance Recovery)—a psychoeducational intervention for adults with low back pain attending secondary care

“…Consequently, their contribution to the massive burden of LBP ( Vos et al, 2016 ) is likely to be significant. General practitioners (GPs) frequently refer their patients to specialist secondary care clinics for surgical opinion ( ABS, 2015 ; Coulter, 1998 )—however surgery is recommended for only a small proportion of cases ( Li & Yen, 2010 ; Robarts et al, 2017 ). For the remainder, clinicians are generally challenged to provide time-efficient, guideline-based, conservative care recommendations.…”