Physiotherapists' ability to diagnose and manage shoulder disorders in an outpatient orthopedic clinic: results from a concordance study

Lowry, Véronique; Bass, Alec; Lavigne, Patrick; Léger-St-Jean, Benjamin; Blanchette, David; Perreault, Kadija; Roy, Jean-Sébastien; Aiken, Alice; Décary, Simon; Desmeules, François

doi:10.1016/j.jse.2019.11.030

Cited by 10 publications

(20 citation statements)

References 38 publications

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“…Participant numbers varied from 30 to 383 (age range 15-85 years, mean age (where available) ranging from 46.2 to 67 years). The majority of studies included patients with one or two problem areas; knee [70,73], hip and knee [20,68,71], shoulder [67,69,72], shoulder or knee [66], shoulder, knee or spinal [19], with two studies having a broader inclusion of musculoskeletal or orthopaedic conditions [24,57,58,67].…”

Section: Search Resultsmentioning

confidence: 99%

“…The RCTs were downgraded one level due to study limitations, mainly lack of blinding. Four of the cohort studies also reported significant differences regarding patient satisfaction, favouring PT-led orthopaedic triage [19,20,66,72] and one reporting no difference between groups [69].…”

Section: Patient-reported Experiencesmentioning

confidence: 96%

“…The RCTs were downgraded one level due to study limitations, mainly lack of blinding. The cohort studies reported equal rate of investigations between PTs and OSs [20,69].…”

Section: Process Outcomesmentioning

confidence: 99%

“…Certainty of evidence was largely constrained. Two RCTs and three cohort studies had low to unclear risk of bias [23,24,57,58,[67][68][69], and seven cohort studies had unclear risk of bias [19,20,66,[70][71][72][73]. One study [19] provided inadequate information and reported incomplete data.…”

Section: Quality Appraisalmentioning

confidence: 99%

“…Only one study [67] blinded patients to the profession of their assessors i.e., the patients did not know which clinician was the PT and which was the OS, and were unaware of their clinical decisions until all assessments had been completed. Almost all studies explicitly stated that they blinded assessors to each other's findings [20,[66][67][68][69][70][71][72][73].…”

Section: Quality Appraisalmentioning

confidence: 99%

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Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

Samsson

Grimmer

Larsson

et al. 2020

BMC Musculoskelet Disord

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Background Physiotherapist-led (PT-led) orthopaedic triage is an evolving model of care for patients with musculoskeletal disorders. Objectives for this study were to establish the current evidence body on the impact of PT-led orthopaedic triage on health, quality, and service outcomes for patients referred for orthopaedic consultation, compared with standard (orthopaedic surgeon) care. Methods Medline, EMBASE, Scopus and CINAHL were searched from inception until 7 May 2018; search updated 24 April 2020. Search terms (including derivatives) included physiotherapy, advanced/extended scope, musculoskeletal/orthopaedic, triage. The search was framed as Population = patients referred for orthopaedic consultation; Intervention = PT-led orthopaedic triage; Comparison = standard care; Outcomes = health, quality and process outcomes. Only randomised controlled trials (RCTs) and prospective comparative cohort studies were eligible for inclusion. Screening, study selection, data extraction, and assessment of methodological quality were performed independently by reviewer pairs. Quality was scored with the Downs and Black checklist. Certainty of evidence was determined using GRADE. PROSPERO registration number CRD42017070950. Results We included two RCTs and eleven cohort studies (n = 1357 participants) of variable methodological quality (range 14–23 of possible 28). Certainty of evidence was low to moderate. There was no difference between PT-led orthopaedic triage and standard care for patient-reported outcomes (two RCTs). Perceived quality of care with PT-led orthopaedic triage was higher (two RCTs, four cohort studies) or equal (one cohort study) compared with standard care. PT-led orthopaedic triage had higher surgery conversion rates (one RCT, three cohort studies) (55–91% vs 22–38%), lower (two RCTs) or equal rate (two cohort studies) of referral for investigations, shorter waiting times (one RCT, one cohort study), and lower costs (one RCT). Furthermore, there was high agreement between physiotherapists’ and orthopaedic surgeons’ treatment approach (eight cohort studies), referral for investigation (five cohort studies), and diagnosis (nine cohort studies). Study limitations were the low number of RCTs, and variable methodological quality. Conclusions Evidence of low to moderate certainty suggests that PT-led orthopaedic triage leads to similar diagnostic decisions as standard care, has a higher conversion-to-surgery rate, reduces waiting times, is cost effective and valued by patients, and that health outcomes are equivalent.

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Section: Search Resultsmentioning

confidence: 99%

Section: Patient-reported Experiencesmentioning

confidence: 96%

“…The RCTs were downgraded one level due to study limitations, mainly lack of blinding. The cohort studies reported equal rate of investigations between PTs and OSs [20,69].…”

Section: Process Outcomesmentioning

confidence: 99%