Physiotherapists’ experiences of direct access for clients with musculoskeletal pain and dysfunction: a qualitative study

Karvonen, Eira; Laitinen‐Väänänen, Sirpa; Paatelma, Markku; Roine, Minna; Heinonen, Ari

doi:10.1080/21679169.2019.1636133

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…Comparing the Findings from Theme 1 with Previous Literature "Opportunity to advance career" was the most prevalent subtheme to emerge under the overarching theme 1: "Decision to choose a career path as a musculoskeletal first contact physiotherapist". A qualitative study of MSK FCPs in two large municipal healthcare organizations in Finland also indicated that FCP was seen as a career advancement (Karvonen et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

The professional development and career journey into musculoskeletal first contact physiotherapy: a telephone interview study

Bassett

Jackson

2021

Physiotherapy Theory and Practice

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Background: Musculoskeletal (MSK) first contact physiotherapy (FCP) is being rolled out in the National Health Service, but limited research exists on career pathways into MSK FCP, or on pre-and-post-registration educational preparation for the knowledge and skills that are required for musculoskeletal first contact physiotherapy. Objectives: From the perspectives of existing MSK FCPs, the study sought to understand the pre-and-post-registration professional developmental journey into musculoskeletal first contact physiotherapy. Methods: Semistructured interviews over the telephone were conducted with a self-selected and snowball sample of 15 MSK FCPs from across Britain. Framework analysis was used to analyze the interview transcripts. Results: Four overarching themes were identified: (1) Decision to choose a career path as a MSK FCP; (2) Relevancy of pre-registration physiotherapy (PT) education for MSK FCP; (3) Relevancy of post-registration continuing professional development for MSK FCP, and; (4) Improving pre-registration PT education for the foundational knowledge and skills required to work in musculoskeletal first contact physiotherapy. Each overarching theme generated several subthemes. Conclusion: The research contributes to understanding the career pathway into the MSK FCP role and showed what relevant knowledge and skills were acquired for this role at pre-and-post registration levels. Findings will inform guidance for pre-registration PT curriculum development.

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Section: Discussionmentioning

confidence: 99%

The professional development and career journey into musculoskeletal first contact physiotherapy: a telephone interview study

Bassett

Jackson

2021

Physiotherapy Theory and Practice

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“…The training also included the identification of signs of serious diseases, assessment of the need for consultation with a doctor, on the basis of symptomatic and findings of examination, and assessment of psychosocial stress factors, e.g. through a written questionnaire [4,5]. When interviewing the clients, it was also instructed to recognize the clients` life situation and its effects on experiencing pain and the suitability of the instructions, utilizing the various elements of the international functional classification (ICF) from general health to environmental and personality factors (Figure 2).…”

Section: Methodsmentioning

confidence: 99%

Visiting a Physiotherapist is Useful in the Early Phase of Low Back Pain

Karvonen¹

2020

APhOT

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Background:The purpose was to examine physiotherapists' (PTs) core competences in direct access practice for low back pain (LBP) in the early phase of pain using tissue-structural classification, and the implementation of this practice after a continuing education with clients' and PTs' experiences. Methods:Although previous research has shown direct access in physiotherapy to be an important method in preventing the recurrence of LBP, data are still lacking on the level of required competences of PTs, classifications of LBP and implementation of direct access practice after a continuing education program.Results: PTs' core competences of clinical reasoning and critical reflection were on a good level when used tissue-structural classification and hypothetico-deductive method. PTs made accurate diagnostic subgroups for their LBP clients. The agreement between PTs and reviewers was 74% (kappa 0.63; 95% CI, 0.47 to 0.77). PTs also analyzed their clinical reasoning systematically from clients' history to choices of clinical tests and conclusions. They justified their manual skills and the adequacy of the LBP classification in use and suggested other alternatives for their performance. 80% of the clients were satisfied with the implementation of direct access in the early visit to PTs and with the information and advice they received.Three months after the physiotherapy, repeat visits were on a low level and only one of the employed was on sick leave. PTs reported their work meaningful which, according to a qualitative analysis, was connected with clients` satisfaction, reasonable division of labor, cooperation with their co-workers and an increase in professional appreciation.Conclusions: This research demonstrates the benefits, as outlined by clients and PTs, of direct access to physiotherapy in the early phase as well as the use of tissue-structural classification (nociceptive pain mechanism) as one of the classifications in this stage. Clinical reasoning and critical reflection competences in the assessment of clients were important during the sub classification and during the evaluation of PTs' own performance. Continuing learning of these competences should also be included in education programs. These results can be utilized in PTs' direct access practice as well as when planning the content of the education program.

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“…MSDs can be managed through the modern practice of referral to physiotherapy at the primary level of health care; the so-called direct access, which refers to a term used for patients seeking the services of a physiotherapist without the recommendation of a third party or a health professional, usually a physician [5,[7][8][9][10][11]. Self-referral is an opportunity for clinical evaluation and physiotherapy advice plan aimed at disabling and preventing possible future dysfunction at an early stage [12] without a referral from a physician [13], usually a specialist, which is contrary to the current practice of the traditional referral model in Croatia. Evidence supports physiotherapeutic management and other specific conditions at the primary level rather than in acute hospitals, such as neurological conditions and women's health problems [14].…”

Section: Introductionmentioning

confidence: 99%

“…Physiotherapists at the primary level of health care contribute to addressing the rapidly growing needs of the population, which represent direct demands on the health system and are directly related to rising health care costs in Europe [14]. In Finland, the Netherlands, Norway, Sweden and the United Kingdom, the self-referral model or direct access to physiotherapy in primary care is standard, thoroughly evaluated and recommended by the National Institute for Health and Care Excellence [12,14]. European studies show that patient self-referral to physiotherapy has proven to be feasible, appropriate, clinically and financially effective, and supported by patients, physiotherapists and family physicians [15], who are considered "gatekeepers" at the primary level of health care.…”

Section: Introductionmentioning

confidence: 99%

Patients’ attitudes about physiotherapists and self-referral to physiotherapy in Croatia – a pilot cross-sectional study

Kelečić¹

2023

Physiother Quart.

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Introduction.Research from developed European countries shows that self-referral to physiotherapy can provide adequate clinically and financially effective care for musculoskeletal disorders and is supported by most healthcare stakeholders. This pilot cross-sectional study aimed to investigate Croatian patients' attitudes about physiotherapists and self-referral to physiotherapy and determine whether specific characteristics of the respondents influence attitudes. Methods. The study involved 125 subjects, outpatient physiotherapy patients. Sociodemographic and medical data were collected at the end of the physiotherapy cycle. At the same time, the respondents filled out a survey questionnaire on attitudes about physiotherapists and self-referral to physiotherapy, which was created for this research. Results. The respondents attitudes show that physiotherapists possess and practice the necessary competencies in the health care of musculoskeletal disorders and that they are insufficiently represented in health care. The results implicate that physiotherapy is a patient-centred, effective and well-accepted health service. Self-referral to physiotherapy has potential socioeconomic implications for the individual and the health system. The results show (p < 0.05) that attitudes do not differ concerning gender, level of education or the number of previously attended cycles of physiotherapy. Still, increasing age decreases a positive attitude towards the effectiveness of physiotherapy and the professional autonomy of physiotherapists. Conclusions. The attitudes of Croatian patients toward physiotherapists and the possibility of self-referral to physiotherapy are positive and negatively correlated only with the characteristic of the age.

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Physiotherapists’ experiences of direct access for clients with musculoskeletal pain and dysfunction: a qualitative study

Cited by 4 publications

References 18 publications

The professional development and career journey into musculoskeletal first contact physiotherapy: a telephone interview study

The professional development and career journey into musculoskeletal first contact physiotherapy: a telephone interview study

Visiting a Physiotherapist is Useful in the Early Phase of Low Back Pain

Patients’ attitudes about physiotherapists and self-referral to physiotherapy in Croatia – a pilot cross-sectional study

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