The Extended Scope Physiotherapist in Orthopaedic Out-Patients – An Audit

Pearse, EO; Maclean, A.D.; Ricketts, David

doi:10.1308/003588406x149183

Cited by 51 publications

(63 citation statements)

References 5 publications

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“…2 Our study shows a higher proportion of independent management (92%) than for other services described in the literature (55-86%). 4,5,[17][18][19] The NUH ESP service was Did not attend consultationrelatively well established when this service evaluation was performed, which may mean that the ESPs had a greater understanding of the surgical reasoning process and were able to identify suitable surgical candidates more accurately because of increased training and experience. 14 Only 8% of all patients seen in the ESP service required input from a consultant.…”

Section: Discussionmentioning

confidence: 99%

A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

Wood

Hendrick

Boszczyk

et al. 2016

annals

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INTRODUCTION Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK. METHODS A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs' ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients. RESULTS A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management or for surgical review. Of the latter, 81% were considered to be suitable surgical referrals. A 99% satisfaction rate was reported by discharged patients. CONCLUSIONS ESP services in a specialist spinal service are effective in managing spinal conditions conservatively and identifying surgical candidates appropriately. Further research is needed to confirm ESPs' diagnostic accuracy, patient outcomes and cost effectiveness.

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Section: Discussionmentioning

confidence: 99%

A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

Wood

Hendrick

Boszczyk

et al. 2016

annals

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“…Some studies have reported more extreme ranges. Pearse and colleagues, 50 who examined a large range of pathologies, noted that …”

Section: Discussionmentioning

confidence: 99%

Evaluation of an Advanced-Practice Physical Therapist in a Specialty Shoulder Clinic: Diagnostic Agreement and Effect on Wait Times

Razmjou

Robarts

Kennedy

et al. 2013

Physiotherapy Canada

107

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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...

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“…(25)(26)(27) Only one of these studies compared treatment provided by an ESP and other professionals and this study was the first to describe an ESP service in an emergency department. (26) It was shown that 55% of patients were independently managed by the ESP and a follow-up suggested higher patient satisfaction with the ESP service.…”

Section: Discussionmentioning

confidence: 99%

Physiotherapy extended scope of practice – who is doing what and why?

et al. 2007

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Objectives: To explore the range, drivers and perspectives of extended or enhanced practitioner roles within physiotherapy.Data sources: Nineteen electronic databases, hand searches, bibliography scanning and personal contact were used to identify published and unpublished resources. Review methods:A systematic review using an expanded approach. Resources were included if they discussed extended scope of practice (ESP, intervention) in physiotherapy (profession) and outcome (for patients, other health professionals, and health services delivery) irrespective of patient group, language, year of publication (up to 2005), study design, or health care systems evaluated. All resources were screened against formal inclusion criteria for relevance. Information from relevant resources was extracted and details were entered into an Access database. Results:152 Physiotherapy-related resources were identified, including seven which met appropriate quality standards (using Cochrane methodology). A meta-analysis was not performed due to the paucity of RCTs. ConclusionsDrivers for the roles in the 152 resources mainly included local or national service demands (34%). Most ESP roles reported included a form of non-invasive assessment (47%) or non-invasive treatment (37%) of patients that was more traditionally carried out by medical colleagues. None of the resources including data were a) unsupportive of ESP or b) mainly expressing concerns. This review has demonstrated overwhelming support 4 for ESP; the vast majority of resources were supportive of ESP despite being largely descriptive or discursive in nature (76%). There is an urgent need for robust research in order to evaluate the expansion of ESP roles, underpin further development of those roles and, strengthen the evidence base of ESP in physiotherapy.

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The Extended Scope Physiotherapist in Orthopaedic Out-Patients – An Audit

Cited by 51 publications

References 5 publications

A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

Evaluation of an Advanced-Practice Physical Therapist in a Specialty Shoulder Clinic: Diagnostic Agreement and Effect on Wait Times

Physiotherapy extended scope of practice – who is doing what and why?

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