The Physical Therapist as a Musculoskeletal Specialist in the Emergency Department

Lebec, Michael; Jogodka, C.E.

doi:10.2519/jospt.2009.2857

Cited by 52 publications

(38 citation statements)

References 67 publications

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“…1 We acknowledge that the addition of another provider with referral for imaging privileges may appear counterintuitive in light of the problem of overutilization; however, the addition of physical therapists as providers with this privilege may add to the efficiency of the health system. 11,25,29,36 For example, the referral of a patient from a physical therapist to another provider requesting a referral for imaging may represent a delay in treatment and increased cost to the healthcare system if the referral could have been made by the physical therapist. This increased responsibility comes with a need to ensure that physical therapists with referral for imaging privileges add value to the healthcare system.…”

Section: The Burden Of Current Referral For Imagingmentioning

confidence: 99%

“…17,33 Physical therapists may be able to use radiologic studies for purposes other than diagnosis, 36 for instance, those related primarily to rehabilitation of the diagnosed pathology. 20 For example, McKinnis 40 suggests that physical therapists may use the image of the healing joint to determine treatment goals with regard to joint mobility or abnormal kinematics of the injured joint and adjacent joints.…”

Section: Evidence Of Competency Within Musculoskeletal Medicine and Ementioning

confidence: 99%

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Physical Therapist Practice and the Role of Diagnostic Imaging

Boyles¹,

Gorman²,

Pinto³

et al. 2011

J Orthop Sports Phys Ther

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Section: The Burden Of Current Referral For Imagingmentioning

confidence: 99%

Section: Evidence Of Competency Within Musculoskeletal Medicine and Ementioning

confidence: 99%

Physical Therapist Practice and the Role of Diagnostic Imaging

Boyles¹,

Gorman²,

Pinto³

et al. 2011

J Orthop Sports Phys Ther

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“…Studies of outpatient orthopaedic caseloads published in the 1980s and 1990s [16][17][18][19][20][21][22][23][24] suggested that a proportion of orthopaedic outpatient referrals could be managed efficiently and effectively with specialist support but without direct surgical intervention. More recent studies [25][26][27][28][29][30][31][32] have supported the notion of using physiotherapists with an extended scope of practice to reduce wait times and improve system efficiencies while maintaining high patient satisfaction.…”

mentioning

confidence: 99%

“…[25][26][27][28][29][30][31][32] It has been reported that experienced physiotherapists have higher levels of expertise in managing MSK conditions than medical students, physician interns, residents, and specialist physicians. 33,34 A validity study using magnetic resonance imaging (MRI) as the gold standard found that clinical diagnostic accuracy of MSK conditions was significantly higher among physiotherapists than among non-orthopaedic physicians, nurse practitioners, and physician assistants and noted no difference between physiotherapists and orthopaedic surgeons.…”

mentioning

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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“…Patients suffering from chronic back pains have better outcomes after rehabilitation [9]. In areas of musculoskeletal rehabilitation, it was found that physiotherapists have the adequate knowledge and expertise and having them in the team ensured faster patient recovery [10]. Since the referring doctor (physician/surgeon) is the first member of the medical team that interacts with the patient, a general idea about rehabilitation could be given but recommending specific Physiotherapy treatments could prove detrimental to the levels of satisfaction of the patients with Physiotherapy treatments, as noted in this study.…”

Section: Discussionmentioning

confidence: 99%

Referring doctors' perspectives about Physiotherapy management for chronic musculoskeletal pain

Rajan¹,

Bellare²

2013

IJTRR

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Background: Patients diagnosed with chronic disabling musculoskeletal pain have better health outcomes and higher levels of satisfaction with Physiotherapy management. A pilot study conducted by the authors found that doctor's referral to Physiotherapy treatment could have affected the satisfaction of the patients towards Physiotherapy management. Objectives:The aim of the current study was to look into the perspectives of referring doctors (physicians and surgeons) towards Physiotherapy as reported by the patients. Secondarily, it was of interest to see how the treatment strategies by the Physiotherapist affect patient satisfaction. Methods: The study was conducted at the orthopedic pain center in the Physiotherapy department at a tertiary care hospital in Mumbai, India. Personal interviews were conducted with 193 patients using a valid questionnaire. Results: The average age of the subjects was 47.5 years. Average duration of pain was close to 8 years, with low back pain being the most common location of pain. Majority of the patients were not referred for any particular Physiotherapy treatment (37.32%). Almost an equal percentage of subjects (33.16%) were referred for both exercise and electrotherapy treatments to the Physiotherapy department. Most of the times (around 68%), there was agreement in the treatment modes suggested by the referring doctor and the attending physiotherapist. However, in about 32% of the patients referred, there seemed to be a mismatch. Conclusion:The referring doctors (physicians/surgeons) gave considerable freedom to the physiotherapists regarding the treatment of chronic musculoskeletal pain. Some of them seemed to recommend electrotherapy as a treatment mode, due to which, there was dissatisfaction amongst patients about the treatment methodologies recommended by the physiotherapist.

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The Physical Therapist as a Musculoskeletal Specialist in the Emergency Department

Cited by 52 publications

References 67 publications

Physical Therapist Practice and the Role of Diagnostic Imaging

Physical Therapist Practice and the Role of Diagnostic Imaging

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

Referring doctors' perspectives about Physiotherapy management for chronic musculoskeletal pain

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