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Minna R, Anna-Maija J, Eira K, Matti M, Pirjo V. Physiotherapy educators' perceptions of physiotherapists' competencies and continuing education in the practice of musculoskeletal physiotherapy direct access. Physiother Theory Pract 2024:1-13. [PMID: 39221614 DOI: 10.1080/09593985.2024.2394512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 08/15/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The aim of direct access (DA) physiotherapy practice in Finland is the treatment of musculoskeletal (MSK) conditions by physiotherapists who have completed continuing DA education. It is difficult to pinpoint the competencies of DA physiotherapists as their roles and scope of practice varies. PURPOSE The present study aimed to explore the competencies and education of DA physiotherapists through the perceptions of DA educators. METHODS Data were collected through individual semi-structured interviews of eleven Finnish physiotherapy educators who described their perceptions of DA physiotherapists' competencies and their continuing DA education. The interviews were recorded and transcribed verbatim and then examined using a reflexive thematic analysis. RESULTS Two main themes were formulated on the basis of the data, conveying the educators' perceptions. The first theme, Interaction as grounds for meaningful clinical reasoning, had two subthemes: Meaningful encounter and Rationally and safely locating the core of the client's problem. The second theme, Continuing professional development in an expert role, had four subthemes: Continuous learning, Self-reflection, Deep understanding and Taking responsibility for one's own expertise. CONCLUSION The present study revealed how DA educators perceive the competencies of DA physiotherapists. The findings highlight the perceived significance of the physiotherapists' interaction with the client as a ground for meaningful clinical reasoning, and their responsibility for their own continuing professional self-development.
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Affiliation(s)
- Roine Minna
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Jäppinen Anna-Maija
- Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
| | - Karvonen Eira
- Fysioterapian Konsultointi Paatelma & Karvonen Ky, Lahti, Finland
| | - Munukka Matti
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Vuoskoski Pirjo
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
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Ó Mír M, Casey MB, Smart KM. Physiotherapist managers views on advanced practice physiotherapy in Ireland. A qualitative study. Physiother Theory Pract 2024:1-10. [PMID: 39011854 DOI: 10.1080/09593985.2024.2370362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 06/16/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION The introduction of physiotherapists working with advanced scope of practice has contributed to improvements in healthcare services. OBJECTIVE This qualitative study explores the views of physiotherapist managers on the Advanced Practice Physiotherapy role and the barriers and enablers to progression of this career pathway. METHODS A qualitative focus group study was conducted online with 10 purposefully sampled physiotherapist managers. The focus groups were audio-recorded, transcribed and thematically analyzed. RESULTS Three main themes were identified; 1) Physiotherapists working in advanced practice are recognized as experts and strong advocates for the physiotherapy profession; 2) Barriers to Advanced Practice Physiotherapy in Ireland include inconsistent role definition and protection, a lack of legislation and uncertainty concerning clinical governance; and 3) Physiotherapist managers can support Advanced Practice Physiotherapy through mentoring and resource provision, and implementation of the Advanced Practice Competency Framework. CONCLUSION Physiotherapist managers recognized the value of Advanced Practice Physiotherapy to the Irish health service but suggest that the role and reporting structures need to be clarified. They highlighted barriers preventing the full potential of this these roles being realized and provided suggestions to support the progression of this healthcare model.
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Affiliation(s)
- Marie Ó Mír
- Irish Society of Chartered Physiotherapists (ISCP), Irish Society of Chartered Physiotherapists, Royal College of Surgeons, Dublin, Ireland
| | - Máire-Bríd Casey
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Keith M Smart
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
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3
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Davis C, Noblet T, Mistry J, Kowalski K, Rushton A. Patient satisfaction with advanced physiotherapy practice internationally: Protocol for a systematic mixed studies review. PLoS One 2023; 18:e0293170. [PMID: 37862302 PMCID: PMC10588830 DOI: 10.1371/journal.pone.0293170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
RATIONALE Patient satisfaction is a complex construct consisting of human and system attributes. Patient satisfaction can afford insight into patient experience, itself a key component of evaluating healthcare quality. Internationally, advanced physiotherapy practice (APP) extends across clinical fields and is characterised as a higher level of practice with a high degree of autonomy and complex decision making. Patient satisfaction with APP appears positive. While evidence synthesis of patient satisfaction with APP exists, no systematic review has synthesised evidence across clinical fields. Therefore, the objectives of this systematic review are 1) to evaluate patient satisfaction with APP internationally, and 2) to evaluate human and system attributes of patient satisfaction with APP. MATERIALS AND METHODS A systematic mixed studies review using a parallel-results convergent synthesis design will be conducted. Searches of Medline, Embase, Web of Science, CINAHL, Cochrane, PEDro and grey literature databases will be conducted from inception to 18/7/2023. Studies of APP (World Physiotherapy definition) whereby practitioners a) have advanced clinical and analytical skills that influence service improvement and provide clinical leadership, b) have post-registration masters level specialisation (or equivalence), c) deliver safe, competent care to patients with complex needs and d) may use particular occupational titles; that measure patient satisfaction across all clinical fields and countries will be included. Two reviewers will screen studies, extract data, assess methodological quality of included studies (mixed methods appraisal tool), and contribute to data synthesis. Quantitative data will undergo narrative synthesis (textual descriptions) and qualitative data thematic synthesis (analytical themes). Integration of data syntheses will inform discussion. IMPLICATIONS This systematic review will provide insight into patient satisfaction with APP internationally, exploring attributes that influence satisfaction. This will aid design, implementation, or improvement of APP and facilitate the delivery of patient-centred, high-quality healthcare. Lastly, this review will inform future methodologically robust research investigating APP patient satisfaction and experience.
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Affiliation(s)
- Chris Davis
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Nuffield Health Learning Foundation, Nuffield Health, Surrey, England
| | - Tim Noblet
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Therapies Department, St Georges University Hospitals NHS Foundation Trust, London, England
| | - Jai Mistry
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Therapies Department, St Georges University Hospitals NHS Foundation Trust, London, England
| | - Katie Kowalski
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Eek F, Åsenlöf P, Stigmar K. Scientific approach and attitudes among clinically working physiotherapists in Sweden -a cross sectional survey. Arch Physiother 2023; 13:20. [PMID: 37807048 PMCID: PMC10561402 DOI: 10.1186/s40945-023-00173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Evidence based medicine (EBM) should be an endeavor within all healthcare professions. Knowledge and understanding of science are important prerequisites of EBM. OBJECTIVE The aim was to examine and compare perspectives on science and perceived inhibiting and facilitating factors for the assimilation and implementation of scientific information among clinically working specialist- and non-specialist physiotherapists in Sweden. METHODS A cross-sectional survey study was conducted via a web-based questionnaire. Clinically active physiotherapists in Sweden were invited to participate. Attitudes and perspectives were compared between physiotherapists with completed or on-going specialist training, and non-specialists. RESULTS In total, 1165 physiotherapists responded to the survey (75.5%, (n = 870) women, mean age 44.8 (SD 12.1), whereof 25.5% (n = 319) with completed or ongoing specialist training). The majority of participants had a high interest in science but did not consider a general scientific approach to be applied within physiotherapy. The main perceived inhibiting factor for a clinical practice more based on scientific evidence was lack of time. Specialists had in general higher interest and ability to interpret and evaluate science, and prioritized scientific evidence to a higher extent. CONCLUSION Among respondents, a scientific approach was considered valuable within physiotherapy but not considered fully applied in practice. The higher interest and perceived ability to interpret science among specialists indicates that further education and specialist training can increase both interest and understanding of science among physiotherapists.
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Affiliation(s)
- Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Pernilla Åsenlöf
- Department of Women's and Children's Health, Physiotherapy and Behavioural Medicine, Uppsala University, Uppsala, Sweden
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Davies F, Pace J, Angus M, Chan-Braddock S, Jagadamma KC. Physiotherapists with musculoskeletal training in an emergency department for patients with non-specific low back pain: A service evaluation. Musculoskeletal Care 2022; 20:960-963. [PMID: 35491528 DOI: 10.1002/msc.1640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Franco Davies
- Department of Physiotherapy, Mater Dei Hospital, Queen Margaret University, Msida, Malta
| | - Josef Pace
- Department of Physiotherapy, Mater Dei Hospital, Middlesex University, Msida, Malta
| | - Michelle Angus
- Department of Emergency, Salford Royal NHS Foundation Trust, Leeds Metropolitan University, Salford, UK
| | - Sharon Chan-Braddock
- Department of Physiotherapy, Manchester NHS Foundation Trust, Queen Margaret University, Manchester, UK
| | - Kavi C Jagadamma
- Division of Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography, Queen Margaret University, Edinburgh, UK
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Mutsekwa RN, Byrnes JM, Larkins V, Canavan R, Angus RL, Campbell KL. Role substitution of specialist medical doctors with allied-health professionals: A qualitative exploration of patients' experiences and perceptions of healthcare quality. J Eval Clin Pract 2022; 28:1096-1105. [PMID: 35470945 DOI: 10.1111/jep.13691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The need to improve patient access, offer increased choice and improve patient outcomes whilst maintaining safe care is driving the healthcare workforce to evolve. Extending allied-health scope of practice by integrating models of care that traverse traditional professional boundaries has been one such strategy. This study explored patients' acceptance and experiences of four allied-health extended scope of practice models of care. The study aimed to identify dimensions of quality healthcare that matter to patients and describe the extent to which they perceived these to be delivered in allied-health professional role substitution models of care. METHODS Qualitative methodology using semistructured interviews were conducted with 29 participants who had received treatment from an allied-health professional role substitution model. This was a purposeful sample with recruitment across genders, ages and social backgrounds. Interviews were audio recorded, transcribed and independently analysed by two researchers using a thematic approach. RESULTS Six major themes were identified which revealed dimensions of healthcare quality that were important to participants: Balancing expectations and overall satisfaction; Timely access and convenience; Continuity, integration and coordination of care; Clinician expert skills, professional manner and interpersonal attributes; Financial considerations when receiving care; and Perceptions of treatment outcomes. CONCLUSIONS This study highlights participants' views and experiences of allied-health extended scope of practice models of care. Service delivery models were an acceptable alternative to traditional specialist medical care with the perception that extended scope of practice models of care delivered many aspects of quality care that mattered to patients.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,School of Medicine, Centre for Applied Health Economics, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, Australia
| | - Joshua M Byrnes
- School of Medicine, Centre for Applied Health Economics, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Vicki Larkins
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rebecca L Angus
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Katrina L Campbell
- School of Medicine, Centre for Applied Health Economics, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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Lewis KJ, Coppieters MW, Vicenzino B, Hughes I, Ross L, Schmid AB. Occupational Therapists, Physiotherapists and Orthopaedic Surgeons Agree on the Decision for Carpal Tunnel Surgery. Int J Health Policy Manag 2022; 11:1001-1008. [PMID: 33590739 PMCID: PMC9808184 DOI: 10.34172/ijhpm.2020.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Therapist-led pathways have been proposed as waitlist management strategies prior to surgery for conditions such as carpal tunnel syndrome (CTS) in public hospitals. These models of care typically shift the initial care of patients and decision-making from surgeons to therapists and, have been shown to reduce the number of patients requiring surgery and improve wait-times. This occurs despite limited evidence of surgeon-therapist agreement on key decisions, such as the need for surgery. The purpose of this was study was to assess the agreement between therapists and orthopaedic surgeons regarding the need for surgery for patients who have CTS. METHODS This blinded inter-rated agreement study was embedded in a multicentre randomised parallel groups trial of 105 patients with CTS referred to four orthopaedic departments and waitlisted for an appointment. The trial evaluated the effect of a therapist-led care pathway on the need for surgery and outcomes related to symptoms and function. Patients were randomised to either remain on the orthopaedic waitlist or receive group education, a splint and home exercises. The decision on the need for surgery at 6 months was made by a member of the orthopaedic consultant team or by one of the 14 participating therapists. The therapists and surgeons were blinded to each other's decision. Agreement was determined using percentage agreement, kappa coefficients (k), prevalence-adjusted and bias-adjusted kappa (PABAK), and Gwet's first-order agreement coefficient (AC1). RESULTS Substantial agreement was seen between therapists and surgeons regarding the need for surgery (PABAK=0.74 (0.60-0.88)). Agreement was significantly associated with experience (P=.02). Therapists with advanced experience and scope of practice demonstrated perfect agreement with surgeons (PABAK=1.00 (95% CI: 1.00-1.00)). Mid-career therapists demonstrated substantial agreement (PABAK=0.67 (95% CI: 0.42-0.91)) and early-career therapists demonstrated fair agreement (PABAK=0.43 (95% CI: -0.04-0.90)). CONCLUSION Therapists with advanced scope of practice make decisions that are consistent with orthopaedic surgeons.
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Affiliation(s)
- Karina J. Lewis
- Occupational Therapy Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Michel W. Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Hughes
- Office of Research Governance and Development, Gold Coast University Hospital, Southport, QLD, Australia
| | - Leo Ross
- Division of Allied Health, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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8
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Thompson J, Gabriel L, Yoward S, Dawson P. The advanced practitioners' perspective. Exploring the decision-making process between musculoskeletal advanced practitioners and their patients: An interpretive phenomenological study. Musculoskeletal Care 2022; 20:128-136. [PMID: 33993603 DOI: 10.1002/msc.1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Advanced practice roles for allied health professionals continue to expand and provide key services within pathways of care for patients with musculoskeletal conditions. Despite the extensive utilisation of these roles and previously reported high patient satisfaction, little is understood about how these practitioners interact with their patients and the factors that influence decision-making conversations. STUDY A qualitative study utilised Interpretive Phenomenological Analysis (IPA) to explore the decision-making process occurring between Advanced Practitioners (APs) and their patients in a musculoskeletal service. AP data were collected through focus groups and analysed using IPA methodology. CONCLUSIONS Advanced practice decision-making is a complex process and APs exhibit a range of styles, from paternalistic to shared decision-making. APs may have a personal preference, but exhibit the ability to flex between styles in consultations. Multiple themes emerged from the data that influenced the decision-making process, including AP staff understanding the importance of patient expectations and the complex factors that influence patient interactions. It is important that clinicians have an awareness of the multiple factors that contribute to the decision-making process.
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Affiliation(s)
| | | | | | - Pamela Dawson
- Northumbria University, Newcastle upon Tyne, UK
- Plymouth Marjon University, Plymouth, UK
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Best S, Brown H, Stark Z, Long JC, Ng L, Braithwaite J, Taylor N. Teamwork in clinical genomics: A dynamic sociotechnical healthcare setting. J Eval Clin Pract 2021; 27:1369-1380. [PMID: 33949753 DOI: 10.1111/jep.13573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Teamworking across sociotechnical boundaries in healthcare is growing as technological advances in medicine abound. With this progress, teams need to find new ways of working together in non-traditional settings. The novel field of clinical genomics provides the opportunity to rethink the existing approach to teamworking and how it needs to evolve. Our aim was to identify the key factors influencing teamworking in the emerging field of clinical genomics and how can they be applied in practice. METHOD We drew on three qualitative datasets from interviews undertaken in Australia, 2018/2019, that explored determinants of implementation of clinical genomics with laboratory scientists (n = 7), service and programme leads (n = 21), project officers (n = 2), clinical genetics staff (n = 26) and other medical specialists (n = 21). Data were analysed using a theory-informed matrix approach to identify themes related to teamworking. RESULTS We identify that teams in clinical genomics work in an elongated adaptive context where there is rapid evolution of the knowledge base, shifting expectations of staff roles, and fast changes of technology. Delivering care in this setting brings additional challenges to teamworking as members strive to stay abreast of current knowledge and technology. We identify four themes: (a) the role of the team in keeping knowledge up-to-date; (b) professional identity; (c) team adaptability, and (d) practical/organisational considerations. CONCLUSION Challenges to teamworking that arise in the elongated adaptive context do not always fit traditional ways of working, and innovative strategies will need to be adopted to ensure the diagnostic advances of clinical genomics are realised. Provision of time and permission for team members to share knowledge and evolve, promoting capacity building, nurturing trustful relationships and establishing boundaries are amongst the practice recommendations for organisational and team leaders, even though these activities may disrupt existing ways of working or hierarchical structures.
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Affiliation(s)
- Stephanie Best
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Australian Genomics Health Alliance, Royal Childrens Hospital, Melbourne, Australia
| | - Helen Brown
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance, Royal Childrens Hospital, Melbourne, Australia.,Victorian Clinical Genetics Services, Royal Childrens Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Larissa Ng
- Victorian Clinical Genetics Services, Royal Childrens Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Vedanayagam M, Buzak M, Reid D, Saywell N. Advanced practice physiotherapists are effective in the management of musculoskeletal disorders: a systematic review of systematic reviews. Physiotherapy 2021; 113:116-130. [PMID: 34607076 DOI: 10.1016/j.physio.2021.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 07/01/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND There are increasing demands for orthopaedic specialist services due to the increasing burden of musculoskeletal (MSK) disorders. This situation creates a barrier for patients to access appropriate health care. Advanced practitioner physiotherapists (APP) may provide an alternative service for patients with MSK disorders. OBJECTIVE To evaluate the evidence on whether APPs are accurate at diagnosis, can triage appropriately and improve patient treatment outcomes and access to care for patients with musculoskeletal disorders. DATA SOURCES CINAHL, MEDline, Web of Science, SPORTdiscus, SCOPUS and AMED between January 2000 and March 2020. STUDY SELECTION Systematic reviews evaluating the efficacy of APPs, in any healthcare setting, treating patients of any age range with MSK disorders, in comparison to orthopaedic surgeons or doctors. DATA EXTRACTION AND SYNTHESIS Two researchers independently extracted and synthesised data according to the inclusion and exclusion criteria. Methodological quality was independently assessed by two reviewers using the AMSTAR tool. A third reviewer resolved discrepancies. RESULTS Thirteen systematic reviews met the inclusion criteria. The evidence consistently found APPs are accurate at diagnosis, can triage appropriately, and improve patient treatment outcomes and access to care. There was a lack of high-quality primary studies in the included reviews, however, the highest quality studies had similar findings. LIMITATIONS A meta-analysis was not possible due to heterogeneity of outcome measures. There was an overlap of primary studies which may cause bias. CONCLUSION The evidence of varying quality consistently shows that APPs can accurately diagnose, appropriately triage and effectively manage patients with musculoskeletal disorders in various clinical settings.
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Affiliation(s)
- Mario Vedanayagam
- Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences AUT University, PO Box 92006, Auckland 1142, New Zealand
| | - Martina Buzak
- Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences AUT University, PO Box 92006, Auckland 1142, New Zealand
| | - Duncan Reid
- Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences AUT University, PO Box 92006, Auckland 1142, New Zealand.
| | - Nicola Saywell
- Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences AUT University, PO Box 92006, Auckland 1142, New Zealand
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Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, Blake H, Yogeswaran G, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review. BMJ Open 2021; 11:e048171. [PMID: 34353799 PMCID: PMC8344309 DOI: 10.1136/bmjopen-2020-048171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. DESIGN A scoping review was undertaken following JBI methodological guidance. METHODS 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. RESULTS 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. CONCLUSION This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Education, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Gowsika Yogeswaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Leicester, UK
| | - Joy Conway
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Richard Collier
- Centre for Advancing Practice, Health Education England, Leeds, UK
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12
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Igwesi-Chidobe CN, Bishop A, Humphreys K, Hughes E, Protheroe J, Maddison J, Bartlam B. Implementing patient direct access to musculoskeletal physiotherapy in primary care: views of patients, general practitioners, physiotherapists and clinical commissioners in England. Physiotherapy 2021; 111:31-39. [PMID: 33316866 PMCID: PMC8120843 DOI: 10.1016/j.physio.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Musculoskeletal problems are the leading cause of chronic disability. Most patients in the UK seek initial care from general practitioners (GPs), who are struggling to meet demand. Patient direct access to National Health Service physiotherapy is one possible solution. The purpose of this study was to understand the experiences of patients, GPs, physiotherapists and clinical commissioners on direct access in a region in England with it commissioned. METHODS The study was informed by Normalisation Process Theory (NTP). Data collection was via semi-structured individual face-to-face and telephone interviews with 22 patients and 20 health care professionals (HCPs). Data were analysed thematically using NPT. RESULTS Three themes emerged: understanding physiotherapy and the direct access pathway; negotiating the pathway; making the pathway viable. HCPs saw direct access as acceptable. Whilst patients found the concept of direct access, those with complex conditions continued to see their GP as first point of contact. Some GPs and patients reported a lack of clarity around the pathway, reflected in ambiguous paperwork and inconsistent promotion. Operational challenges emerged in cross-disciplinary communication and between HCPs and patients, and lack of adequate resources. CONCLUSION Direct access to NHS musculoskeletal physiotherapy is acceptable to patients and HCPs. There is need to ensure: effective communication between HCPs and with patients, clarity on the scope of physiotherapy and the direct access pathway, and sufficient resources to meet demand. Patient direct access can free GPs to focus on those patients with more complex health conditions who are most in need of their care.
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Affiliation(s)
- Chinonso N Igwesi-Chidobe
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom; Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Annette Bishop
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Katrina Humphreys
- Central Cheshire Integrated Care Partnership, Leighton Hospital, Middlewich Road, Crewe, Cheshire, United Kingdom; The North West Coast Clinical Research Network, United Kingdom
| | - Emily Hughes
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Joanne Protheroe
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - John Maddison
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Bernadette Bartlam
- Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom.
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Távora-Vieira D, Voola M, Majteles L, Timms L, Acharya A, Kuthubutheen J. Extended scope of practice audiology in the ENT outpatient clinic - a pilot study. Int J Audiol 2021; 61:29-33. [PMID: 33771083 DOI: 10.1080/14992027.2021.1900610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the feasibility of using an extended scope (ES) audiology service to provide care to non-urgent adult patients waiting for an Ear Nose and Throat (ENT) appointment. DESIGN Based on suitability criteria developed by the Audiology and ENT departments, an internal review of the ENT wait list identified patients who would be suitable for an ES audiology clinic. STUDY SAMPLE 220 non-urgent patients on the ENT wait list with hearing loss and/or tinnitus. RESULTS A total of 220 patients were transferred from the ENT wait list to the ES audiology clinic: 200 (90.9%) were seen by the ES Audiologist and 20 (9.1%) patients self-discharged or did not attend the appointment. Out of the 200 patients seen, 175 (87.5%) were assessed, managed and discharged without the need for input from an Otologist. The remaining 25 (12.5%) patients needed an Otologist's input. CONCLUSION This study has demonstrated the feasibility of an ES audiology clinic in a tertiary teaching hospital. Of those seen by ES audiologist, 87.5% were discharged from the ENT wait list without medical intervention. This model may represent an effective alternative pathway for lengthy outpatient waiting list management whilst providing patients with timely access to care.
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Affiliation(s)
- Dayse Távora-Vieira
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Marcus Voola
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, Australia
| | - Lisa Majteles
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| | - Lydia Timms
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Aanand Acharya
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, Australia
| | - Jafri Kuthubutheen
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, Australia
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Kjeken I, Bergsmark K, Haugen IK, Hennig T, Hermann-Eriksen M, Hornburg VT, Hove Å, Prøven A, Sjøvold TA, Slatkowsky-Christensen B. Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial. BMC Musculoskelet Disord 2021; 22:194. [PMID: 33593307 PMCID: PMC7888184 DOI: 10.1186/s12891-021-04019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Current health policy states that patients with osteoarthritis (OA) should mainly be managed in primary health care. Still, research shows that patients with hand OA have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care. In this randomized controlled non-inferiority trial, we will test if a new model, where patients referred to consultation in specialist health care receive their first consultation by an occupational therapy (OT) specialist, is as safe and effective as the traditional model, where they receive their first consultation by a rheumatologist. More specifically, we will answer the following questions:
What are the characteristics of patients with hand OA referred to specialist health care with regards to joint affection, disease activity, symptoms and function? Is OT-led hand OA care as effective and safe as rheumatologist-led care with respect to treatment response, disease activity, symptoms, function and patient satisfaction? Is OT-led hand OA care equal to, or more cost effective than rheumatologist-led care? Which factors, regardless of hand OA care, predict improvement 6 and 12 months after baseline?
Methods Participants will be patients with hand OA diagnosed by a general practitioner and referred for consultation at one of two Norwegian departments of rheumatology. Those who agree will attend a clinical assessment and report their symptoms and function in validated outcome measures, before they are randomly selected to receive their first consultation by an OT specialist (n = 200) or by a rheumatologist (n = 200). OTs may refer patients to a rheumatologist consultation and vice versa. The primary outcome will be the number of patients classified as OMERACT/OARSI-responders after six months. Secondary outcomes are pain, function and satisfaction with care over the twelve-month trial period. The analysis of the primary outcome will be done by logistic regression. A two-sided 95% confidence interval for the difference in response probability will be formed, and non-inferiority of OT-led care will be claimed if the upper endpoint of this interval does not exceed 15%. Discussion The findings will improve access to evidence-based management of people with hand OA. Trial registration ClinicalTrials.gov, NCT03102788. Registered April 6th, 2017, https://clinicaltrials.gov/ct2/show/NCT03102788?term=Kjeken&draw=2&rank=1 Date and version identifier: December 17th, 2020. First version.
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Affiliation(s)
- Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.
| | - Kjetil Bergsmark
- Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, N-0319, Vinderen, Oslo, Norway
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, N-0319, Vinderen, Oslo, Norway
| | | | | | | | - Åshild Hove
- Division of Clinical Service, Diakonhjemmet Hospital, Oslo, Norway
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15
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Lyric analysis in adult mental health settings: An exploratory interpretivist study of music therapists’ clinical decision-making processes. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2020.101712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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16
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O Mir M, Blake C, Cunningham C, Fennelly O, O'Sullivan C. Orthopaedic consultant surgeons perceptions of an advanced practice physiotherapy service in paediatrics: A qualitative study. Musculoskeletal Care 2020; 19:149-157. [PMID: 32881295 DOI: 10.1002/msc.1508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to determine orthopaedic consultants' perceptions of an advanced practice physiotherapy (APP) service in paediatrics. DESIGN This is a qualitative study that use semi-structured interviews to explore consultant doctors' experiences of an APP paediatric orthopaedic service and its development. Data were transcribed verbatim and subsequently underwent thematic analysis. PARTICIPANTS Five orthopaedic consultants in two hospital settings participated, and all of whom had experience of working with paediatric orthopaedic APPs. RESULTS Seven themes were derived from the analysis, with all participants in the study identifying factors affecting the development of the service and demonstrating broad support for the APP role, with benefits noted as including improved efficiency of service, expansion of skill mix within the team, positive impressions of the standard of care and improved education and liaison with the families and community practitioners at large. CONCLUSIONS This paper highlights many of the factors that should be considered when introducing an APP service in an outpatient setting. This study demonstrates consistent cross-site positive regard in the skill and competency of the APP in paediatric orthopaedics, to enhance orthopaedic services for children.
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Affiliation(s)
- Marie O Mir
- Physiotherapy Department, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Catherine Blake
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Caitriona Cunningham
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Orna Fennelly
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Cliona O'Sullivan
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
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17
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Lowry V, Bass A, Lavigne P, Léger-St-Jean B, Blanchette D, Perreault K, Roy JS, Aiken A, Décary S, Desmeules F. Physiotherapists' ability to diagnose and manage shoulder disorders in an outpatient orthopedic clinic: results from a concordance study. J Shoulder Elbow Surg 2020; 29:1564-1572. [PMID: 32199757 DOI: 10.1016/j.jse.2019.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/15/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Advanced practice physiotherapy has emerged as a promising solution to improve health care access because access to orthopedic care is limited in several countries. However, evidence supporting advanced practice physiotherapy models for the management of shoulder pain remains scarce. The purpose of this study was to establish diagnostic, surgical triage, and medical imaging agreement between advanced practice physiotherapists (APPs) and orthopedic surgeons (OSs) for the management of patients with shoulder disorders in an outpatient orthopedic clinic. METHODS Patients referred to an OS for shoulder complaints were recruited and independently assessed by an OS and an APP. Each provider completed a standardized form indicating diagnosis, imaging test requests, and triage of surgical candidates. Patient satisfaction with care was recorded with the 9-item Visit-Specific Satisfaction Questionnaire (VSQ-9). Inter-rater concordance was calculated with the Cohen κ, prevalence-adjusted bias-adjusted κ, and associated 95% confidence interval (CI). We used χ2 tests to compare differences between providers in terms of treatment plan options and Student t tests to compare patient satisfaction between providers. RESULTS Fifty participants were evaluated. Good diagnostic agreement was observed between providers (κ, 0.80; 95% CI, 0.67-0.93). Agreement for triage of surgical candidates was moderate (κ, 0.46; 95% CI, 0.21-0.71) as APPs tended to refer patients more often to OSs for further evaluation. Imaging test request agreement was moderate as well (κ, 0.42; 95% CI, 0.19-0.66). Patient satisfaction with care was high, with no significant differences found between providers (P = .70). CONCLUSION APPs could improve access to orthopedic care for shoulder disorders by safely initiating patient care without compromising satisfaction. These results support further development and evaluation of APP care for orthopedic patients presenting with shoulder disorders.
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Affiliation(s)
- Veronique Lowry
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada; Faculty of Medicine, School of Rehabilitation, University of Montréal, Montréal, QC, Canada.
| | - Alec Bass
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada; Faculty of Medicine, School of Rehabilitation, University of Montréal, Montréal, QC, Canada
| | - Patrick Lavigne
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada
| | - Benjamin Léger-St-Jean
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada
| | - David Blanchette
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada; Faculty of Medicine, Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - Jean-Sebastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada; Faculty of Medicine, Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - Alice Aiken
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Simon Décary
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Faculty of Medicine, Québec, QC, Canada
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada; Faculty of Medicine, School of Rehabilitation, University of Montréal, Montréal, QC, Canada
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18
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Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol. BMJ Open 2020; 10:e036192. [PMID: 32439696 PMCID: PMC7247387 DOI: 10.1136/bmjopen-2019-036192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective. METHODS AND ANALYSIS This scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework). DISSEMINATION The review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Nottingham, UK
| | - Joy Conway
- College of Health and Life Sciences, Brunel University, Uxbridge, UK
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Lowry V, Desmeules F. Extended Role Practitioners to Improve Access to Rheumatic Care: What is the Evidence in the Classification of Patients with Spondyloarthritis? J Rheumatol 2020; 47:483-485. [PMID: 32238541 DOI: 10.3899/jrheum.190693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, University of Montreal; Maisonneuve-Rosemont Hospital Research Center;
| | - François Desmeules
- School of Rehabilitation, University of Montreal; Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
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20
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The Use of Stents in Children with Nasolacrimal Duct Obstruction Requiring Surgical Intervention: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031067. [PMID: 32046207 PMCID: PMC7037191 DOI: 10.3390/ijerph17031067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. It is managed conservatively in the first year of life, after which surgical treatment is classically based on a stepwise paradigm of probing, intubation, and dacryocystorhinostomy. This systematic review aims to present the current role of intubation in the management of children with NLDO requiring surgical intervention. A search for English-language articles from the electronic databases PubMed, SCOPUS, and the COCHRANE library was conducted over a period of five months in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. The following keywords were used to aid retrieval: stents, children, lacrimal intubation, endoscopic dacryocystorhinostomy, external dacryocystorhinostomy, NLDO, dacryocystitis, congenital, acquired. The primary outcome was defined as the success of the intervention, determined by resolution of symptoms and patency of the lacrimal anatomy confirmed by the fluorescein dye disappearance test or syringing. Secondary outcomes included the presence of complications. A total of 144 articles were identified; of these, 35 fulfilled the study criteria. The majority of the included studies involved lacrimal intubation alone, followed by intubation as an adjunctive procedure to balloon dacryoplasty and dacryocystorhinostomy. The overall success rate of these procedures ranged from 41.1% to 100%. Post-operative complications were reported in 65.7% of the included studies. Lacrimal intubation was most commonly performed as a primary procedure in children with NLDO, with high success rates. The main complication was stent dislodgement. There is lack of evidence regarding the benefit of intubation over probing as primary treatment of congenital NLDO. In the absence of high-quality evidence, the decision of whether to perform lacrimal intubation in children with NLDO requiring surgical intervention depends on clinical judgement and other low-level evidence, such as observational non-randomised trials.
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Moretto N, Stute M, Sam S, Bhagwat M, Raymer M, Buttrum P, Banks M, Comans TA. A uniform data set for determining outcomes in allied health primary contact services in Australia. Aust J Prim Health 2020; 26:58-69. [PMID: 31954431 DOI: 10.1071/py18104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
The project aim was to develop and implement a set of metrics to capture and demonstrate the performance of newly established allied health primary contact services. Selection of the metrics and performance indicators was guided by an existing state-wide data collection system and from a review of the published literature. The metrics were refined after consultation with a working group of health service managers and clinicians. The data collection and reporting framework were developed for use in allied health primary contact services and implemented at public health facilities in Queensland, Australia. The set of metrics consists of 18 process and outcome measures. Patient-reported metrics include the global rating of change scale and patient satisfaction. Service metrics include wait times; referral source; triage category; diagnosis; occasions of service; referrals and investigations initiated; effects; care duration; discharge status; waitlist reinstatement reasons; treatment non-completion reasons; and expedited care. Safety, patient demographics and service improvement metrics were included. The metrics will enable analysis of the effectiveness of allied health primary contact services and will facilitate reporting, advocacy, service improvement, service continuity and research. The metrics are suitable for use by all providers of allied health primary contact services in hospital and primary care settings.
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Affiliation(s)
- Nicole Moretto
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia; and Corresponding author
| | - Michelle Stute
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Sonia Sam
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Marita Bhagwat
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Maree Raymer
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Peter Buttrum
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Merrilyn Banks
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Tracy A Comans
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
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22
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Froment FP, Olson KA, Hooper TL, Shaffer SM, Sizer PS, Woodhouse LJ, Brismée JM. Large variability found in musculoskeletal physiotherapy scope of practice throughout WCPT and IFOMPT affiliated countries: An international survey. Musculoskelet Sci Pract 2019; 42:104-119. [PMID: 31102821 DOI: 10.1016/j.msksp.2019.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/18/2019] [Accepted: 04/20/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advanced practice physiotherapy (APP) rights are part of the evolution of the Physical Therapy profession. To date, no study has investigated musculoskeletal APP rights within the World Confederation for Physical Therapy (WCPT). OBJECTIVE To investigate musculoskeletal APP rights for physical therapists worldwide and examine the relationship between level of education (entry and post-professional) and direct access for countries that are vs. are not members of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT). DESIGN Cross-sectional study with descriptive and exploratory online surveys. METHODS An electronic survey-based descriptive and exploratory investigation was conducted. We assessed variability between WCPT member organizations descriptively and the strength of the relationships among the number and types of APP rights with: (1) country affiliation to IFOMPT; (2) entry-level professional degree; (3) post-professional training; and (4) direct access. RESULTS Some countries reported having the right to practice all 20 APP rights while others reported no APP rights. Countries with IFOMPT member organization countries displayed fair correlation (rs = .48, p < .03) between entry-level physical therapy degrees and number of APP rights. IFOMPT member organization countries were less likely to require post-professional training for direct access and manipulation. CONCLUSION APP rights for countries with direct access were significantly higher than for countries without direct access. IFOMPT member organizations demonstrated higher APP rights prevalence and were less likely to require post-professional training to obtain the right to direct access and perform manipulation.
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Affiliation(s)
- Frédéric P Froment
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| | - Kenneth A Olson
- Northern Rehab Physical Therapy Specialists, DeKalb, Illinois, USA; International Federation of Orthopaedic Manipulative Physical Therapists, New Zealand
| | - Troy L Hooper
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Stephen M Shaffer
- Doctor of Physical Therapy Program, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Phillip S Sizer
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Linda J Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Alberta, Canada
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Passalent L, Hawke C, Lawson DO, Omar A, Alnaqbi KA, Wallis D, Steinhart H, Silverberg M, Wolman S, Derzko-Dzulynsky L, Haroon N, Inman RD. Advancing Early Identification of Axial Spondyloarthritis: An Interobserver Comparison of Extended Role Practitioners and Rheumatologists. J Rheumatol 2019; 47:524-530. [PMID: 31043543 DOI: 10.3899/jrheum.180787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare clinical impression and confidence of extended role practitioners (ERP) with those of rheumatologists experienced in axial spondyloarthritis (axSpA) according to (1) evaluation of patients with chronic back pain assessed for axSpA; and (2) magnetic resonance imaging (MRI) recommendation for further investigation of these patients. METHODS Patients with ≥ 3 months of back pain and age of onset < 45 years were referred for axSpA evaluation. An ERP assessed consecutive patients and recorded standardized clinical information in written form. Three rheumatologists subsequently evaluated each patient based on the recorded information. Patients were classified as having axSpA or mechanical back pain based on clinical and investigative findings. Level of confidence was noted for classification and MRI indication. Agreement between assessors was evaluated using percentage agreement and κ coefficient. RESULTS Fifty-seven patients were assessed. Interobserver agreement of clinical impression for all raters was moderate (κ = 0.52). Agreement of clinical impression between ERP and rheumatologists ranged between 71.2% (κ = 0.41) and 79.7% (κ = 0.57). Agreement of clinical impression among rheumatologists ranged from 74.1% (κ = 0.49) to 79.7% (κ = 0.58). All rater agreement for MRI indication was fair (κ = 0.37). ERP agreement with rheumatologist for MRI recommendation ranged from 64.2% (κ = 0.32) to 75% (κ = 0.48). Agreement for MRI indication among rheumatologists ranged from 62.9% (κ = 0.27) to 74% (κ = 0.47). Confidence in clinical impression was similar among all practitioners. CONCLUSION ERP with specialty training in inflammatory arthritis demonstrate clinical impressions comparable with those of rheumatologists in the assessment of axSpA. Incorporation of such roles into existing models of care may assist in early detection of axSpA.
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Affiliation(s)
- Laura Passalent
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada. .,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute.
| | - Christopher Hawke
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Daeria O Lawson
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Ahmed Omar
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Khalid A Alnaqbi
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Dinny Wallis
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Hillary Steinhart
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Mark Silverberg
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Stephen Wolman
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Larissa Derzko-Dzulynsky
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Nigil Haroon
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
| | - Robert D Inman
- From the Spondylitis Program, Toronto Western Hospital; and Faculty of Medicine, University of Toronto, Krembil Research Institute, Toronto, Ontario, Canada.,L. Passalent, MHSc, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; C. Hawke, BSc Hons (PT), Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; D.O. Lawson, HBSc, Spondylitis Program, Toronto Western Hospital; A. Omar, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto; K.A. Alnaqbi, MD, Rheumatology Division, Al Ain Hospital, United Arab Emirates; D. Wallis, MD, University Hospital Southampton, Southampton, UK; H. Steinhart, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; M. Silverberg, MD, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto; S. Wolman, MD, Faculty of Medicine, University of Toronto, Toronto General Hospital, Toronto; L. Derzko-Dzulynsky, MD, Faculty of Medicine, University of Toronto, St. Michael's Hospital, Toronto; N. Haroon, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute; R.D. Inman, MD, Spondylitis Program, Toronto Western Hospital, Faculty of Medicine, University of Toronto, Krembil Research Institute
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O Mir M, Oʼ Sullivan C, Blake C, Lennon O. An Exploration of Parental Satisfaction With an Advanced Practice Physical Therapy Clinic in Pediatric Orthopedics. Pediatr Phys Ther 2019; 31:192-199. [PMID: 30865147 DOI: 10.1097/pep.0000000000000586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate parent satisfaction of patients attending a novel advanced practice physical therapy clinic in pediatric orthopedics. METHODS A cross-sectional survey collected data using 2 approaches: a modified version of the VSQ-9 and open-ended responses. The component structure of the Visit Specific Satisfaction Questionnaire (VSQ) was explored and the Cronbach alpha assessed internal consistency. Responses were summarized as mean (95% CI). An inductive content analysis was performed for open-ended responses. RESULTS Satisfaction ratings were excellent. A 2-component structure for the VSQ was confirmed. The Cronbach alpha coefficient was 0.85, indicating high internal consistency. Emergent themes were mostly positive in relation to Time, Communication, Professionalism, and Service Delivery, with Physical Resources receiving negative comments. CONCLUSIONS This study evaluated parent satisfaction with a novel advanced practice in pediatric orthopedics, demonstrating high levels of satisfaction and identifying positive and negative themes that impact parent perceptions of quality of care.
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Affiliation(s)
- Marie O Mir
- Physiotherapy Department (Ms O Mir), Our Lady's Children's Hospital, Crumlin, Dublin, Ireland; School of Public Health, Physiotherapy and Sport Science (Drs O' Sullivan, Blake, and Lennon), University College Dublin, Dublin, Ireland
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Aujla RS, Patel S, Jones A, Bhatia M. Non-operative functional treatment for acute Achilles tendon ruptures: The Leicester Achilles Management Protocol (LAMP). Injury 2019; 50:995-999. [PMID: 30898390 DOI: 10.1016/j.injury.2019.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study is to present outcomes and objective measures of assessment for acute Achilles tendon (AT) ruptures treated with an eight-week functional dynamic treatment protocol in a VACOped® boot with immediate full weight bearing mobilisation, the Leicester Achilles Management Protocol (LAMP). METHODS A prospective study of all patients treated with the LAMP with minimum 12-month follow-up was performed. Patients completed the Achilles Tendon Rupture Score (ATRS) and in the latter part of the study, objective measures of the calf muscle girth and heel raise height were obtained. RESULTS 442 patients were treated with the LAMP. There were nine (2%) re-ruptures in the 442 non-operative treated group of patients throughout the study period. ATRS at twelve months or more were available in 234 patients and objective measures in 77 patients. The mean age was 50 years. The mean ATRS was 75.5 at an average of 23 months post injury. Men had a statistically significant higher ATRS score when compared to women (p < 0.05). There was statistically significant difference in the calf muscle girth and the heel raise height when compared to the uninjured side at 12-months post-injury (p < 0.05). These differences did not correlate with the ATRS (p > 0.05). CONCLUSIONS The LAMP is a simple yet effective regime for the non-operative treatment of acute AT ruptures, which can be universally adopted without the need for many resources. Compared to other studies, the overall time in the boot is less with low complication rates and similar patient reported outcomes.
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Affiliation(s)
- Randeep S Aujla
- Trauma & Orthopaedic Surgery, University Hospitals of Leicester, Leicester, United Kingdom.
| | - Shakil Patel
- Trauma & Orthopaedic Surgery, University Hospitals of Leicester, Leicester, United Kingdom
| | - Annette Jones
- Trauma & Orthopaedic Surgery, University Hospitals of Leicester, Leicester, United Kingdom
| | - Maneesh Bhatia
- Trauma & Orthopaedic Surgery, University Hospitals of Leicester, Leicester, United Kingdom
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Ó Mír M, O'Sullivan C, Lennon O, Blake C. An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints. Musculoskeletal Care 2018; 16:433-439. [PMID: 30109917 DOI: 10.1002/msc.1357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of the present study was to establish diagnostic agreement rates between orthopaedic consultants and advanced practice physiotherapists (APPs) for paediatric orthopaedic patients, examine the appropriateness of referrals by APPs to consultants and report on the surgical conversion rate (SCR). METHODS A retrospective review of all patients referred from an APP clinic to orthopaedic consultants was conducted for 2013, with a 3-year longitudinal follow-up through to the end of 2016. Study participants were two APPs and four orthopaedic consultants at a single site. Descriptive statistics report the proportion of appropriate onward referrals and SCRs. Raw proportion agreement and kappa coefficients were used to evaluate diagnostic agreement rates. RESULTS The mean raw agreement was 82% (95% confidence interval = 73 to 87), with 12 of the 15 individual codes demonstrating agreement rates ≥90% (range 57-100). Good to excellent agreement was demonstrated in almost all categories based on the kappa coefficient. Eighty-seven per cent of referrals from APPs were deemed to be appropriate by the orthopaedic consultants. The SCR was 23%. CONCLUSIONS This was the first study to evaluate diagnostic agreement rates between APPs and orthopaedic consultants, the appropriateness of onward referral by APPs and the SCR for paediatric musculoskeletal patients referred from an APP clinic. Good to excellent diagnostic agreement was observed for routine elective paediatric orthopaedic patients, in tandem with agreement levels reported in the adult literature. The study demonstrates that APPs are clinically effective in the diagnosis and onward referral of paediatric orthopaedic patients in a triage setting.
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Affiliation(s)
- Marie Ó Mír
- Physiotherapy Department, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Cliona O'Sullivan
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Olive Lennon
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Catherine Blake
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
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Shaw BR, Heywood SE, Page CJ, Phan UM, Harding PA, Walter K, Terrill DL, Granger CL. Advanced musculoskeletal physiotherapy: Barriers and enablers to multi-site implementation. Musculoskeletal Care 2018; 16:440-449. [PMID: 30113766 DOI: 10.1002/msc.1358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Advanced musculoskeletal physiotherapy (AMP) services are a safe, effective model of care, but without broad-scale healthcare implementation to date. The aim of the present study was to identify the barriers and enablers to implementation of 12 AMP services from the perspective of clinical staff. METHODS In a qualitative study, 12 participants (physiotherapists), from 12 different healthcare networks (seven metropolitan, three regional, two rural), were included. Their departments implemented AMP services (orthopaedic postoperative joint replacement review, n = 10; general orthopaedic, n = 1; emergency, n = 1; and neurosurgery n = 1) over a 12-month period. Participants completed a structured survey specifically designed for the study. Thematic analysis was used, with themes mapped to the validated Theoretical Domains Framework. RESULTS Nine major themes emerged from the data regarding barriers and enablers to the implementation of the AMP services from the perspective of clinical staff. These were: demand/capacity; model of care; the organization; stakeholders; communication; planning and processes; evaluation; workforce; and learning and assessment framework. Important enablers included engagement and buy-in from key stakeholders and medical staff, and well-established AMP learning frameworks for training and operational frameworks. Barriers included competitive funding environment, and issues that hindered effective communication. The knowledge, skills, availability, motivation and experience of the advanced musculoskeletal physiotherapists had a large impact on the implementation. CONCLUSIONS The study identified a number of factors that should be considered for successful implementation of AMP services across healthcare services or wider healthcare networks.
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Affiliation(s)
- Bridget R Shaw
- Department of Physiotherapy, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Sophie E Heywood
- Department of Physiotherapy, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, 4556, Australia
| | - Carolyn J Page
- Department of Physiotherapy, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Uyen M Phan
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia
| | - Paula A Harding
- Department of Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia
| | - Kerrie Walter
- Department of Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia
| | - Desiree L Terrill
- Department of Health and Human Services, Health and Wellbeing Workforce Reform, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Catherine L Granger
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia.,Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia
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McGowan E, Elliott N, Stokes E. Leadership capabilities of physiotherapy leaders in Ireland: Part 2. Clinical specialists and advanced physiotherapy practitioners. Physiother Theory Pract 2018; 35:1044-1060. [PMID: 29733739 DOI: 10.1080/09593985.2018.1469179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Investigation of the leadership capabilities of physiotherapy managers found that they report predominantly demonstrating capabilities associated with the human resource and structural frames. However, little is known about the leadership capabilities of clinical specialists and advanced physiotherapy practitioners (APPs) who also are identified as having responsibility for leadership. Objective: To explore clinical specialists´ and APPs' perceptions of their leadership capabilities and compare them with the reported leadership capabilities of physiotherapy managers. Methods: Semi-structured interviews were conducted with a purposive sample of 17 physiotherapy clinical specialists and APPs from a range of practice settings across Ireland. The interviews were analyzed using template analysis and the coding template was based on the Bolman and Deal Leadership framework. Results: The participants described demonstrating leadership capabilities associated with each of the four leadership frames. However, the language used by the clinical specialists/APPs suggested that they work predominantly through the human resource frame. Structural frame capabilities were reported by the clinical specialists/APPs and there were some differences to those reported by the managers. In keeping with the reported leadership capabilities of the physiotherapy managers, the employment of capabilities associated with the political frame varied between participants and symbolic frame capabilities were underused. Conclusion: There are many similarities in the self-reported leadership capabilities of managers and clinical specialists/APPs. However, differences were also noted. Both cohorts of physiotherapy leaders may benefit from specific development programs to develop leadership capabilities associated with the political and symbolic frames.
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Affiliation(s)
- E McGowan
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St James's hospital , Dublin , Ireland
| | - N Elliott
- School of Nursing and Midwifery, Trinity College Dublin , Dublin , Ireland
| | - E Stokes
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St James's hospital , Dublin , Ireland
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Gwynne-Jones DP, Hutton LR, Stout KM, Abbott JH. The Joint Clinic: Managing Excess Demand for Hip and Knee Osteoarthritis Referrals Using a New Physiotherapy-Led Outpatient Service. J Arthroplasty 2018; 33:983-987. [PMID: 29258762 DOI: 10.1016/j.arth.2017.11.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/05/2017] [Accepted: 11/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are increasing problems with access to both outpatient assessment and joint replacement surgery for patients with hip or knee osteoarthritis. METHODS Data were collected on all patients seen at the Joint Clinic over a 2-year period with minimum 12-month follow-up. Patients were assessed by a nurse and a physiotherapist, baseline scores and demographic details collected, and an individualized personal care plan developed. Patients could be referred for a first specialist assessment (FSA) if their severity justified surgical assessment. RESULTS Three hundred fifty-eight patients were seen at Joint Clinic, of whom 150 (44%) had hip and 189 (56%) had knee OA. The mean age was 67.4 years and there were 152 men (45%) and 187 women (55%). The mean baseline Oxford score was 19.8 (standard deviation 8.2). Fifty-four patients were referred directly to FSA (mean Oxford score 13.0, standard deviation 6.7) and 89 after a subsequent review. The scores of patients referred for FSA were significantly worse than those managed in the Joint Clinic (P < .001). Of the 143 referred for FSA, 115 underwent or were awaiting surgery, 18 were recommended surgery but scored below prioritization threshold, and 10 were not recommended surgery. The Oxford scores of the 194 patients managed non-operatively improved from 22.0 to 25.0 (P = .0013). CONCLUSION This study shows that the Joint Clinic was effective as a triage tool with 93% of those referred for FSA being recommended surgery. This has freed up surgeon time to see only those patients most in need of surgical assessment.
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Affiliation(s)
- David P Gwynne-Jones
- Section of Orthopaedic Surgery, Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Liam R Hutton
- Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Kirsten M Stout
- Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand
| | - J Haxby Abbott
- Section of Orthopaedic Surgery, Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Ó Mír M, O'Sullivan C. Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery. Ir J Med Sci 2017; 187:131-140. [PMID: 28478610 DOI: 10.1007/s11845-017-1611-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/28/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION One in eight paediatric primary care presentations is for a musculoskeletal (MSK) disorder. These patients are frequently referred to paediatric orthopaedic surgeons; however, up to 50% of referrals are for normal variants. This results in excessive wait-times and impedes access for urgent surgical cases. Adult MSK medicine has successfully utilised advanced practice physiotherapists (APP) managing non-surgical candidates, with documented benefits both to patients and services. There is a gap in the literature with regard to APP in paediatric orthopaedics. AIM In this review, we investigate demands on paediatric orthopaedic services, examine the literature regarding APP in paediatric orthopaedics and explore the value the role has to offer current outpatient services. RESULTS Paediatric orthopaedic services are under-resourced with concurrent long wait times. Approximately 50% of referrals are for normal variants, which do not require specialist intervention. Poor musculoskeletal examination skills and low diagnostic confidence amongst primary care physicians have been identified as a cause of inappropriate referrals. APP clinics for normal variants have reported independent management rate and discharge rates of 95% and marked reduction in patient wait times. CONCLUSION There is limited evidence to support the APP in paediatric orthopaedics. Further studies are needed investigating diagnostic agreement, patient/stakeholder satisfaction, patient outcomes and economic evaluation. Paediatric orthopaedics is in crisis as to how to effectively manage the overwhelming volume of referrals. Innovative multidisciplinary solutions are required so that the onus is not solely on physicians to provide all services. The APP in paediatric orthopaedics may be part of the solution.
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Affiliation(s)
- M Ó Mír
- Physiotherapy Department, Our Lady's Children's Hospital, Dublin, Ireland.
- School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland.
| | - C O'Sullivan
- School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
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