Advanced practice physiotherapists can diagnose and triage patients with musculoskeletal disorders while providing effective care: a systematic review

Is One Enough? The Effectiveness of a Single Session of Education and Exercise Compared to Multiple Sessions of a Multimodal Physiotherapy Intervention for Adults With Spinal Disorders in an Advanced Practice Physiotherapy Model of Care: A Randomized Controlled Trial

OBJECTIVE: To assess the effectiveness of a single session of education and exercise compared with multiple sessions of a multimodal physiotherapy intervention for adults with spinal disorders in an advanced practice physiotherapy specialized spine model of care. DESIGN: Pragmatic randomized controlled trial. METHODS: We randomized patients with spinal disorders, who were referred for a spinal surgery consultation and triaged as nonsurgical cases by an advanced practice physiotherapist, to a single session of education and prescription of an exercise program (n = 52) or multiple sessions (6 in total) of a multimodal physiotherapy intervention (n = 54). The primary outcomes were the short form Brief Pain Inventory pain severity scale (BPI-S) and the Brief Pain Inventory pain interference scale (BPI-I), and secondary outcomes included disability, quality of life, catastrophization, and satisfaction. Linear mixed models were used to assess differences between groups across time points at 6, 12, and 26 weeks. RESULTS: There were no significant between-group differences on the BPI-S and only a significant improvement at 6 weeks on the BPI-I in the multiple-session group (mean difference: -0.96/10; 95% CI, -1.87 to -0.05). There were no other statistically significant differences between groups, except for satisfaction where participants in the multiple-session group reported statistically significantly greater satisfaction on the 9-item Visit-Specific Satisfaction Questionnaire and the MedRisk questionnaire. Both groups saw significant improvements over time on all outcomes except for the BPI-S. CONCLUSION: Adding supervised multimodal physiotherapy sessions did not result in better clinical outcomes when compared to a single session of education and exercise. Patients were more satisfied with the multiple-session approach. J Orthop Sports Phys Ther 2024;54(10):1-13. Epub 9 September 2024. doi:10.2519/jospt.2024.12618.

The educational pathway to Advanced Practice for the physiotherapist: Protocol for a systematic mixed studies review

RATIONALE

Advanced Practice Physiotherapy (APP) is a post-licensure higher level of practice that requires distinctly increased skills, clinical reasoning and experience. The four pillars that underpin APP are clinical practice, leadership, education and research. Multiple systematic reviews support that APP is beneficial to health care systems. While APP exists in over a dozen countries, it has yet to reach international recognition. A steppingstone in gaining global acknowledgement is understanding the educational pathway that physiotherapists traverse to become Advanced Practitioners. No systematic review has synthesized evidence to describe and evaluate the educational pathway for physiotherapists to APP. Therefore, the objectives of this review are 1) to describe the post-licensure educational pathways that physiotherapists engage in to advance their level of practice, 2) to evaluate the pillars of APP demonstrated by the physiotherapist after traversing a post-licensure educational pathway.

MATERIALS AND METHODS

A systematic mixed studies review using a data based convergent qualitative synthesis design will be conducted. MEDLINE (Ovid), Embase, CINAHL, the Cochrane Library, Web of Science, PEDro, SportDiscus, ProQuest Education databases as well as the grey literature will be searched from inception to 02/29/2024. Studies that aim to describe and or evaluate the capacity of educational pathways to influence the level of practice of the physiotherapist will be included. Two independent reviewers will screen studies, extract data and assess methodological quality (Quality Assessment of Diverse Studies). Quantitative data will be 'qualitized', and all data will be synthesized via a clustered textual description and directed content analysis. After synthesis, two reviewers will assess confidence in the cumulative evidence (GRADE-CERQual), which will inform the discussion.

IMPLICATIONS

The optimal pathway(s) to Advanced Practice for the physiotherapist will be evaluated to inform future high-quality research investigating the effectiveness of post-licensure education in developing Advanced Practice physiotherapists.

Investigating the Use of Telemedicine by Health Care Providers to Diagnose and Manage Patients With Musculoskeletal Disorders: Systematic Review and Meta-Analysis

BACKGROUND

Access to care is a major challenge for patients with musculoskeletal disorders (MSKDs). Telemedicine is one of the solutions to improve access to care. However, initial remote diagnosis of MSKDs involves some challenges, such as the impossibility of touching the patient during the physical examination, which makes it more complex to obtain a valid diagnosis. No meta-analysis has been performed to date to synthesize evidence regarding the initial assessment including a physical evaluation using telemedicine to diagnose patients with MSKDs.

OBJECTIVE

This study aims to appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of telemedicine and usual in-person assessment for the initial evaluation of various MSKDs.

METHODS

An electronic search was conducted up to August 2023 using terms related to telemedicine and assessment of MSKDs. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Random-effect model meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to synthesize the quality and certainty of the evidence.

RESULTS

A total of 23 concordance studies were eligible and included adult participants (N=1493) with various MSKDs. On the basis of high certainty, pooled κ and prevalence-adjusted and bias-adjusted κ for the diagnostic concordance between remote and in-person assessments of MSKDs were 0.80 (95% CI 0.72-0.89; 7 studies, 353 patients) and 0.83 (95% CI 0.76-0.89; 6 studies, 306 patients). On the basis of moderate certainty, pooled Gwet AC1 for treatment plan concordance between remote and in-person assessments of MSKDs was 0.90 (95% CI 0.80-0.99; 2 studies, 142 patients).

CONCLUSIONS

The diagnostic concordance for MSKDs is good to very good. Treatment plan concordance is probably good to excellent. Studies evaluating the accuracy to detect red and yellow flags as well as the potential increase in associated health care resources use, such as imaging tests, are needed.

Physiotherapist managers views on advanced practice physiotherapy in Ireland. A qualitative study

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.

Developing and embedding an advanced practice musculoskeletal physiotherapy service in public specialist outpatient services in Queensland: A health service masterclass

INTRODUCTION

The Musculoskeletal Physiotherapy Screening Clinic and Multi-disciplinary Service (MPSC&MDS) is an advanced practice physiotherapist-led model of care developed initially to address overburdened specialist orthopaedic outpatient public hospital services across Queensland, Australia.

PURPOSE

This Masterclass explores the experiences and success of embedding the MPSC&MDS state-wide across the Queensland public health system and its expansion in scale and reach to other specialist services. Key characteristics and development strategies are described that have collectively underpinned the expansion and sustainability of the service, using relevant stream sections and themes from a recommended musculoskeletal model of care framework.

IMPLICATIONS

The aim of this masterclass is to be informative for readers involved in the future development or refinement of similar models of care.