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Lindgaard MF, England A, Portelli JL, Hogg P, Johansen S. Advanced practice among diagnostic radiographers - An international survey. Radiography (Lond) 2024; 30:1604-1611. [PMID: 39396442 DOI: 10.1016/j.radi.2024.09.068] [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: 05/28/2024] [Revised: 09/13/2024] [Accepted: 09/30/2024] [Indexed: 10/15/2024]
Abstract
INTRODUCTION As the global healthcare system evolves, diagnostic radiographers (DRs) are taking on advanced roles, constituting advanced radiography practice. This study explored the definition of ARP tasks among DRs, radiology department managers (RDMs), and National Society Officers (NSOs) on a global scale. METHODS Data collection was obtained via a self-developed online survey administered via email and social media to DRs, RDMs, and NSOs. The survey sought to collect demographic data, insights into definition of ARP tasks, and perceptions regarding global practice. RESULTS 206 respondents from 25 countries participated, predominantly from Norway (n = 77), Australia (n = 34), and Portugal (n = 20). 71.7 % of DR respondents defined teaching as ARP task, while RDMs (74.2) and NSOs (88.8 %) identified approving image quality independently as ARP. 53.4 % of DRs perceived their practice as ARP-aligned, with awareness reported by 44.8 % of DRs, 66.7 % of RDMs, and 77.8 % of NSOs. CONCLUSION This study provides a clearer understanding of the task respondents consider ARP and the extent to which it is practiced, whereas DRs are increasingly performing advanced tasks globally. Clarifying ARP tasks in the workplace will promote a common understanding of the role and foster support for its establishment in diagnostic radiography. Further research is required to gather a more comprehensive international perspective on ARP tasks, especially given the limitations of this study, as well as the limited responses from the Americas and African regions. IMPLICATIONS FOR PRACTICE Clear definitions of ARP tasks are necessary for seamless integration of ARP into current practices. Additionally, advocating for official recognition, and global acknowledgement by the profession and key stakeholders are imperative for DRs to fully develop in these areas.
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Affiliation(s)
- M F Lindgaard
- Oslo Metropolitan University, Health Faculty, Oslo, Norway.
| | - A England
- School of Medicine, University College Cork, Cork, England, United Kingdom.
| | - J L Portelli
- Radiography Department, Faculty of Health Sciences, University of Malta, Malta.
| | - P Hogg
- Centre of Health Sciences Research, University of Salford, Frederick Road, Salford, United Kingdom.
| | - S Johansen
- Oslo Metropolitan University, Health Faculty, Oslo, Norway; Department of Cancer Treatment, Oslo University Hospital, Oslo, Norway; Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.
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Thompson JH, Thompson J, Bailey S. Shared decision-making in advanced physiotherapy and first contact physiotherapy management of adults with musculoskeletal disorders in the United Kingdom: An online cross-sectional survey. J Eval Clin Pract 2024; 30:1297-1308. [PMID: 38881399 DOI: 10.1111/jep.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/25/2024] [Accepted: 05/25/2024] [Indexed: 06/18/2024]
Abstract
RATIONALE Advanced practice physiotherapy roles (Advanced Physiotherapy Practitioners [APPs] and First Contact Physiotherapists [FCPs]) are pivotal in supporting patients to manage their musculoskeletal (MSK) conditions. Having a greater understanding of how decisions are made by these practitioners will inform competency frameworks and improve the provision of patient-centred care. AIM To evaluate the current knowledge, views and use of shared decision-making in MSK advanced physiotherapy practice in the United Kingdom. METHODS A cross-sectional survey using an online questionnaire was used to collect demographic information, knowledge, views and self-reported use of shared decision-making (SDM) of APPs and FCPs who work with adults with MSK disorders in the United Kingdom. RESULTS Responses from 49 participants (25 APPs and 24 FCPs) were included in the study. In total, 80% of participants had received SDM training and overall high levels of knowledge were shown. Only 12% of participants used a communication model to facilitate SDM. In total, 80% of participants reported making decisions together with the patient either always or most of the time. FCPs favoured a more patient-led approach to decision-making compared to APPs who favoured collaborative decision-making. The most commonly reported barriers to SDM included lack of time, lack of patient education resources, lack of access to patient decision aids and treatment pathway restrictions. CONCLUSIONS The responses in this study showed that overall APPs and FCPs have good knowledge of SDM and report routine use of collaborative and patient-led decision-making approaches.
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Maddigan K, Kowalski KL, Tawiah AK, Rushton AB. The educational pathway to Advanced Practice for the physiotherapist: Protocol for a systematic mixed studies review. PLoS One 2024; 19:e0308921. [PMID: 39331670 PMCID: PMC11432879 DOI: 10.1371/journal.pone.0308921] [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: 03/07/2024] [Accepted: 07/31/2024] [Indexed: 09/29/2024] Open
Abstract
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.
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Affiliation(s)
- Kaitlyn Maddigan
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Katie L. Kowalski
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Andrews K. Tawiah
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Alison B. Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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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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Murphy MC, French H, McCarthy G, Cunningham C. Informing low back pain care from the ground up: Survey of national musculoskeletal triage physiotherapists in Ireland. Musculoskelet Sci Pract 2024; 72:103101. [PMID: 38851176 DOI: 10.1016/j.msksp.2024.103101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Healthcare is changing to meet the challenge of a rising musculoskeletal burden associated with the expanding, aging population. Clinicians, important stakeholders in healthcare provision, have crucial insights into service improvement, but clinician consultation is a shortcoming in healthcare development. In Ireland, specialist physiotherapist-led musculoskeletal (MSK) triage services operate at the primary-secondary care interface to expedite patient care. OBJECTIVES To inform future development of low back pain (LBP) care in Ireland through profiling the operationalisation of the national MSK triage service for LBP, including access, referral management, clinical investigations, onward referral options, access to multidisciplinary team (MDT) services and integration with primary healthcare services. DESIGN Cross-sectional observational study using a bespoke, anonymous electronic survey. PARTICIPANTS Thirty-eight clinical specialist physiotherapists working in national programme Irish MSK triage services. RESULTS Thirty-eight MSK Triage physiotherapists submitted responses (response rate 72%). There was considerable site-dependent variation in LBP service provision, with discrepancies in access to triage services, wait times, referral processing and prioritisation, access to clinical investigations and onward referral options. Most respondents (81%) reported wait times exceeding the three-month target; 75% reported that the level of clinical autonomy associated with their role limited service efficiency; 75% were dissatisfied with primary-secondary care service integration. Respondents identified insufficient availability of primary care multidisciplinary services. CONCLUSION Lack of standardisation of LBP services exists in Ireland. Services would benefit from improved standardisation, reduced wait times, national accreditation and a defined scope of advanced physiotherapy practice and the development of nationwide community multidisciplinary infrastructure with enhanced interservice communication.
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Affiliation(s)
- Ms Cathriona Murphy
- Physiotherapy Department, University Hospital Kerry, Tralee, Co. Kerry, Ireland.
| | - Helen French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Geraldine McCarthy
- School of Medicine, University College Dublin, Ireland; Department of Rheumatology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
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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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Tawiah AK, Stokes E, Wieler M, Desmeules F, Finucane L, Lewis J, Warren J, Lundon K, Noblet T, Cunningham C, Woodhouse LJ. Developing a core competency and capability framework for advanced practice physiotherapy: A qualitative study. Physiother Theory Pract 2024; 40:1477-1491. [PMID: 36715443 DOI: 10.1080/09593985.2023.2170196] [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: 06/29/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION There is an urgent need to develop an international competency and capability framework to support standardization of education and roles in advanced practice physiotherapy (APP). This need arose due to the rapid growth of the APP model of care, implemented out of necessity in the absence of agreement as to the competencies and capabilities or formal education required for the roles. This study explores the views and perceptions of practitioners and key stakeholders on a draft competency and capability framework for advanced practice physiotherapists. OBJECTIVES The purpose of this study was to: 1) gather feedback from key stakeholders (advanced practice physiotherapists, researchers, and leaders) on a draft competency and capability framework and 2) use that feedback to revise and improve the draft framework. DESIGN Qualitative study using a series of four multi-national online focus groups. Thematic analysis was conducted according to Braun and Clarke. RESULTS Sixteen participants from the United Kingdom, Ireland, Canada, Australia, and New Zealand participated in the study. Five themes were generated after data analysis: clinical expert, experienced communicator, strong leader, collaborator, and knowledge creator). A modified competency and capability framework was developed based on feedback from the focus groups and input from subject matter experts (SMEs). CONCLUSION This study provides a modified core competency and capability framework comprising 24 competencies grouped under six domains. This study is a step toward international standardization of advanced practice physiotherapy based on a commonly agreed framework for the education and training of advanced practice physiotherapists.
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Affiliation(s)
- Andrews K Tawiah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Emma Stokes
- Trinity College Dublin, University of Dublin. College Green, Dublin, Ireland
| | - Marguerite Wieler
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Laura Finucane
- Physiotherapy Department, Sussex MSK Partnership, Eastbourne, UK
- Department of Health, Social Care and Education, St George's University London, London, UK
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Jonathan Warren
- Strategic Team, Office of Health and Disability Commissioner, Technology, Wellington, New Zealand
| | - Katie Lundon
- Office of Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tim Noblet
- Department of Health, Social Care and Education, St George's University London, London, UK
- Physiotherapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Linda J Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Public Health & Community Medicine, Division of Physical Therapy, Tufts University, School of Medicine, Phoenix, AZ, USA
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Tawiah AK, Stokes E, Wieler M, Desmeules F, Finucane L, Lewis J, Warren J, Lundon K, Noblet T, Cunningham C, Woodhouse LJ. Evaluating the importance of a core competency and capability framework for advanced practice physiotherapy: A cross-sectional survey. Physiother Theory Pract 2024:1-13. [PMID: 38912894 DOI: 10.1080/09593985.2024.2368593] [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: 02/24/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The need for a global core competency and capability framework for advanced practice physiotherapy is important due to the rapidly changing nature of health care delivery internationally and the need to standardize advanced practice physiotherapy. OBJECTIVE To determine the importance of a proposed international core competency and capability framework for advanced practice physiotherapy. METHODS We conducted a cross-sectional online survey of advanced practice physiotherapists across seven countries. The importance of each competency and capability was rated on a five-point agreement Likert scale. Participants were from the United Kingdom, Ireland, Australia, New Zealand, Canada, Switzerland and Argentina. RESULTS A total of 99 participants completed the survey, comprising 63% (57/90) females and 33% (30/90) males. Sixty percent, 60% (54/90), had over 20 years of experience. The survey participants represented a diverse geographic distribution, with 25% (23/90) from Australia, 25% (23/90) from Canada, 18% (6/90) from New Zealand, and 18% (6/90) from the United Kingdom. Four percent 4% (4/90) from Ireland, and 4% (4/90) from other countries (Switzerland and Argentina). The survey revealed a strong consensus among participants, with all competencies and capabilities ranked as high and considered important to advanced practice. CONCLUSION This study demonstrates a consensus among advanced practice physiotherapists across seven countries on the importance of a proposed competency and capability framework. The findings highlight the need for a global standard in advanced practice physiotherapy, particularly in light of the rapidly changing healthcare landscape.
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Affiliation(s)
- Andrews K Tawiah
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Emma Stokes
- Trinity College Dublin, The University of Dublin, College Green, Dublin, Ireland
| | - Marguerite Wieler
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, Canada
| | | | - Laura Finucane
- Sussex MSK Partnership, Eastbourne, UK
- Department of Health, Social Care and Education, St Georges University London, London, UK
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Jonathan Warren
- Strategic Team, Office of Health and Disability Commissioner, Technology One House, Wellington, New Zealand
| | - Katie Lundon
- Office of Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tim Noblet
- Department of Health, Social Care and Education, St Georges University London, London, UK
- Physiotherapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Linda J Woodhouse
- School of Medicine, Department of Public Health & Community Medicine, Division of Physical Therapy- Phoenix, Tufts University, Phoenix, AZ, USA
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Boyle EM, Evans K, Coates S, Fary RE, Bennell K, Sterling M, Rebbeck T, Beales DJ. Patient experiences of referral practices and primary care physiotherapy for chronic nonspecific low back pain. Physiother Theory Pract 2024; 40:1326-1342. [PMID: 36331383 DOI: 10.1080/09593985.2022.2141599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings. PURPOSE This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy. METHODS An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices. RESULTS Four themes described the participants' experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices. CONCLUSION Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist's role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people's experiences of care and health outcomes.
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Affiliation(s)
- Eileen M Boyle
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
- Healthia Limited, Bowen Hills Queensland, Australia
| | - Sonia Coates
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
| | - Robyn E Fary
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
| | - Kim Bennell
- Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Parkville Carlton, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMR Centre of Research Excellence in Road Traffic Injury recovery, The University of Queensland, Brisbane City Queensland, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
| | - Darren J Beales
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
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Eustachio JHPP, Filho WL, Baars C, Barbosa-Silva J, Lourenção M, Barbir J, Röseler J, Büddig S, de Lima PQ, Bandos MC. Fostering the discussion of planetary health in occupational therapy and physiotherapy. Aust Occup Ther J 2024; 71:423-442. [PMID: 38720015 DOI: 10.1111/1440-1630.12959] [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: 10/04/2023] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Occupational therapists and physiotherapists aim to promote health, prevent various diseases and help people in their rehabilitation processes. So far, there is a paucity of understanding of the big picture of how the new paradigm of planetary health (PH) is connected to the education and practice of these professionals. METHODS This research aimed to address this gap by investigating and deploying a bibliometric analysis to elucidate the pivotal role of occupational therapists and physiotherapists in addressing PH challenges. The ultimate goal is to construct a comprehensive framework crosschecking the bibliometric analysis and the collection of 10 case studies selected by experts to outline how best practices in occupational therapy and physiotherapy, related to the three pillars of sustainability and the UN's Sustainable Development Goals (SDGs), can contribute to increasing PH. RESULTS The bibliometric analysis revealed four major research strands: 1) enhancing patient care and quality of life; 2) integrating sustainability in health care and rehabilitation; 3) professional development and clinical competence; and 4) evidence-based practice and quality improvement. Moreover, further temporal analysis revealed how the topic evolved, from advancing evidence-based practice and clinical effectiveness, exploring the strengthening of health care and person-centred practices, to connecting the topic to aspects also predicted by the SDGs, such as integrating environmental and climate concerns in therapy and addressing psychological and self-care impacts on health. The case studies confirmed this trend, and a framework of PH in occupational therapy and physiotherapy through the lens of the SDGs was developed to support future research and practitioners in advancing this research field. CONCLUSIONS Occupational therapists and physiotherapists are essential players in public health and can integrate sustainability at every level of practice, from using resources during therapy sessions to advocating for more sustainable lifestyles.
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Affiliation(s)
- João Henrique Paulino Pires Eustachio
- Faculty of Life Sciences, Research and Transfer Centre Sustainability & Climate Change Management (FTZ-NK), Hamburg University of Applied Sciences, Hamburg, Germany
| | - Walter Leal Filho
- European School of Sustainability Science and Research (ESSSR), Hamburg University of Applied Sciences, Germany
- Department of Natural Sciences, Manchester Metropolitan University, Manchester, UK
| | - Caterina Baars
- Faculty of Life Sciences, Research and Transfer Centre Sustainability & Climate Change Management (FTZ-NK), Hamburg University of Applied Sciences, Hamburg, Germany
| | - Jordana Barbosa-Silva
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos (UFSCar), Sao Carlos, Brazil
| | - Marina Lourenção
- School of Economics, Business Administration and Accounting at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Jelena Barbir
- Faculty of Life Sciences, Research and Transfer Centre Sustainability & Climate Change Management (FTZ-NK), Hamburg University of Applied Sciences, Hamburg, Germany
| | - Jasmin Röseler
- Faculty of Life Sciences, Research and Transfer Centre Sustainability & Climate Change Management (FTZ-NK), Hamburg University of Applied Sciences, Hamburg, Germany
| | - Swantje Büddig
- Faculty of Life Sciences, Research and Transfer Centre Sustainability & Climate Change Management (FTZ-NK), Hamburg University of Applied Sciences, Hamburg, Germany
| | - Priscilla Queiroz de Lima
- School of Physiotherapy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Melissa Cavalcanti Bandos
- Uni-FACEF, Post-Graduation Program in Regional Development, Municipal University Center, Franca, SP, Brazil
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Kent F, Haruta J. Culture and context in Interprofessional education: Expectations in Australia and Japan. MEDICAL EDUCATION 2024. [PMID: 38728120 DOI: 10.1111/medu.15424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024]
Abstract
The attributes of collaborative practice in health care vary across contexts, necessitating the adaptation of interprofessional education curricula to prepare students for the collaborative practice expected in their respective health care systems. Culture, when conceptualised through an organisational lens, allows an analysis of the shared assumptions, beliefs and values, without seeking to reduce to a uniform construct. This article explores the differences in interprofessional education competencies between Australia and Japan and considers the systems and patient expectations, which underpin each. While collaborative competence exhibits some similarities across contexts, competency frameworks differ in emphasis, language and key terminology, which highlight multiple points of difference in the expectations of interprofessional collaborative practice across contexts. There are education and practice consequences of these different perspectives of collaborative practice, in an increasingly mobile international workforce.
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Affiliation(s)
- Fiona Kent
- Education Portfolio, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Health Professions Education Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Junji Haruta
- Medical Education Center, School of Medicine, Keio University, Tokyo, Japan
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Raymer M, Swete Kelly P, O'Leary S. Developing and embedding an advanced practice musculoskeletal physiotherapy service in public specialist outpatient services in Queensland: A health service masterclass. Musculoskelet Sci Pract 2024; 70:102917. [PMID: 38309180 DOI: 10.1016/j.msksp.2024.102917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 02/05/2024]
Abstract
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.
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Affiliation(s)
- Maree Raymer
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Patrick Swete Kelly
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Shaun O'Leary
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia; University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD 4072, Australia.
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Tawiah AK, Stokes E, Wieler M, Desmeules F, Finucane L, Lewis J, Warren J, Lundon K, Noblet T, Cunningham C, Woodhouse LJ. Developing an international competency and capability framework for advanced practice physiotherapy: a scoping review with narrative synthesis. Physiotherapy 2024; 122:3-16. [PMID: 38029504 DOI: 10.1016/j.physio.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/02/2023] [Accepted: 07/08/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The need to address increasing numbers of people seeking care, insufficient numbers of physicians, and providing high-value and sustainable care has contributed to changing physiotherapy practice across the world, often referred to as advanced practice physiotherapy. Currently, there is no internationally standardized competency and capability framework to support advanced practice physiotherapy. OBJECTIVES This scoping review has two aims; 1) To identify and map out the competencies of advanced practice physiotherapy available in the literature. 2) To develop a competency and capability framework by mapping the competencies identified from the review. DESIGN The Arksey and O'Malley framework and the PRISMA Scoping review methodology were used. Databases searched included CINAHL Plus, MEDLINE Ovid, PubMed, and Scopus. The competency and capability framework was developed through a narrative synthesis approach. RESULTS Nineteen documents were included in the final review, with 13 grey literature (government reports, policy documents, thesis) and six research papers. Included publications came from the United Kingdom, Ireland, Australia, New Zealand, and Canada. The included documents covered predominantly musculoskeletal practice (n = 17). The others focused on cardiorespiratory care, incontinence and pelvic health. Through narrative synthesis, 27 competencies and capabilities were identified and grouped under seven domains. CONCLUSION The synthesis of this scoping review provides the first competency and capability framework for advanced practice physiotherapy that integrates competencies and capabilities from five different countries. With the expansion of advanced practice physiotherapy, the framework developed from this review is the first step towards international recognition, standardization and consistency of education and training of practitioners. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Andrews K Tawiah
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
| | | | - Marguerite Wieler
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Laura Finucane
- Sussex MSK Partnership, United Kingdom; Department of Health, Social Care and Education, St Georges University London, United Kingdom
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; School of Health Sciences, University of Nottingham, UK
| | - Jonathan Warren
- Strategic Team, Office of Health and Disability Commissioner, Wellington, New Zealand
| | - Katie Lundon
- Office of Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tim Noblet
- Department of Health, Social Care and Education, St Georges University London, United Kingdom; St George's University Hospitals NHS Foundation Trust, Physiotherapy Department, London, United Kingdom
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Linda J Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada; Tufts University, School of Medicine, Department of Public Health & Community Medicine, Division of Physical Therapy, Phoenix, AZ, USA
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Herrington J, Soever L, Desmeules F, Farrer C, Lundon K, MacLeod A, Rushton A, Passalent L. The Future is Now for Advanced Practice Physiotherapy in Canada. Physiother Can 2024; 76:1-3. [PMID: 38465308 PMCID: PMC10919361 DOI: 10.3138/ptc-2023-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 03/12/2024]
Affiliation(s)
- Julie Herrington
- From the:
School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Leslie Soever
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Qc, Canada
| | - Chandra Farrer
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Katie Lundon
- Continuing Professional Development, Temerty Faulty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne MacLeod
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Laura Passalent
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Rheumatology, Schroeder Arthritis Insitute, University Health Network, Toronto, ON, Cananda
- Krembil Research Institute, University Health Insitute, Toronto ON, Canada
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Herrington J, Desmeules F, Farrer C, Lundon K, MacLeod A, Rushton A, Soever L, Passalent L. L’avenir, c’est maintenant pour la pratique avancée de la physiothérapie au Canada. Physiother Can 2024; 76:4-7. [PMID: 38465313 PMCID: PMC10919368 DOI: 10.3138/ptc-2023-0085.fr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Julie Herrington
- École des sciences de la réadaptation, Université McMaster, Hamilton (Ontario) Canada
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton (Ontario), Canada
| | - Francois Desmeules
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal (Québec) Canada
| | - Chandra Farrer
- Département de physiothérapie, Faculté de médecine Temerty, Université de Toronto, Toronto (Ontario) Canada
- Women's College Hospital, Toronto (Ontario) Canada
| | - Katie Lundon
- Perfectionnement professionnel continu, Faculté de médecine Temerty, Université de Toronto, Toronto (Ontario) Canada
| | - Anne MacLeod
- Université de l’École de médecine du nord de l’Ontario, Thunder Bay (Ontario) Canada
| | - Alison Rushton
- École de physiothérapie, Faculté des sciences de la santé, Université Western, London (Ontario) Canada
| | - Leslie Soever
- Département de physiothérapie, Faculté de médecine Temerty, Université de Toronto, Toronto (Ontario) Canada
- Division de chirurgie orthopédique, Schroeder Arthritis Institute, Réseau universitaire de santé, Toronto (Ontario) Canada
| | - Laura Passalent
- Département de physiothérapie, Faculté de médecine Temerty, Université de Toronto, Toronto (Ontario) Canada
- Division de rhumatologie, Schroeder Arthritis Institute, Réseau universitaire de santé, Toronto (Ontario) Canada
- Institut de recherche Krembil, Réseau universitaire de santé, Toronto (Ontario) Canada
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Ó Mír M, Casey MB, Smart KM. A survey of physiotherapist managers in Ireland and their views on the role of Advanced Practice Physiotherapists. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2064. [PMID: 38069448 DOI: 10.1002/pri.2064] [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: 01/25/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Within the current context of implementation of an Advanced Practice Grade, the Irish Society of Chartered Physiotherapists commissioned a survey of physiotherapy manager opinions regarding the role of Advanced Practice Physiotherapists. OBJECTIVES The aim of this survey was to explore the views of physiotherapist managers in relation to the characteristics, role, competencies and management of Advanced Practice Physiotherapists (APPs) in Ireland. METHODS Physiotherapist managers based in primary and secondary care settings in Ireland were invited to participate in a survey on Advanced Practice. Quantitative data from a custom designed online survey was analysed with descriptive statistics and qualitative data from open-ended survey questions were analysed using thematic analysis. RESULTS The response rate to the survey was 32% (24/75). On average, respondents thought that 54% (range: 15%-80%) of an APPs time should be spent in clinical practice and between 17% and 20% variously on managerial and leadership, teaching and education and research and development duties. Four themes were identified from the surveys' open-ended questions related to the description of APP: 'Extended scope 'Advanced clinical training, knowledge, and decision-making', 'Autonomy, independence and responsibility', and 'Wider roles'. CONCLUSION Irish physiotherapist managers recognised the extended scope of practice, expertise and multiple roles characteristic of APPs. They indicated the need for legislative changes and clarity around governance.
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Affiliation(s)
- Marie Ó Mír
- Irish Society of Chartered Physiotherapists (ISCP), Royal College of Surgeons, St Stephen's Green, Dublin, Ireland
| | - Maire-Brid Casey
- Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Keith M Smart
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Vervaeke R, Lafrance S, Demont A. Core competencies for first contact physiotherapists in a direct access model of care for adults with musculoskeletal disorders: A scoping review. Musculoskeletal Care 2023; 21:1353-1363. [PMID: 37641476 DOI: 10.1002/msc.1813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION To optimise the management of Musculoskeletal disorders (MSKDs), many countries have implemented direct access to physiotherapy; however, the core competencies required for first contact physiotherapists (PTs) have not been precisely defined. The aim of this scoping review is to identify and describe the core competencies required for first contact PTs treating adults with MSKDs. METHODS We conducted a scoping review of the literature by searching eight databases and grey literature up to July 2023. We performed a thematic analysis of the competencies identified based on predefined themes relevant to first contact physiotherapy in direct access models in primary or emergency care settings. RESULTS Sixty-five articles were included. Seventeen core competencies were identified and grouped into 5 themes: (1) Assessment and examination; (2) Management and interventions; (3) Communication; (4) Cooperation and collaboration; and (5) Professionalism and leadership. CONCLUSIONS Our findings provide an international perspective on the core competencies required for first contact PTs.
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Affiliation(s)
| | - Simon Lafrance
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Center, Université de Montréal Affiliated Research Center, Montreal, Quebec, Canada
| | - Anthony Demont
- INSERM UMR-S 1153, Centre de Recherche Épidémiologique et Statistique Sorbonne Paris Cité, Paris, France
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Lafrance S, Vincent R, Demont A, Charron M, Desmeules F. Advanced practice physiotherapists can diagnose and triage patients with musculoskeletal disorders while providing effective care: a systematic review. J Physiother 2023; 69:220-231. [PMID: 37714771 DOI: 10.1016/j.jphys.2023.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 06/19/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023] Open
Abstract
QUESTIONS What is the diagnostic and surgical triage concordance between advanced practice physiotherapists (APPTs) and physicians? What is the clinical efficacy of advanced practice physiotherapy care compared with usual medical care? DESIGN Systematic review with meta-analyses. LITERATURE SEARCH Medline, Embase, Cochrane CENTRAL and CINAHL were searched up to March 2022. STUDY SELECTION CRITERIA Concordance studies on diagnostic or surgical triage between APPTs and physicians and randomised controlled trials comparing the clinical efficacy of an advanced practice physiotherapy (APP) model of care compared with usual medical care for participants with musculoskeletal disorders. DATA SYNTHESIS Meta-analyses were performed for concordance and clinical outcomes. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to evaluate the certainty of evidence. RESULTS Nineteen concordance studies (n = 1,745) and six randomised trials (n = 1,960) were included. Based on moderate-certainty evidence, the pooled Kappa for diagnostic concordance between APPTs and physicians was 0.76 (95% CI 0.68 to 0.85, n = 1,108). Based on high-certainty evidence, the pooled Kappa for surgical triage concordance was 0.71 (95% CI 0.63 to 0.78, n = 1,128). Based on moderate-certainty evidence, APP care resulted in a comparable or greater reduction in pain (MD -0.92 out of 10, 95% CI -1.75 to -0.10, n = 494) when compared with usual medical care at medium-term follow-up. Based on low-certainty evidence, APP care resulted in a comparable or greater reduction in disability (SMD -0.31, 95% CI -0.67 to 0.04, n = 535) when compared with usual medical care at medium-term follow-up. CONCLUSION Concordance between APPTs and physicians is probably good to very good for diagnosis and good to very good for surgical triage of musculoskeletal disorders. Patients with musculoskeletal disorders managed in an APP model of care probably report comparable or greater pain and disability reductions when compared with usual medical care. REGISTRATION CRD42022320950.
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Affiliation(s)
- Simon Lafrance
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada; Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal Affiliated Research Center, Montreal, Canada.
| | - Raphaël Vincent
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada; Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal Affiliated Research Center, Montreal, Canada
| | | | - Maxime Charron
- Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal Affiliated Research Center, Montreal, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada; Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal Affiliated Research Center, Montreal, Canada
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Finucane LM, Greenhalgh SM, Mercer C, Selfe J. Defensive medicine: A symptom of uncertainty? Musculoskelet Sci Pract 2022; 60:102558. [PMID: 35367770 DOI: 10.1016/j.msksp.2022.102558] [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: 02/04/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/30/2022]
Abstract
Defensive medicine is a well-documented phenomenon and refers to the practice of over-cautious management of patients, leading to excessive clinical activity such as over-investigation, unnecessary appointments and additional interventions. Adopting this approach is not in the best interest of patients and can lead to clinical reasoning being replaced by lists, guidelines and algorithms which do not consider the complexity of a patients presentation or the reasoning inherent in good clinical judgement. The drivers of defensive medicine are varied and include a high level of uncertainty alongside other factors including clinical experience with past cases, system pressures and patient expectations. This paper explores these drivers and considers strategies on how best to avoid a defensive medicine approach. It reinforces the need to adopt a patient centred focus and use sound clinical reasoning to support the management of patients.
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Affiliation(s)
- Laura M Finucane
- Sussex MSK Partnership, Brighton, UK; Department of Health, Social Care and Education, St Georges University London, UK.
| | - Susan M Greenhalgh
- Bolton NHS Foundation Trust, UK; Department of Health Professions, Manchester Metropolitan University, UK
| | - Christopher Mercer
- Western Sussex Hospitals NHS Trust, Chichester, UK; University Hospitals Sussex NHS Trust, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, UK; Physiotherapy Department, Satakunta University of Applied Sciences, Pori, Finland
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Pellekooren S, Donker M, Reijnders E, Boutalab L, Ostelo R, van Tulder M, Pool-Goudzwaard A. The introduction of advanced practice physiotherapy within Dutch primary care is a quest for possibilities, added value, and mutual trust: a qualitative study amongst advanced practice physiotherapists and general practitioners. BMC Health Serv Res 2022; 22:529. [PMID: 35449100 PMCID: PMC9026935 DOI: 10.1186/s12913-022-07906-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the increased deployment and added value of Advanced Practitioner Physiotherapy (APP) in musculoskeletal care internationally, APP is not yet widely accepted within Dutch primary care. This may be due to specific constraints in the implementation of APP within the Dutch healthcare system. This study aimed to explore the experiences and perceptions of Advanced Practitioner Physiotherapists (APPs) and General Practitioners (GPs) with respect to implementing APP within Dutch primary care. Methods This explorative and interpretive qualitative study included 12 APPs and 3 GPs who were in various stages of implementing an APP care model. Semi-structured interviews were conducted between January and March 2021. The topic list was based on existing literature, the personal input of researchers, and the Constellation Approach framework. Data were analysed using a thematic inductive approach. Results Four main themes emerged from the data; 1) Both GPs’ trust in APP and a clear added value of APP are critical for starting implementation, 2) APPs need continuous support from GPs, 3) APPs believe that their position needs strengthening, and 4) Implementation of the APP model creates tension over ownership. These four themes highlight the perceived difficulties in gaining trust, lack of clarity over the added value of APP, ambiguity over APPs’ professional profile and positioning, a need on behalf of GPs to maintain authority, lack of reimbursement structure, and the struggle APPs face to strike a balance with current care. Conclusion This study demonstrates that implementing an APP model of care is challenging, in part, because the deployment of APP does not sufficiently align with the core values of GPs, while GPs appear reluctant to hand over control of elements of patient care to APPs. APPs do not appear to have ownership over the implementation, given their strong dependence on the practice, values and needs of GPs. Trial registration Ethical approval was obtained from the Medical Ethics Committee of VU University Medical Centre in Amsterdam; reference number 2020.17 . All participants were asked to provide written informed consent prior to participating in the study. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07906-6.
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Affiliation(s)
- Sylvia Pellekooren
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands. .,Department of Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.
| | - Marianne Donker
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Eddy Reijnders
- Huisartsopleiding VUmc, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Lamyae Boutalab
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam Movement Sciences Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Maurits van Tulder
- Department of Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Annelies Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,SOMT University of Physiotherapy, Amersfoort, The Netherlands
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