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Ferrández-Gómez JÉ, Gacto-Sánchez M, Nouni-García R, Gascón-Jaén J, Lozano-Quijada C, Baño-Alcaraz A. Physiotherapists' adherence to Clinical Practice Guidelines in fibromyalgia: a cross-sectional online survey. Rheumatol Int 2024; 44:1509-1520. [PMID: 38839659 PMCID: PMC11222258 DOI: 10.1007/s00296-024-05630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
To evaluate the level of knowledge and adherence to Clinical Practice Guidelines on fibromyalgia of physiotherapists in Spain. A cross-sectional study using an ad-hoc online survey was implemented to assess aspects on the assessment, treatment, and decision of the length of the therapeutic approach on fibromyalgia. Based on the results, professionals were classified as adherent, partially adherent, or non-adherent. The level of agreement with several statements on the condition was also evaluated across the professionals surveyed to evaluate the potential consensus. A total of 240 physiotherapists met inclusion criteria, amongst which 68 (28.33%) were adherent. The academic level of studies (Chi-square = 48.601, p-value = 0.001) and having had previous training in fibromyalgia (Chi-square = 151.011, p-value = 0.001) displayed statistically significant differences across adherence-based groups. Consensus was reached for 15 out of 24 statements. Our findings highlight the presence of an acceptable level of knowledge and adherence to clinical practice guidelines in the field of fibromyalgia among physiotherapists in Spain.Practice implicationsOur results also reveal the existence of an evidence-to-practice gap in the field, with potential room for improvement: further efforts on promoting and reinforcing the importance of evidence-based therapies are needed, from university teaching plans to clinical updates for daily practice.
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Affiliation(s)
- José Édgar Ferrández-Gómez
- Physiotherapy Area, Pathology and Surgery Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550, San Juan de Alicante, Spain
- Faculty of Physiotherapy, Occupational Therapy and Podiatry, UCAM Catholic University of Murcia, Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, Campus of Health Sciences, University of Murcia, Av. Buenavista, 32 El Palmar, 30120, Murcia, Spain.
| | - Rauf Nouni-García
- Physiotherapy Area, Pathology and Surgery Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550, San Juan de Alicante, Spain
- Diagnostic Center, Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante, Fifth Floor, Pintor Baeza Street, 12, 03110, Alicante, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550, San Juan de Alicante, Spain
| | - Jaime Gascón-Jaén
- Physiotherapy Area, Pathology and Surgery Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550, San Juan de Alicante, Spain
| | - Carlos Lozano-Quijada
- Department of Pathology and Surgery, Faculty of Medicine, Center for Translational Research in Physiotherapy, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8,7-N 332, 03550, Alicante, Spain
| | - Aitor Baño-Alcaraz
- Department of Physical Therapy, Campus of Health Sciences, University of Murcia, Av. Buenavista, 32 El Palmar, 30120, Murcia, Spain
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Msomi NL, Ross AJ. Social accountability challenges and recommendations by community service rehabilitation therapists. S Afr Fam Pract (2004) 2024; 66:e1-e9. [PMID: 38949449 PMCID: PMC11219701 DOI: 10.4102/safp.v66i1.5936] [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: 02/16/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Social accountability entails providing equitable and accessible services that are tailor-made for the community's healthcare needs and enable rehabilitation therapists to improve the efficiency and efficacy of healthcare delivery and their response. Enabling them to provide optimal care during their community service year requires understanding the gaps in their knowledge, experience and the support they provide to the communities they service. METHODS Four in-depth individual interviews and four focus group discussions were conducted via Zoom. The qualitative responses to the questions related to the challenges and recommendations associated with social accountability in clinical settings were analysed using an inductive thematic approach via NVIVO. RESULTS Four sub-themes emerged for each of the two areas of interest: the challenges relating to (1) budget and equipment constraints, (2) staff shortages, (3) cultural and language barriers and (4) scope of practice limitations. The recommendations related to (5) collaboration with community caregivers, (6) service inclusion in primary health care clinics, (7) improved executive management support and (8) continuing professional development. CONCLUSION Equipping graduates with the knowledge, skills and support needed to work in an under-resourced setting is essential for community service rehabilitation therapists to ensure social accountability, given that they often work alone, specifically in rural settings.Contribution: Being aware of the challenges that face community service rehabilitation therapists, having the necessary tools and health facility management support will enable ongoing improvements in their ability to provide socially accountable services.
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Affiliation(s)
- Ntandoyenkosi L Msomi
- Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban.
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Crowther K, Carey N, McFadden S, Stenner K, Hughes C. Therapeutic radiographer prescribing practices in the United Kingdom: Questionnaire survey. Radiography (Lond) 2024; 30:964-970. [PMID: 38657390 DOI: 10.1016/j.radi.2024.04.008] [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: 01/24/2024] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Non-medical professionals in the United Kingdom (UK) have been granted prescribing rights to improve patient care quality and cost-effectiveness. There is limited evidence on how therapeutic radiographer prescribers have impacted medicine management or patient services. METHODS An online survey was conducted amongst non-medical prescribing therapeutic radiographers in the UK between 2019 and 2022. The study teams initially analysed the individual data sets, subsequently combined, and secondary analysis was performed to provide a UK perspective, to understand the services provided and identify areas for improvement. Data was analysed using descriptive statistics from Microsoft Excel® and SPSS®. RESULTS 74 non-medical prescribing therapeutic radiographers who were predominantly over 40 years old and in full-time work participated. The main job categories were consultant radiographers (n = 23, 31.1%) and advanced practice practitioners (n = 18, 24.3%). Many use their prescribing qualifications (87.5%, n = 62), issuing a mean of 15 independent and seven items by supplementary and prescribing per week. Most received assessment and diagnostic skills training before prescribing courses (91.6%, n = 67). Respondents prescribed from a median of six areas, with the highest being in GI (82%), skin (68%), infections (58%), urinary tract disorders (55%) and ear, nose, and oropharynx conditions (54%). CONCLUSION This study presents the first report on therapeutic radiographers prescribing in the UK, offering insights into current practices and highlighting the success of non-medical prescribing. Therapeutic radiographers' roles continue to expand into advanced practice and medicine-prescribing responsibilities, contributing to holistic and patient-centred care. IMPLICATIONS FOR PRACTICE The results are relevant for nations grappling with oncology workforce shortages and contemplating similar roles for therapeutic radiographers. The study can be a valuable resource for policymakers and healthcare organisations worldwide.
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Affiliation(s)
- K Crowther
- School Health Sciences, Institute of Nursing and Health Research, Ulster University, Belfast, York Street, Belfast, Northern Ireland, UK; Accuray Incorporated, 1240 Deming Way, Madison, WI, USA.
| | - N Carey
- Centre for Rural Health Sciences, University of the Highlands and Islands, 12B Ness Walk, Inverness, Scotland, UK
| | - S McFadden
- School Health Sciences, Institute of Nursing and Health Research, Ulster University, Belfast, York Street, Belfast, Northern Ireland, UK
| | - K Stenner
- School of Health Sciences, University of Surrey, 30 Priestley Road, Surrey Research Park, Guildford, England, UK
| | - C Hughes
- School Health Sciences, Institute of Nursing and Health Research, Ulster University, Belfast, York Street, Belfast, Northern Ireland, UK
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Kechichian A, Pommier D, Druart L, Lowry V, Pinsault N, Desmeules F. "Cooperation between physicians and physios fosters trust you know": a qualitative study exploring patients' experience with first-contact physiotherapy for low back pain in French primary care. BMC PRIMARY CARE 2024; 25:69. [PMID: 38395795 PMCID: PMC10885482 DOI: 10.1186/s12875-024-02302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Physiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage acute low back pain patients as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore patients' experience and perceptions when attending a first-contact physiotherapist (FCP) in an advanced practice collaborative primary care model for acute low back pain (LBP). METHODS A qualitative study using semi-structured interviews was conducted. Patients that consulted a FCP for acute LBP care in new collaborative model were included. Interviews were transcribed verbatim and inductive thematic analysis was performed to generate themes related to patients' experience and perceptions. RESULTS Ten patients were interviewed (3 women, 7 men; mean age 36.5 ± 9.63 years). All LBP participants experienced important level of pain and disability. Four overarching themes related to patients' experience with the new FCP model were formalized: 1) "Going to see a physiotherapist who specializes in painful movements, well that makes sense to me", 2) "Physiotherapist offered to give me exercises to do at home to relieve the back pain", 3) "I went there feeling confident", 4) "The physiotherapist can do more than just send you to see more appropriate people". Participants highlighted the need to receive timely and high-quality care and were receptive with being autonomously managed by a FCP. Overall, patients' experiences with FCP model of care were positive. Participants were highly confident in the FCP's ability to perform delegated medical tasks including making a medical diagnosis and prescribing oral medication such as analgesic drugs. Patients felt that a greater expansion of FCPs' scope of practice was needed to improve the model. CONCLUSION Findings from this study can inform the implementation of FCP in countries where patients are not typically granted FCP by underlining that patients are favourable towards the advance practice model as such models support timely and high-quality care. Further research is needed to better determine the future advance practice physiotherapists' scope of practice in French primary and secondary care settings.
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Affiliation(s)
- Amélie Kechichian
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France.
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France.
| | - Dylan Pommier
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - Léo Druart
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - Véronique Lowry
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Nicolas Pinsault
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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Hernández-Lázaro H, Mingo-Gómez MT, Jiménez-del-Barrio S, Lahuerta-Martín S, Hernando-Garijo I, Medrano-de-la-Fuente R, Ceballos-Laita L. Researcher's Perspective on Musculoskeletal Conditions in Primary Care Physiotherapy Units through the International Classification of Functioning, Disability, and Health (ICF): A Scoping Review. Biomedicines 2023; 11:biomedicines11020290. [PMID: 36830831 PMCID: PMC9953260 DOI: 10.3390/biomedicines11020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
(1) Background: Musculoskeletal disorders are the second cause of disability in the world. The International Classification of Functioning Disability and Health (ICF) is a tool for systematically describing functioning. Outcome measures for musculoskeletal disorders and functioning concepts embedded in them have not been described under the ICF paradigm. The objective of this scoping review was to identify ICF categories representing the researcher's perspective and to compare them with the ICF core set for post-acute musculoskeletal conditions. (2) Methods: This review was conducted as follows: (a) literature search using MEDLINE/PubMed, CINAHL, Web of Science, and Scopus databases; (b) study selection applying inclusion criteria (PICOS): musculoskeletal conditions in primary care, application of physiotherapy as a treatment, outcome measures related to functioning, and experimental or observational studies conducted in Western countries during the last 10 years; (c) extraction of relevant concepts; (d) linkage to the ICF; (e) frequency analysis; and (f) comparison with the ICF core set. (3) Results: From 540 studies identified, a total of 51 were included, and 108 outcome measures were extracted. In the ICF linking process, 147 ICF categories were identified. Analysis of data showed that 84.2% of the categories in the ICF core set for post-acute musculoskeletal conditions can be covered by the outcome measures analyzed. Sixty-eight relevant additional ICF categories were identified. (4) Conclusion: Outcome measures analyzed partially represent the ICF core set taken as a reference. The identification of additional categories calls into question the applicability of this core set in primary care physiotherapy units.
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Affiliation(s)
- Héctor Hernández-Lázaro
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
- Ólvega Primary Care Health Center (Soria, Spain), Soria Health Care Management, Castilla y León Regional Health Management (SACYL), 47007 Valladolid, Spain
| | - María Teresa Mingo-Gómez
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Sandra Jiménez-del-Barrio
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
- Correspondence:
| | | | - Ignacio Hernando-Garijo
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Ricardo Medrano-de-la-Fuente
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Luis Ceballos-Laita
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
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Schwarz M, Ward EC, Seabrook M, Coccetti A, Dunn K, Whitfield BCS, Bond C, Suliman E, Winckel C. Speech pathology prescribing in the outpatient setting: A review of requirements, considerations and barriers. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1194-1206. [PMID: 35793383 DOI: 10.1111/1460-6984.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND As health systems face increasing demands, non-medical prescribing is a workforce redesign strategy adopted within some services. Despite successful implementation in other professional groups, non-medical prescribing within speech pathology (SP) has not yet been described. AIMS To provide a descriptive account of the development and planned implementation of two SP prescribing models. METHODS & PROCEDURES The evolution of two SP-led prescribing models, including relevant training and credentialing, for use of (1) nystatin oral drops (100,000 units/mL); and (2) lidocaine (lignocaine) and phenylephrine nasal spray (5 mg/500 μg/spray), in the outpatient setting is detailed. Challenges to implementation are outlined. MAIN CONTRIBUTION The development of relevant governance structures, a research evidenced-based project evaluation framework, and an overview of training pathways and credentialing was successfully completed. However, implementation of the models was unable to be achieved. A thorough review of the requirements and a discussion of contextual considerations that had a negative influence on the implementation of SP-led prescribing within this specific service context is provided. CONCLUSIONS & IMPLICATIONS The successful implementation of SP-led prescribing is complex and highly context dependent. This work offers a discussion and review of the complexities of introducing a non-medical prescribing model in an outpatient hospital setting. WHAT THIS PAPER ADDS What is already known on the subject Allied Health prescribing is an emerging practice area aiming to reduce current pressures on health services. SP-led prescribing has not been thoroughly investigated in the Australian context. What this study adds to existing knowledge This study describes the development of a SP-led prescribing process in the outpatient setting, and a thorough review and discussion of the drivers and barriers to the model's implementation. What are the potential or actual clinical implications of this work? The successful implementation of SP-led prescribing was identified to be complex from a legislative and operational perspective, as well as being highly context dependent. This study further highlights the importance of a thorough context evaluation and workflow mapping prior to full-scale implementation of SP prescribing trials.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Anne Coccetti
- Allied Health, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Katrina Dunn
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Speech Pathology Department, West Moreton Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Bernard C S Whitfield
- Integrated Specialist Ear Nose and Throat Service, Department of Otolaryngology Head and Neck Surgery, Division of Surgery, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
- Griffith University (Associate Professor), Brisbane, Queensland, Australia
| | - Craig Bond
- Ear Nose and Throat Service, Ipswich Hospital, West Moreton Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Erin Suliman
- Speech Pathology Department, West Moreton Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Cal Winckel
- Pharmacy Department, Ipswich Hospital, West Moreton Hospital and Health Service, Queensland Health, Queensland, Australia
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Noblet T, Jadhakhan F, Bennett A, McCrum C, O'Shea S, Hensman-Crook A, Barratt P, Regan P, Ronan L, Baker D, Rushton A. A multi-site prospective, observational study of physiotherapist independent prescribing activity across musculoskeletal clinics in the United Kingdom. Musculoskelet Sci Pract 2022; 61:102616. [PMID: 35785573 DOI: 10.1016/j.msksp.2022.102616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To establish how advanced practice physiotherapists in the UK working in the musculoskeletal specialty are utilising their independent non-medical prescribing skills. DESIGN Multi-site, prospective, descriptive observational study. Ethics reference No: ERN_19-0994). METHOD The study was conducted by seven advanced practitioners, across seven clinical sites representative of advanced musculoskeletal practice in the UK, between 1st October 2019-March 31, 2020. Advanced physiotherapy practitioner independent prescribers working in a variety of musculoskeletal specialty areas collected data across 5 contexts of musculoskeletal clinical service: first contact practice, primary care, community triage, secondary care orthopaedics, secondary care rheumatology and private practice. Quantitative data were analysed descriptively with qualitative data analysed/synthesised via thematic analysis. RESULTS Prescribing activity data for n = 2470 patients were collected. Prescribing activity was highest for the treatment of nociceptive pain (51.3%) and inflammation (39.6%). Most prescribing activity occurred in the first 2-6 weeks (34.1%) following onset of condition. Medicines optimisation accounted for most of prescribing activity (18.1%), followed by over-the-counter medication recommendation (15.5%). De-prescribing accounted for 10.8% of all prescribing activity recorded. Qualitative data were synthesised into 4 themes: multimodal physiotherapeutic approach, joint decision making and patient choice, working with complexity, and legal and regulatory restriction. CONCLUSIONS Physiotherapist independent prescribing was used within all health sectors in conjunction with advanced skills in musculoskeletal physiotherapy as part of a multimodal physiotherapeutic approach. Prescribing activity was dictated by the clinicians' clinical reasoning and use of joint decision-making. Prescribing activity for acute back and neuropathic radicular pain was limited secondary to recent reclassification of gabapentin and pregabalin.
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Affiliation(s)
- Tim Noblet
- St George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London, SW17 0QT, UK.
| | - Feroz Jadhakhan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Andrew Bennett
- Sutton Health and Care Alliance, Epsom and St Helier NHS Trust, Outpatient Physiotherapy Department, Fergerson House, St Helier Hospital, Wrythe Lane, SM5 1AA, UK; NHS England and NHS Improvement, 22 London Road, Elephant and Castle, London, SE1 6JW, UK
| | - Carol McCrum
- East Sussex Healthcare NHS Trust, Kings Drive, Eastbourne, BN21 2UD, UK; University of Brighton, Darley Road, Eastbourne, BN20 7UR, UK
| | - Simon O'Shea
- Sheffield Teaching Hospitals NHS Foundation Trust, Graves Move Moore Health and Sports Centre, Bochum Parkway, Sheffield, S8 8JR, UK
| | | | - Paul Barratt
- Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Paul Regan
- Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Lynne Ronan
- Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Dave Baker
- Complete Physio, The Bankside Fitness Hub, Blue Fin Building, 110 Southwark St, London, SE1 0SU, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; School of Physical Therapy Western University London, Ontario, N6G 1H1, Canada
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Yeowell G, Leech R, Greenhalgh S, Willis E, Selfe J. Medico-legal litigation of UK physiotherapists in relation to cauda equina syndrome: a multimethods study. BMJ Open 2022; 12:e060023. [PMID: 35820745 PMCID: PMC9274518 DOI: 10.1136/bmjopen-2021-060023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim was to investigate the extent of cauda equina syndrome (CES) litigation and explore the process of medico-legal litigation in relation to physiotherapy in the UK. DESIGN A multimethods inquiry that followed on from a previously conducted scoping literature review was undertaken to address the aim. This included freedom of information requests and direct communication with relevant stakeholders and organisations. RESULTS A total of 2496 CES claims were found in the UK between 2012 and 2020. 51 of these were attributed to physiotherapists. There was little information available to physiotherapists regarding the legal process of litigation and much of this information was not from a physiotherapist's perspective. CONCLUSION This is the first study that has investigated the extent and process of CES litigation in physiotherapy in the UK. The extent of CES litigation appears to be high considering CES is a rare spinal condition. Furthermore, the extent of CES litigation is suspected to be considerably higher than the data reported in this study due to the issues identified in how CES claims are recorded. Finally, there is no clearly articulated, easily accessible information describing the process and support available for physiotherapists in receipt of a legal claim.
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Affiliation(s)
- Gillian Yeowell
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Rachel Leech
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Susan Greenhalgh
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
- Orthopaedic Interface Service, Bolton One, Bolton NHS Foundation Trust, Bolton, UK
| | - Emma Willis
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Fitzpatrick MT, Borthwick AM. A decade of independent prescribing in the UK: a review of progress. J Foot Ankle Res 2022; 15:35. [PMID: 35546680 PMCID: PMC9092823 DOI: 10.1186/s13047-022-00541-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 2022 marks a decade since the profession of podiatry secured independent prescribing rights in the UK. Widely viewed as a significant milestone, its advent appeared to herald a new age of practice, with increased autonomy, a broader scope of practice and improved patient care. Access to any medicine within the British National Formulary (with a few notable exceptions) seemed to signal an end to the perennial difficulties and frequent disappointments in obtaining ease of access to medicines necessary for effective practice. MAIN BODY Recent attempts to expand the scope of prescribing practice to include access to a broader range of controlled drugs (CDs) have led to unanticipated complications which may even threaten existing rights. These issues highlight the limitations of current independent prescribing and the continuing inability of podiatrists to access certain key medicines, primarily controlled drugs. Reliance on specified 'lists' of approved medicines, whether a controlled drug list for prescribers or the use of statutory exemptions by non-prescriber podiatrists, remain inflexible and difficult to change. The data underpinning much of this paper is derived from the work undertaken by the authors as representatives of podiatry on NHS England's Chief Professions' Officers' Medicines project, in particular involving submissions to the Commission on Human Medicines and the Advisory Council on the Misuse of Medicines, spanning the years 2017-2021. It describes a complex process, and highlights a misalignment between two legislative frameworks that threaten to unravel existing rights. SHORT CONCLUSION Ongoing difficulties relating to controlled drugs illustrate the problematic nature of current supply, administration and prescribing rights in podiatry. Efforts to keep pace with periodic legal reclassifications of medicines are constrained by limited and inflexible legal mechanisms, and formal approval for extended access via prescribing remains unpredictable and complex. For prescriber and non-prescriber1 (1Non- prescriber podiatrists are those who are neither supplementary or independent prescribers, but do enjoy existing administration and supply rights to certain medicines.) podiatrists alike, the profession of podiatry faces a new challenge to its ability to access medicines, and to realise its full clinical potential.
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Affiliation(s)
- Matthew Tj Fitzpatrick
- School of Clinical Sciences, QUT, Brisbane, Australia. .,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Alan M Borthwick
- School of Clinical Sciences, QUT, Brisbane, Australia.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,School of Health and Human Sciences, Southern Cross University, Lismore, Australia
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Fennelly O, Desmeules F, O'Sullivan C, Heneghan NR, Cunningham C. Response to letter to the editor regarding "advanced musculoskeletal physiotherapy practice: Informing education curricula". Musculoskelet Sci Pract 2020; 49:102211. [PMID: 32861366 DOI: 10.1016/j.msksp.2020.102211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Orna Fennelly
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland.
| | | | - Cliona O'Sullivan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland.
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, United Kingdom.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland.
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