Advanced Practice Physiotherapy (APP)

Reference:Desmeules F, et al. Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic. BMC Musculoskelet Disord. 2013 May 8;14:162.

Orthopaedic surgeons find it frustrating that the majority of their referrals from MDs are non-surgical patients. After all, is it not a waste of their time consulting patients who only need physiotherapy / good conservative care?

What if when a family MD referred a patient to an orthopaedic surgeon, they were first screened by a PT? Would that not potentially reduce the long waiting list for seeing a surgeon? Would that not make surgeons happy? Would that not make patients happy? Is that possible?

Across Canada there is a growing number of PTs referred to as Advanced Practice Physiotherapists (APP). What exactly is APP? These are PTs who diagnose and triage patients with various musculoskeletal disorders BEFORE they consult an orthopaedic surgeon.

This study looked at the diagnostic and management agreements between APP and orthopaedic surgeons. They also looked at patient satisfaction when APPs were involved.

This study took place in an outpatient physiotherapy clinic of a hospital in Montreal where 120 patients with hip or knee complaints were independently assessed by an APP and an orthopaedic surgeon (3 surgeons involved).

Result #1: The agreement for diagnosis was 88% (which is considered excellent) and diagnostic inter-rater agreement was very high.

Result #2: The triage recommendations (conservative vs. surgical management) agreement was 88% (which is again excellent) and inter-rater agreement for triage recommendation was high.

Result #3: APPs and surgeons ordered the same number of imaging tests.

Result #4: APPs gave significantly more education and prescribed more NSAIDs, joint injections, exercises and supervised physiotherapy. …and most importantly

Result #5: Patients receiving APP care had significantly higher satisfaction than those who directly saw the surgeons.

What can we conclude? There is a growing body of literature now showing that PTs can be pretty good gate keepers for extremely busy orthopaedic surgeons. This is likely to be a win win win situation for PTs, surgeons and patients! Now if we could get the politics out of the way of patient care and have the ball rolling in all hospitals across Canada.

Instead of cutting back on PT clinics in hospitals, they should be adding PTs to make surgeons happy, improve surgical efficiency, increase patient satisfaction and save $$!!!

Posted on: July 04, 2013

Categories: Relevant Physical Therapy Articles

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