Objectives
The aim of this study was to profile the advanced practice physiotherapy services, established in 2011, by the National Clinical Programmes for Orthopaedics and for Rheumatology. The objectives were to (i) profile the qualification and clinical experience of the physiotherapists in post; (ii) profile the advanced practice physiotherapy services across hospital sites (n=16); and (iii) explore the physiotherapists’ experiences of the advanced practice role.
Methods
Ethical approval was received from University College Dublin Human Research Ethics Committee. A national online survey of physiotherapists working in the established advanced practice physiotherapist (APP) posts (n=25) was conducted using google forms, with follow-up reminders sent after 2 weeks and again at 3 weeks. The questionnaire was specifically designed, and informed by stakeholder consultation and current literature. Data were analysed using descriptive statistics and an inductive qualitative content analysis.
Results
Profile of physiotherapists
A response rate of 68% (n=17) of APPs, working at 13 different hospitals, was achieved. Most APPs had a Master’s degree (n=14), and all had more than five years musculoskeletal clinical experience. Training for the advanced practice role was most commonly on an ad hoc basis, via consultant shadowing and mentoring (n=14); while some APPs received HSE specific training (n=7) and seven of the APPs were qualified to administer injections.
Advanced practice physiotherapy services
More than half of the APPs worked in both orthopaedic and rheumatology services, with multiple Consultant Doctors; a total of 67 Orthopaedic Consultants and 25 Consultant Rheumatologists. The service varied in terms of the following:
- Direct referrals from General Practitioners (GPs) to the APP were accepted at only three sites.
- Eight APPs permitted patients to return for an additional appointment within one year of their initial appointment, without another referral.
- At some sites, APPs screened the GP referral letters to determine suitability (n=10) for APP services, as opposed to screening by the Consultant.
- APP clinics were usually co-located with the Consultant clinic (n=15).
- Most APPs (n=16) reported that Consultant Doctors were 'usually' or 'sometimes' available for input on patient management on the day of the appointment.
- Clinical investigations deemed appropriate by APPs, were most commonly ordered via discussion of the patient case with the doctor, who then ordered the investigation. Only one APP had delegated authority to order clinical imaging (excluding CT scans).
- Most APPs (n=15) subsequently delivered physiotherapy treatment to at least some of their patients, as part of their role.
Experiences of the role
Themes which emerged from the exploration of the physiotherapists’ experiences, included:
- Need for service development
- Opportunity for interdisciplinary communication and support
- Learning opportunities
- Formal training required
- Service dependent on specific Consultant Doctor
Conclusion:
The operation of APP services and APP roles varied between hospital sites and Consultant services. Ad hoc training approaches, similar to UK practice (Dawson and Ghazi, 2004) may be reasonable, but lead to inconsistent services and career progression. Additional formal training and further progression of the service are deemed important by the APPs and would allow standardisation of services, but a more in-depth evaluation of APP experiences is required.
References
Dawson, LJ & Ghazi, F 2004. The experience of physiotherapy extended scope practitioners in orthopaedic outpatient clinics. Physiotherapy, 90, 210-216. 10.1016/j.physio.2004.06.001
Acknowledgements
The National Clinical Programmes for Orthopaedics and for Rheumatology, and the HSE for contribution to university fees and permission to conduct the research.
