Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department

University of the West of England, Bristol, Bristol, England, United Kingdom
Emergency Medicine Journal (Impact Factor: 1.84). 06/2006; 23(5):384-7. DOI: 10.1136/emj.2005.029231
Source: PubMed


To evaluate the effect of introducing an extended scope physiotherapy (ESP) service on patient satisfaction, and to measure the functional outcome of patients with soft tissue injuries attending an adult emergency department (ED), comparing management by ESPs, emergency nurse practitioners (ENPs), and all grades of ED doctor.
The ESP service operated on four days out of every seven in a week in an urban adult ED. A satisfaction questionnaire was sent to all patients with a peripheral soft tissue injury and fractures (not related to the ankle) within one week of attending the ED. Patients with a unilateral soft tissue ankle injury were sent the acute Short Form 36 (SF-36) functional outcome questionnaire, with additional visual analogue scales for pain, at 4 and 16 weeks after their ED attendance. Waiting times and time spent with individual practitioners was also measured.
The ESP service achieved patient satisfaction that was superior to either ENPs or doctors. Overall 55% of patients seen by the ESP service strongly agreed that they were satisfied with the treatment they received, compared with 39% for ENPs and 36% for doctors (p = 0.048). Assessment of long-term outcome from ankle injury was undermined by poor questionnaire return rates. There was a trend towards improved outcomes at four weeks in those patients treated by an ESP, but this did not achieve statistical significance.
Adding an ESP service to the interdisciplinary team achieves higher levels of patient satisfaction than for either doctors or ENPs. Further outcomes research, conducted in a wider range of emergency departments and integrated with an economic analysis, is recommended.

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Available from: Jonathan Benger, Apr 03, 2014
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    • "While occupational therapy has a documented positive impact on the ability of older, vulnerable patients to cope after discharge [9] , physiotherapy skills have been shown primarily to contribute to diagnosis, mobilization, discharge planning, and the transferral of patients [10] [11] [12] [13] [14] . Existing studies have mainly surveyed or audited therapists' work in order to gain knowledge of the therapeutic action [3] [4] [5] [6] [10] [15] [16] , or they have studied organizational issues such as waiting time assessment, patient satisfaction, therapists' competencies, referral patterns, etc., and have primarily related to emergency rooms [11] [12] [13] [14] [17] [18] [19] [20] . "

    Full-text · Article · Nov 2014
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    • "Whilst systematic reviews evaluating the role of ESPs are largely positive, the research evidence is not sufficiently robust and is of limited methodological quality [9] [11] [15] [26]. The majority of the research to date has been carried out in the UK [15], and there have been recent published studies from Australia [25] and Canada [22] [26] [29]. Data concerning the role of ESPs in Irish healthcare settings are currently limited to two studies [2] [21]. "
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    ABSTRACT: Background: Extended Scope Physiotherapist (ESP) posts have been set up to reduce long waiting lists in orthopaedic clinics. The purpose of this study was to evaluate the activity and outcomes of an ESP clinic within the Irish health care system. The specific aims were to: (i) examine the proportion of patients managed independently by the ESP, (ii) analyse the accuracy of an ESP's clinical diagnosis, and (iii) to calculate the conversion rate to surgery of patients referred for orthopaedic consultation. Methods: All knee pain patients referred to the Knee Screening Clinic (KSC) from November 2010 to December 2011 were included in this audit. A prospective audit was carried out in relation to patient demographics, baseline clinical characteristics and a KSC clinical care pathway. Medical records were reviewed retrospectively of patients referred onward for orthopaedic consultation, to investigate their outcomes. RESULTS 140 patients were included in the study. The ESP independently managed 59.3% of patients. The remaining 40.7% of patients were referred on for orthopaedic surgical consultation. Of these, 84% underwent surgery. ESP clinical diagnostic accuracy was 'substantial' (percentage agreement = 88%; κ = 0.795 (95% CI, 0.58-1.00)). Conclusions The majority of patients (59.3%) referred to the orthopaedic clinic did not need to see an Orthopaedic Surgeon. The ESP clinical diagnostic accuracy was 'substantial' and the high conversion rate to surgery suggests that appropriate patients were referred on for orthopaedic consultation. The results of this study provide some evidence supporting the role of ESPs in orthopaedic triage.
    Full-text · Article · Dec 2013 · Physiotherapy Practice and Research
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    • "Seven studies were cohort studies on the effectiveness of treatment provided by physiotherapists in APP roles; [13,28-33] of which two studies also included economic evaluation components [29,30], and five others evaluated patient satisfaction of services provided by APPs [13,29-32]. In terms of design, two studies were randomized controlled trials [29,30], one was a non-randomized controlled trial [32], one was a prospective quasi experimental study [13], one study was a prospective observational study [31] and two were retrospective observational studies [28,33]. "
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    ABSTRACT: Background The convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals. Physiotherapists in advanced practice/extended scope roles have emerged as key providers in such new models, especially in settings providing services to patients with musculoskeletal disorders. However, evidence of the systematic evaluation of advance physiotherapy practice (APP) models of care is scarce. A systematic review was done to update the evaluation of physiotherapists in APP roles in the management of patients with musculoskeletal disorders. Methods Structured literature search was conducted in 3 databases (Medline, Cinahl and Embase) for articles published between 1980 and 2011. Included studies needed to present original quantitative data that addressed the impact or the effect of APP care. A total of 16 studies met all inclusion criteria and were included. Pairs of raters used four structured quality appraisal methodological tools depending on design of studies to analyse included studies. Results Included studies varied in designs and objectives and could be categorized in four areas: diagnostic agreement or accuracy compared to medical providers, treatment effectiveness, economic efficiency or patient satisfaction. There was a wide range in the quality of studies (from 25% to 93%), with only 43% of papers reaching or exceeding a score of 70% on the methodological quality rating scales. Their findings are however consistent and suggest that APP care may be as (or more) beneficial than usual care by physicians for patients with musculoskeletal disorders, in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. Conclusions The emerging evidence suggests that physiotherapists in APP roles provide equal or better usual care in comparison to physicians in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. There is a need for more methodologically sound studies to evaluate the effectiveness APP care.
    Full-text · Article · Jun 2012 · BMC Musculoskeletal Disorders
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