Background & Aims

Interprofessional chronic pain management programs are recommended by clinical practice guidelines based on evidence of effectiveness[1,2]. Unfortunately, chronic pain clinics are often difficult to access and have lengthy waitlists [3]. Advanced practice physiotherapy (APP) models of care in which physiotherapists take on a first-contact role within the team is a potential strategy to reduce wait times. APP models of care have resulted have resulted in effective care and reduced wait times in orthopedic clinics and emergency departments, but have not been tested in chronic pain clinic settings. The aim of this study was to determine the feasibility and acceptability of implementing an APP role in an interprofessional chronic pain clinic and conducting a clinical trial to evaluate the effects of this new model of care.

Methods

A single-arm mixed-methods feasibility study was conducted to determine the feasibility of carrying out the new model of care. Consecutive adult patients with chronic musculoskeletal pain referred to an interprofessional chronic pain clinic were invited to participate. The APP model of care involved participants seeing a physiotherapist as the first point of contact within the team and supporting the patient by coordinating care the interprofessional team members. Feasibility outcomes for the trial were recruitment, retention and assessment completion rates; and fidelity of the model of care. Semi-structured Interviews were completed and analyzed using interpretive description to understand patient and provider experiences with the new model of care.

Results

Forty-five participants (21 men;24 women) with chronic primary musculoskeletal pain and a mean age of 51.47 (SD:13.45) years were recruited over 18 weeks. 28 (62.2%) participants completed assessments at 6-months follow-up. Over 90% of assessment items were completed by respondants. A fidelity checklist indicated that the APP model of care was carried out with high fidelity. Themes from the patient interviews included high levels of acceptability of the model of care, but concerns that their pain experience was not well understood by the members of the interprofessional team. Themes from the provider interviews included a need for greater role clarification and clearer processes for interprofessional collaboration, concerns about the appropriateness or preparedness of the physiotherapist for the first-contact role, and beliefs that the model did not actually improve efficiency of care.

Conclusions

The APP model of care was carried out with high fidelity; however, additional strategies would need to be embedded when implementing the new model of care to address concerns about the need for greater role clarification, processes for collaboration, and a better understanding of the physiotherapists training and preparedness for the role. Additionally, alternate strategies to address attrition challenges would be needed prior to proceeding with a clinical trial.

References

[1] Rosenquist RW, Benzon HT, Connis RT, et al. Practice Guidelines for Chronic Pain Management. Anesthesiology 2010; 112:1–1
[2] Korownyk CS, Mongomer L, Young J, et al. PEER Simplified Chronic Pain Guideline. Canadian Family Physician March 2022, 68 (3) 179-190.
[3]Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. Am Psychol. 2014;69(2):119.
[4]Desmeules, F., Roy, JS., MacDermid, J.C. et al. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord 2012; 13, 107.
[5] Lafrance, S., Demont, A., Thavorn, K. et al. Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses. BMC Health Serv Res 2021; 21, 1214.

Presenting Author

Jordan Miller

Poster Authors

Jordan Miller, BSc, MSc, PhD

PhD

Queen’s University

Lead Author

Abey Abebe

Queen's University

Lead Author

Andrews Tawiah

Western University

Lead Author

Tom Doulas

Kingston Health Sciences Centre

Lead Author

Etienne Bisson

Kingston Health Sciences Centre

Lead Author

Mulugeta Chala

Lawson Health Research Institute/ St. Joseph's Health Care London

Lead Author

Chad McClintock

Queen's University

Lead Author

Kevin Varette

Queen's University

Lead Author

Topics

  • Access to Care