Background & Aims
Models of care using advanced practice physiotherapists (APPTs) have been proposed as a solution to improve healthcare access and efficiency for patients with spinal pain. The purpose of this study was to explore the experience and perceptions of both APPTs and patients with spinal pain within an advanced practice physiotherapy (APP) model of care.
Methods
APPTs and patients with spinal pain who provided or received care as part of a randomized controlled trial evaluating a new spine surgery model of care were invited to participate in this qualitative study. Semi-structured interviews were performed to identify themes related to their experience and perception of this model of care for patients having spinal pain. Verbatim were transcribed, coded, and analyzed using an inductive thematic analysis.
Results
Interviews with nine patients and seven APPTs were conducted. Three main themes emerged from our analysis. APPTs and patients reported that: 1) the standard medical model of care for spinal pain is problematic, 2) the advanced practice physiotherapy model of care is a great solution to help manage patients with spinal pain, but 3) there are areas for improvements in this model by including more follow-up consultations with APPTs for non-surgical care, pathways for referral to pain clinics and more geographically accessible care by having more APPTs in the community.
Conclusions
While some improvements to the model could be beneficial, overall, patients and APPTs had positive views on this model.
References
Bak Bødskov E, Palmhøj Nielsen C, Ramer Mikkelsen L, Martin Klebe T, Terp Høybye M, Nørgaard Madsen M 2022 High Patient Satisfaction with Examination by Advanced Practice Physiotherapists in an Orthopaedic Outpatient Shoulder Clinic: A Cross-Sectional Study Using Quantitative and Qualitative Methods. Physiotherapy Canada 74: 342-352.
Braun V, Clarke V 2006 Using thematic analysis in psychology. Qualitative research in psychology 3: 77-101.
Braybrooke J, Ahn H, Gallant A, Ford M, Bronstein Y, Finkelstein J, Yee A 2007 The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery. European Spine Journal 16: 1832-1839.
Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T 2020 Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet 396: 2006-2017.
Fennelly O, Blake C, FitzGerald O, Breen R, Ashton J, Brennan A, Caffrey A, Desmeules F, Cunningham C 2018 Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit. BMC Musculoskeletal Disorders 19: 1-8.
Fennelly O, Blake C, FitzGerald O, Caffrey A, Fletcher L, Smart K, Corcoran S, Shé ÉN, Casserley-Feeney S, Desmeules F 2020 Advanced musculoskeletal physiotherapy practice: The patient journey and experience. Musculoskeletal Science and Practice 45: 102077.
Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, Hay EM 2008 A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Care & Research: Official Journal of the American College of Rheumatology 59: 632-641.
Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S 2011 Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet 378: 1560-1571.
Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS 2004 Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. The Clinical journal of pain 20: 309-318.
Lafrance S, Demont A, Thavorn K, Fernandes J, Santaguida C, Desmeules F 2021 Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses. BMC health services research 21: 1-15.
Lafrance S, Desmeules F, Charron M, Elkaim LM, Fernandes J, Santaguida C 2023 Advanced practice physiotherapy surgical triage and management of adults with spinal disorders referred to specialized spine medical care: a retrospective observational study. Physiotherapy theory and practice: 1-10.
Lafrance S, Lapalme J-G, Méquignon M, Santaguida C, Fernandes J, Desmeules F 2021 Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis. European Spine Journal 30: 990-1003.
Lafrance S, Raphaël V, Demont A, Charron M, Desmeules F 2023 Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis. Journal of physiotherapy 69: 220-231.
Lafrance S, Santaguida C, Perreault K, Bath B, Thavorn K, Feldman D, Hébert LJ, Fernandes J, Desmeules F 2021 Single session compared to multiple sessions of education and exercise for older adults with spinal pain in an advanced practice physiotherapy model of care: protocol for a randomized controlled trial. BMJ open.
Laverdière M 2007 Les suites de l’arrêt Chaoulli et les engagements internationaux du Canada en matière de protection des droits fondamentaux.
Lynch ME, Campbell F, Clark AJ, Dunbar MJ, Goldstein D, Peng P, Stinson J, Tupper H 2008 A systematic review of the effect of waiting for treatment for chronic pain. Pain 136: 97-116.
Marks D, Comans T, Bisset L, Scuffham PA 2017 Substitution of doctors with physiotherapists in the management of common musculoskeletal disorders: a systematic review. Physiotherapy 103: 341-351.
Matifat E, Méquignon M, Cunningham C, Blake C, Fennelly O, Desmeules F 2019 Benefits of Musculoskeletal Physical Therapy in Emergency Departments: A Systematic Review. Physical therapy 99: 1150-1166.
Moir M, Barua B 2022 Waiting Your Turn: Wait Times for Health Care in Canada, 2022 Report.
Pellekooren S, Donker M, Reijnders E, Boutalab L, Ostelo R, van Tulder M, Pool-Goudzwaard A 2022 The introduction of advanced practice physiotherapy within Dutch primary care is a quest for possibilities, added value, and mutual trust: a qualitative study amongst advanced practice physiotherapists and general practitioners. BMC health services research 22: 529.
Quentin C, Bagheri R, Ugbolue UC, Coudeyre E, Pélissier C, Descatha A, Menini T, Bouillon-Minois J-B, Dutheil F 2021 Effect of home exercise training in patients with nonspecific low-back pain: a systematic review and meta-analysis. International journal of environmental research and public health 18: 8430.
Samsson K, Grimmer K, Larsson M, Morris J, Bernhardsson S 2020 Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies. BMC Musculoskeletal Disorders 21: 1-20.
Tong A, Sainsbury P, Craig J 2007 Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19: 349-357.
Woolf AD, Erwin J, March L 2012 The need to address the burden of musculoskeletal conditions. Best practice & research Clinical rheumatology 26: 183-224.
Presenting Author
François Desmeules
Poster Authors
Topics
- Access to Care