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Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Introduction

One in eight paediatric primary care presentations is for a musculoskeletal (MSK) disorder. These patients are frequently referred to paediatric orthopaedic surgeons; however, up to 50% of referrals are for normal variants. This results in excessive wait-times and impedes access for urgent surgical cases. Adult MSK medicine has successfully utilised advanced practice physiotherapists (APP) managing non-surgical candidates, with documented benefits both to patients and services. There is a gap in the literature with regard to APP in paediatric orthopaedics.

Aim

In this review, we investigate demands on paediatric orthopaedic services, examine the literature regarding APP in paediatric orthopaedics and explore the value the role has to offer current outpatient services.

Results

Paediatric orthopaedic services are under-resourced with concurrent long wait times. Approximately 50% of referrals are for normal variants, which do not require specialist intervention. Poor musculoskeletal examination skills and low diagnostic confidence amongst primary care physicians have been identified as a cause of inappropriate referrals. APP clinics for normal variants have reported independent management rate and discharge rates of 95% and marked reduction in patient wait times.

Conclusion

There is limited evidence to support the APP in paediatric orthopaedics. Further studies are needed investigating diagnostic agreement, patient/stakeholder satisfaction, patient outcomes and economic evaluation. Paediatric orthopaedics is in crisis as to how to effectively manage the overwhelming volume of referrals. Innovative multidisciplinary solutions are required so that the onus is not solely on physicians to provide all services. The APP in paediatric orthopaedics may be part of the solution.

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Authors and Affiliations

  1. Physiotherapy Department, Our Lady’s Children’s Hospital, Dublin, Ireland

    M. Ó Mír

  2. School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland

    M. Ó Mír & C. O’Sullivan

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  1. M. Ó Mír
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  2. C. O’Sullivan
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Correspondence to M. Ó Mír.

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This article does not contain any studies with human participants performed by any of the authors.

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Funding

This review forms part of a PhD undertaken at University College Dublin by Marie O Mir, which has been part funded by the National Children’s Research Centre, Dublin.

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The authors declare that they have no conflict of interest.

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Ó Mír, M., O’Sullivan, C. Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery. Ir J Med Sci 187, 131–140 (2018). https://doi.org/10.1007/s11845-017-1611-2

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