Orthopaedic triage at a physiotherapist-led ‘Musculoskeletal Assessment Clinic’: a seven-month service evaluation of outcomes
- 595 Downloads
A number of clinical specialist physiotherapist (CSP)-led musculoskeletal triage clinics have been established in the Republic of Ireland as a means of managing patients referred for an outpatient orthopaedic consultation.
The purpose of this study was to evaluate the outcomes of a recently established ‘Musculoskeletal Assessment Clinic’ (MAC) in St Vincent’s University Hospital (SVUH) Dublin. We identified the (a) number of patients independently managed by the CSPs and (b) conversion rate to orthopaedic intervention as a useful measure of this.
University College Dublin Research Ethics Committee granted ethical exemption and the Clinical Audit Department of SVUH approved the study. A retrospective service evaluation was carried out on all orthopaedic patients who attended the MAC between January and July 2012. Data were analysed using SPSS v20 using descriptive statistics.
Seven-hundred and fourteen patients attended the MAC, 54 % of whom were female; mean age 50 years (range 12–89). The majority of patients were diagnosed with low back pain (35 %) and knee osteoarthritis (16 %). The majority of patients who attended the MAC (76 %) were independently managed by the CSPs without need for orthopaedic consultation; from a valid sample (n = 110), 80 patients required orthopaedic intervention, a conversion rate of 73 %. The most common interventions were arthroplasty (22 %) and arthroscopy (16 %).
The findings of this service evaluation indicate that a significant number of patients referred for an orthopaedic consultation may be managed independently by a CSP and that onward referrals for orthopaedic consultation were highly appropriate.
KeywordsOrthopaedic triage Physiotherapy Service evaluation Outcomes
The authors would like to thank Ms. Orla Bannon (Medical Records Department) and the following consultant orthopaedic surgeons (St. Vincent’s University Hospital) for their assistance with this project; Mr. Sean Dudeney, Mr. Gary O’Toole, Mr. Conor Hurson, Mr. Kieran O’Rourke, Mr. Eamonn Kelly and Mr. Robert Flavin.
- 2.Woolf AD (2012) The bone and joint decade: working together to make musculoskeletal conditions a health priority. Reports on the rheumatic diseases, Series 6, Summer 2012, topical reviews no 12. Arthr Res UKGoogle Scholar
- 3.Oldmeadow LB, Bedi SH, Burch HT et al (2007) Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care. M J Aust 187:624–628Google Scholar
- 14.Health Service Executive. http://www.hse.ie/eng/about/Who/clinical/natclinprog/orthopaedicsprogramme/orthprog.html. Accessed 22 April 2013
- 15.Health Service Executive. National Service Plan 2011. Downloaded from http://www.hse.ie/eng/services/Publications/corporate/nsp2011.pdf. Accessed 22 April 2013
- 21.Hattam P, Smeatham A (1999) Evaluation of an orthopaedic screening service in primary care. Br J Clin Gov 4:45–49Google Scholar
- 22.Curley AE, Cassells M, Cooke G et al (2004) Physiotherapy-led low back pain triage. The Irish experience. Physiother Ir 25:3–9Google Scholar
- 26.Mccormack A, Fleming D, Charlton J (1995) Morbidity statistics from general practice. 4th National study 1991–1992. Series MB5 no.3. HMSO, LondonGoogle Scholar
- 30.Raftery MN, Sarma K, Murphy AW et al (2011) Chronic pain in the Republic of Ireland–Community prevalence, psychosocial profile and predictors of pain-related disability: results from the prevalence, impact and cost of chronic pain (PRIME) study, part 1. Pain 152:1096–1103PubMedCrossRefGoogle Scholar