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Irish Journal of Medical Science (1971 -)

, Volume 183, Issue 4, pp 565–571 | Cite as

Orthopaedic triage at a physiotherapist-led ‘Musculoskeletal Assessment Clinic’: a seven-month service evaluation of outcomes

  • S. O’Farrell
  • K. M. Smart
  • A. Caffrey
  • O. Daly
  • C. Doody
Original Article

Abstract

Background

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.

Aims

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.

Methods

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.

Results

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 %).

Conclusions

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.

Keywords

Orthopaedic triage Physiotherapy Service evaluation Outcomes 

Notes

Acknowledgments

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.

References

  1. 1.
    Vos T, Falzman AD, Naghavi M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1999–2010. A systematic analysis for the Global Burden of Diseases Study 2010. Lancet 380:2163–2196PubMedCrossRefGoogle Scholar
  2. 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. 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
  4. 4.
    Elwyn G, Stott N (1994) Avoidable referrals? Analysis of 170 consecutive referrals to secondary care. BMJ 309:567–568CrossRefGoogle Scholar
  5. 5.
    Roland M, Porter R, Matthews J et al (1991) Improving care: a study of orthopaedic outpatient referrals. BMJ 302:1124–1128PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Desmeules F, Toliopoulos P, Roy J et al (2013) Validation of an advance practice physiotherapy model of care in an orthopaedic outpatient clinic. BMC Musculoskelet Disord 14:164CrossRefGoogle Scholar
  7. 7.
    Hattam P (2004) The effectiveness of orthopaedic triage by extended scope physiotherapists. Clin Gov: Int J 9:244–252CrossRefGoogle Scholar
  8. 8.
    MacKay C, Davis AM, Mahomed N et al (2009) Expanding roles in orthopaedic care: a comparison of physiotherapist and orthopaedic surgeon recommendations for triage. J Eval Clin Pract 15:178–183PubMedCrossRefGoogle Scholar
  9. 9.
    Speed CA, Crisp AJ (2005) Referrals to hospital-based rheumatology and orthopaedic services: seeking direction. Rheumatology 44:469–471PubMedCrossRefGoogle Scholar
  10. 10.
    Weale AE, Bannister GC (1995) Who should see orthopaedic outpatients-physiotherapists or surgeons? Ann R Coll Surg Engl 77:71–73PubMedGoogle Scholar
  11. 11.
    Kersten P, McPherson K, Lattimer V et al (2007) Physiotherapy extended scope of practice—who is doing what and why? Physiother 93:235–242CrossRefGoogle Scholar
  12. 12.
    Daker-White G, Carr AJ, Harvey I et al (1999) A randomized controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments. J Epidemiol Community Health 53:643–650PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Desmeules F, Roy J, MacDermid JC et al (2012) Advance practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord 13:107PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
  15. 15.
    Health Service Executive. National Service Plan 2011. Downloaded from http://www.hse.ie/eng/services/Publications/corporate/nsp2011.pdf. Accessed 22 April 2013
  16. 16.
    Byles SE, Ling RSM (1989) Orthopaedic out-patients—A fresh approach. Physiother 75:435–437CrossRefGoogle Scholar
  17. 17.
    Hockin J, Bannister G (1994) The extended role of a physiotherapist in an out-patient orthopaedic clinic. Physiother 80:281–284CrossRefGoogle Scholar
  18. 18.
    Hourigan PG, Weatherley CR (1994) Initial assessment and follow-up by a physiotherapist of patients with back pain referred to a spinal clinic. J R Soc Med 87:213–214PubMedPubMedCentralGoogle Scholar
  19. 19.
    Hourigan PG, Weatherley CR (1995) The physiotherapist as an orthopaedic assistant in a back pain clinic. Physiother 81:546–548CrossRefGoogle Scholar
  20. 20.
    Weatherley CR, Hourigan PG (1998) Triage of back pain by physiotherapists in orthopaedic clinics. J R Soc Med 91:377–379PubMedPubMedCentralGoogle Scholar
  21. 21.
    Hattam P, Smeatham A (1999) Evaluation of an orthopaedic screening service in primary care. Br J Clin Gov 4:45–49Google Scholar
  22. 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
  23. 23.
    Pearse EO, Maclean A, Ricketts DM (2006) The extended scope physiotherapist in orthopaedic outpatients—an audit. Ann R Coll Surg Engl 88:653–655PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Blackburn MS, Cowan SM, Cary B et al (2009) Physiotherapy-led triage clinic for low back pain. Aust Health Rev 33:663–670PubMedCrossRefGoogle Scholar
  25. 25.
    Rabey M, Morgans S, Barrett C (2009) Orthopaedic physiotherapy practitioners: surgical and radiological referral rates. Clin Gov Int J 14:15–19CrossRefGoogle Scholar
  26. 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
  27. 27.
    Vioreanu MH, O’Daly BJ, Shelly MJ et al (2013) Design, implementation and prospective evaluation of a new interactive musculoskeletal module for medical students in Ireland. Ir J Med Sci 182:191–199PubMedCrossRefGoogle Scholar
  28. 28.
    Atkins E (2003) Physiotherapists experience of implementing their injection therapy skills. Physiother 89:145–157CrossRefGoogle Scholar
  29. 29.
    Breivik H, Collett B, Ventafridda V et al (2006) Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 10:287–333PubMedCrossRefGoogle Scholar
  30. 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
  31. 31.
    Geertzen JHB, Van Wilgen CP, Schrier E et al (2006) Chronic pain in rehabilitation medicine. Disabil and Rehabil 28:363–367CrossRefGoogle Scholar
  32. 32.
    Fullen B, Hurley DA, Power C et al (2006) The need for a national strategy for chronic pain management in Ireland. Ir J Med Sci 175:68–73PubMedCrossRefGoogle Scholar
  33. 33.
    Raftery MN, Ryan P, Normand C et al (2012) The economic cost of chronic noncancer pain in Ireland: results from the PRIME study, part 2. J Pain 13:139–145PubMedCrossRefGoogle Scholar
  34. 34.
    McPherson K, Kersten P, George S et al (2006) A systematic review of evidence about extended roles for allied health professionals. J Health Serv Res Policy 11:240–247PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2013

Authors and Affiliations

  • S. O’Farrell
    • 1
  • K. M. Smart
    • 2
  • A. Caffrey
    • 2
  • O. Daly
    • 2
  • C. Doody
    • 1
  1. 1.UCD School of Public Health, Physiotherapy and Population ScienceUniversity College DublinDublin 4Ireland
  2. 2.Physiotherapy DepartmentSt. Vincent’s University HospitalDublin 4Ireland

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