Abstract
BackgroundThe convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals. Physiotherapists in advanced practice/extended scope roles have emerged as key providers in such new models, especially in settings providing services to patients with musculoskeletal disorders. However, evidence of the systematic evaluation of advance physiotherapy practice (APP) models of care is scarce. A systematic review was done to update the evaluation of physiotherapists in APP roles in the management of patients with musculoskeletal disorders.MethodsStructured literature search was conducted in 3 databases (Medline, Cinahl and Embase) for articles published between 1980 and 2011. Included studies needed to present original quantitative data that addressed the impact or the effect of APP care. A total of 16 studies met all inclusion criteria and were included. Pairs of raters used four structured quality appraisal methodological tools depending on design of studies to analyse included studies.ResultsIncluded studies varied in designs and objectives and could be categorized in four areas: diagnostic agreement or accuracy compared to medical providers, treatment effectiveness, economic efficiency or patient satisfaction. There was a wide range in the quality of studies (from 25% to 93%), with only 43% of papers reaching or exceeding a score of 70% on the methodological quality rating scales. Their findings are however consistent and suggest that APP care may be as (or more) beneficial than usual care by physicians for patients with musculoskeletal disorders, in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction.ConclusionsThe emerging evidence suggests that physiotherapists in APP roles provide equal or better usual care in comparison to physicians in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. There is a need for more methodologically sound studies to evaluate the effectiveness APP care.
Highlights
The convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals
We added three new components to the present search strategy and included: 1- keywords related to diagnostic ability and/or diagnostic agreement between advance physiotherapy practice (APP) and other health providers or diagnostic imaging; 2- keywords related to emergency medicine and 3- the search was limited to a population with musculoskeletal disorders (Appendix)
Nine studies included in the present review had never been methodologically appraised before and seven studies had been included in previous systematic reviews (Table 1) [8,9,11]
Summary
The convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals. Over the past few decades the convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries [1,2] These health system transformations have resulted in the development of new models of care that have wartime with formalization of extended scope/advanced practice roles in the United States during the Vietnam War. But today, aging of the population and increased prevalence of chronic diseases is taxing health care systems demanding broader implementation and expansion of such models [5]. Evaluations involve a variety of different research designs to assess structure, process and outcomes related to these new models of care These include evaluation of the extended scope practitioner’s competencies (e.g. diagnostic accuracy) and satisfaction with their new roles, the patient’s satisfaction with the new service delivery models, cost of the new models of care and whether they have improved outcomes (such as reduced wait times, expedited recovery and improved function for the recipients of the care)
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