An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints.

Abstract

The purpose of the present study was to establish diagnostic agreement rates between orthopaedic consultants and advanced practice physiotherapists (APPs) for paediatric orthopaedic patients, examine the appropriateness of referrals by APPs to consultants and report on the surgical conversion rate (SCR). A retrospective review of all patients referred from an APP clinic to orthopaedic consultants was conducted for 2013, with a 3-year longitudinal follow-up through to the end of 2016. Study participants were two APPs and four orthopaedic consultants at a single site. Descriptive statistics report the proportion of appropriate onward referrals and SCRs. Raw proportion agreement and kappa coefficients were used to evaluate diagnostic agreement rates. The mean raw agreement was 82% (95% confidence interval = 73 to 87), with 12 of the 15 individual codes demonstrating agreement rates ≥90% (range 57-100). Good to excellent agreement was demonstrated in almost all categories based on the kappa coefficient. Eighty-seven per cent of referrals from APPs were deemed to be appropriate by the orthopaedic consultants. The SCR was 23%. This was the first study to evaluate diagnostic agreement rates between APPs and orthopaedic consultants, the appropriateness of onward referral by APPs and the SCR for paediatric musculoskeletal patients referred from an APP clinic. Good to excellent diagnostic agreement was observed for routine elective paediatric orthopaedic patients, in tandem with agreement levels reported in the adult literature. The study demonstrates that APPs are clinically effective in the diagnosis and onward referral of paediatric orthopaedic patients in a triage setting.