P67. The efficacy of advanced practice physiotherapy assessment for cervical and lumbar spine pathologies

Abstract

BACKGROUND CONTEXT We developed an Advanced Practice Physiotherapist (APP) spine assessment to improve access and quality of care for patients with cervical (CER) and lumbar (LUM) spine pathologies. To date, other Canadian assessment models have been limited to lumbar pathologies only. PURPOSE We present the results of our 1-year pilot examining its efficacy and exploring any differences between cervical and lumbar presentations. STUDY DESIGN/SETTING This prospective cohort was done at a rapid access phystiotherapy triage clinic at a single quaternary referral spine center. PATIENT SAMPLE A total of 1,576 patients METHODS Two APPs underwent 3 months training from spine surgeons, based on the ISAEC program. Adaptations of CORE Cervical and Lumbar Tools were utilized for assessment. All consecutive referrals to our quaternary spine program were assessed. Wait times for all referrals (WT1), for Emergency Dept referrals (WTEmerg) and for final surgical consult (WTSurgCon) were compared to the prior 12-month historical. We prospectively recorded referral patterns and agreement between APP and surgeon, for both diagnosis and urgency. Patient satisfaction was also examined. Data is presented as mean, for the first (6M1) and second (6M2) 6 months of the pilot. RESULTS A total of 1,576 patients were seen in the 12-month pilot. 34% were CER cases. WT1 decreased from 687 to 14 days. WTEmerg decreased from 55 to 7 days. WTSurgCon decreased from 687 to 62 days. Percentage of patients referred monthly to a surgeon remained unchanged for LUM (mean 36%), but decreased for CER 30% to 11% (6M1 to 6M2). Percentage agreement for diagnosis improved for LUM from 82% to 94% (6M1 to 6M2), and for CER from 77% to 98% (6M1 to 6M2). Percentage agreement for urgency improved for LUM from 81% to 93% (6M1 to 6M2), and for CER from 74% to 96% (6M1 to 6M2). Patient satisfaction was 95% for 6M1 and 97% for 6M2. CONCLUSIONS APP assessment provides timely and appropriate triage of patients with both cervical and lumbar spine pathologies. Significant reductions are achieved for all wait times. Lumbar complaints predominate while there appears to be a learning curve to improved screening of cervical pathology. APP/surgeon agreement increases with APP experience. Patient satisfaction with the process is very high. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.