Patient satisfaction with physiotherapists is not inferior to surgeons in an arthroplasty review clinic: non-inferiority study of an expanded scope model of care.

Abstract

Objective This study evaluated whether the satisfaction of patients attending a physiotherapy-led postarthroplasty review out-patient clinic was non-inferior to that of patients attending traditional surgeon clinics. Methods Using a modified nine-item Visit-Specific Satisfaction Instrument (VSQ-9), 50 patients attending the physiotherapy clinic and 50 patients attending surgeon clinics were surveyed. Sample means (±s.d.) were calculated for each domain of the VSQ-9. Non-inferiority testing was performed using 95% confidence intervals (CIs) of the adjusted mean difference to examine whether normalised patient satisfaction scores in the physiotherapy group were no worse than those in the surgeon group. Results Both groups were satisfied (overall domain; 100% of both groups rated good-excellent). Based on mean item score, there was strong evidence that the satisfaction of the physiotherapy group was non-inferior to that of the surgeon group (adjusted mean difference (physiotherapy - surgeon) in mean score 5.1 (95% CI -0.3, 10.4). Furthermore, the mean differences in all but one of the nine domains were in favour of the physiotherapy group in this study. Conclusion The satisfaction of patients attending a physiotherapy arthroplasty review clinic is not inferior to that of patients attending traditional surgeon clinics. What is known about the topic? A substitution model of care where an advanced practice physiotherapist reviews routine postarthroplasty patients instead of surgeons originated in the UK and has been adopted in Canada and Australia to address the increasingly overloaded public out-patient health services. Evidence of clinical and cost effectiveness has been demonstrated but, to the best of the authors' knowledge, only one paper has evaluated consumer engagement, and that paper was in a Canadian population. What does this paper add? This study evaluated the satisfaction of patients in an Australian public healthcare system and was able to demonstrate that patients seen by physiotherapists were no less satisfied than those seen by surgeons in traditional clinics. The findings support those reported in the Canadian study. This is an important step in the development and acceptance of these substitution model of care innovations locally. What are the implications for practitioners? The results of this study will provide an important addition to the evidence of the clinical efficacy of this model of care: that of consumer acceptance. This will assist with planning, expansion and rollout of similar initiatives in Australia.