Extended Scope Practitioners Research Articles

A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting.

Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK. A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs' ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients. A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management or for surgical review. Of the latter, 81% were considered to be suitable surgical referrals. A 99% satisfaction rate was reported by discharged patients. ESP services in a specialist spinal service are effective in managing spinal conditions conservatively and identifying surgical candidates appropriately. Further research is needed to confirm ESPs' diagnostic accuracy, patient outcomes and cost effectiveness.

A comparison of diagnostic accuracy in the identification of meniscal tears between extended scope practitioners and consultant orthopaedic surgeons

A comparison of diagnostic accuracy in the identification of meniscal tears between extended scope practitioners and consultant orthopaedic surgeons

The role of the ESP in orthopaedics

Objectives Allied Health Professionals work within outpatients departments and community-based practices in the UK. In Orthopaedics, Extended Scope Practitioners (ESPs) are increasingly managing initial referrals and management within primary and secondary care settings. The aim of this study was to establish their working practices. Methods An electronic survey was distributed through the Specialist Interest group of the Chartered Society of Physiotherapists. Results We received 102 responses from ESPs. All had received some additional training for the role, but there was no single-defined universal qualification necessary beyond a primary degree. Appraisal was undertaken by non-clinical staff in 51% of cases. Of ESPs, 43% did not work within an orthopaedic team. Discussion We conclude that there should be greater interaction between all ESPs and orthopaedic surgeons to deliver a comprehensive musculo-skeletal service.

Improving the Standard of Care for People with Ankylosing Spondylitis and a New Approach to Developing Specialist ESP‐Led AS Clinics

In the UK, there is a wide variation in the quality of care that people with ankylosing spondylitis (AS) receive. People with AS require early diagnosis and referral to a specialist team to commence treatment and optimize outcome. At East Kent Hospitals University Foundation Trust, a specialist clinic led by an extended scope practitioner (ESP) physiotherapist has been set up for the assessment and monitoring of patients with AS. This report describes the service provided by the AS clinic. Over eight years, the number of patients seen has risen from 62 to 352, and annual consultations from 186 to 986, with an average of 2.8 visits per patient per year. Ninety-seven patients have started treatment with a Tumour Necrosis Factor (TNF) blocker. The service has expanded by the addition of a support worker and biologic clinics. For the Trust, the specialist service provides an improved quality of care and cost-effective use of staff resources. Evaluation has demonstrated that patients welcome the new service.

Development and Implementation of a Hand Therapy Extended Scope Diagnostic Clinic for Both Elective and Trauma Hand Conditions to Enhance Patient Care

A changing and competitive health market demands the need to review existing services and develop new ways of working in order to improve and maintain service delivery. Developing the role of the extended scope practitioner (ESP) and altering patient pathways through specialist hand units is one way service delivery can be improved to enhance patient care by providing early access to a specialist opinion and investigations.

Development and implementation of a hand therapy extended scope practitioner clinic to support the 18-week waiting list initiative

Background A changing and competitive health market demands the need to review existing services and develop new ways of working in order to improve and maintain service delivery. Developing the role of the extended scope practitioner (ESP) and altering patient pathways through specialist hand units is one way that service delivery can be improved to adhere to the 18-week waiting time from a General Practitioner (GP) referral to the start of treatment. Methods One-hundred GP referrals for carpal tunnel syndrome (CTS) and first carpometacarpal osteoarthritis (CMC OA) were selected to attend an ESP clinic audit led by two specialist occupational therapists for diagnosis and implementation of a conservative treatment programme, which was confirmed by a consultant. The ESP clinic was audited against key performance indicators to evaluate ESP effectiveness and improvements in the patient pathway. Results The ESP can effectively diagnose and manage CTS and CMC OA patients without increasing the demand for surgical opinion or procedures. The ESP is also effective in diagnosing other conditions such as early-onset Dupuytren's disease, de Quervain's disease, ganglions and trigger finger. Conclusions ESP clinics have the potential to improve the patient pathway by providing earlier access to a specialist opinion for a diagnosis and management of hand conditions thereby improving service delivery.

Canadian physiotherapists' views on certification, specialisation, extended role practice, and entry-level training in rheumatology

BackgroundSince the last decade there has been a gradual change of boundaries of health professions in providing arthritis care. In Canada, some facilities have begun to adopt new arthritis care models, some of which involve physiotherapists (PT) working in extended roles. However, little is known about PTs' interests in these new roles. The primary objective of this survey was to determine the interests among orthopaedic physiotherapists (PTs) in being a certified arthritis therapist, a PT specialized in arthritis, or an extended scope practitioner in rheumatology, and to explore the associated factors, including the coverage of arthritis content in the entry-level physiotherapy training.MethodsSix hundred PTs practicing in orthopaedics in Canada were randomly selected to receive a postal survey. The questionnaire covered areas related to clinical practice, perceptions of rheumatology training received, and attitudes toward PT roles in arthritis care. Logistic regression models were developed to explore the associations between PTs' interests in pursuing each of the three extended scope practice designations and the personal/professional/attitudinal variables.ResultsWe received 286 questionnaires (response rate = 47.7%); 258 contained usable data. The average length of time in practice was 15.4 years (SD = 10.4). About 1 in 4 PTs agreed that they were interested in assuming advanced practice roles (being a certified arthritis therapist = 28.9%, being a PT specialized in rheumatology = 23.3%, being a PT practitioner = 20.9%). Having a caseload of ≥ 40% in arthritis, having a positive attitude toward advanced practice roles in arthritis care and toward the formal credentialing process, and recognizing the difference between certification and specialisation were associated with an interest in pursing advanced practice roles.ConclusionOrthopaedic PTs in Canada indicated a fair level of interest in pursuing certification, specialisation and extended scope practice roles in arthritis care. Future research should focus on the effectiveness and cost-effectiveness of the emerging health service delivery models involving certified, specialized or extended scope practice PTs in the management of arthritis.

Orthopaedic shoulder clinic diagnosis and treatment plan audit

Purpose – The orthopaedic consultants at East Kent Hospitals NHS Trust had questioned whether the Extended Scope Practitioners (ESPs) and consultants were forming a comparable diagnosis and treatment plan. This audit aims to identify what percentage of patients received a comparable diagnosis from the ESPs and the orthopaedic consultant and to find out what percentage of patients referred from the ESP to the orthopaedic consultant for a surgical opinion underwent surgery.Design/methodology/approach – The medical notes of a sample of patients from the ESP clinic who had been referred to the orthopaedic consultant were reviewed retrospectively and the following information was documented in a table: the ESP's diagnosis, the consultant's diagnosis and whether the patient underwent surgery.Findings – The audit found a 31 per cent partially and 65 per cent fully comparable diagnosis rate between the consultant and the ESPs, and the ESPs predicted which patient would undergo surgery in 86 per cent of cases. The...

Invited Commentary

Effective continuing education methods are necessary not only to assist clinicians in maintaining currency in practice, but also for training physical therapists to advance in rapidly changing scopes of practice. In various parts of the world, physical therapists are practicing as specialists, as extended-scope practitioners, or as the first-contact practitioners in the previously traditional medical settings such as hospital emergency departments and hospital orthopedic, pediatric, and neurosurgical clinics. Health care delivery is changing, and the changes at all levels require effective methods of continuing professional development. Cleland and colleagues’ research is timely, and it is hopefully the beginning of many future studies to evaluate best methods for delivery of effective continuing education for physical therapists.

Extended scope practitioners and clinical specialists: A place in rural health?

This review identifies two models of allied health advanced practitioner practice that are currently in place in the National Health Service in the United Kingdom (UK). A review of the background to advanced practitioner status is given for UK allied health professionals and comments made on the outcomes of the UK roles. Description of the work of Clinical Specialist and Extended Scope Practitioner is given. Alignment with senior physiotherapy staff roles in Australia is commented upon. Some barriers or impediments to implementation of such a system in Australia are discussed with respect to registration, funding and support. The feasibility of such advanced practice roles for physiotherapy is discussed while benefits and cautions are identified. The potential for such a model of health service to be used in Australia, particularly in rural and remote areas, is identified for debate.

Changing health-care landscape set to challenge extended scope practitioners

Allied health professionals (AHPs) and nurses in extended scope practitioner (ESP) roles are clinical specialists who work beyond the recognized scope of practice of their professional bodies in innovative and non-traditional roles (Collins, 2000). In the United Kingdom (UK) these roles were first developed in the 1990s to reduce secondary care medical consultation waiting times. In 2000 the NHS Plan (Department of Health (DH), 2000) highlighted the need to improve the range and access to primary care services, and ESP posts have had a key role in redesigning health services. With 90% of all NHS activity occurring in primary care (DH, 2004a), in contrast to other countries, UK health services have maximized the potential of ESP posts. This editorial discusses the challenges that ESPs face working in a rapidly changing health system.

The influence of a postgraduate clinical master's qualification in manual therapy on the careers of physiotherapists in the United Kingdom

Over the last decade there has been potential for manual therapists to extend their roles and develop their careers. In order to explore the career pathways of a group of postgraduate manual therapists and to identify the influence of Master's education on those careers, a postal questionnaire was sent to all graduates from a clinically based programme (response rate 62.3%, n = 48 , with representation from each year over a 10-year period). All the respondents were still working in physiotherapy and the majority had a clinical element to their role (83%). The new career framework, which seeks to enable therapists to progress their careers and retain a clinical work load is demonstrated within this sample, with 6.2% achieving Consultant Therapist roles, 14.4% in Extended Scope Practitioner posts and 16.6% working as Clinical Specialists. Positive contributions from Master's education were the status of the qualification, improved clinical skills and increased confidence. Negative factors were less clinical ‘hands-on’ within their roles, lack of time and an increase in management responsibilities. Findings suggest that Master's education has enabled the participants to take on the new roles that have resulted from a raft of political imperatives but further work could explore the issues around positive and negative drivers.

Specialist Physiotherapists In Orthopaedic Triage - The Results Of A Military Spinal Triage Clinic

Changes in professional boundaries have allowed many of the tasks traditionally undertaken by doctors to be delegated to Nurses and Allied Health professionals. The employment of an appropriately experienced specialist...

A Delphi Study of the Role Parameters and Requirements of Extended Scope Practice in Hand Therapy

Physiotherapists and occupational therapists working within hand therapy in the United Kingdom are undertaking roles working beyond their normal professional boundaries. The aim of this study was to reach consensus on the role parameters and required knowledge, training and competencies desirable for such extended roles. A panel of 21 expert stakeholders comprising hand therapy clinicians, educators, doctors, existing extended scope practitioners and a representative from a patient group participated in three survey rounds using the Delphi technique. They examined three groups of parameters with reference to the competencies, knowledge and activities desirable for such extended roles. A prioritised list of parameters was developed. Data were analysed using descriptive statistics. Response rates for each round were consistently 95% or greater. The results showed areas of clear consensus, with prioritisation supporting the development of an independent practitioner working without direct supervision by a medical practitioner. Specific criteria were identified for such practice with regards to knowledge, training and activities, such as the ability to order, understand and interpret clinical investigations. In-house formal training tailored to individual service needs was the favoured approach. The results of this study can inform the development of a national strategy for the implementation of new ways of working while ensuring the provision of a quality health service.

The experience of physiotherapy extended scope practitioners in orthopaedic outpatient clinics

Objectives Over the last decade there has been an increase in the number of physiotherapists working with an extended scope of practice in the orthopaedic outpatient clinic. There has been a growing feeling within the profession and the literature that these posts are more difficult than first perceived. The purpose of this qualitative study was to look at physiotherapists working in this setting and discover what has been their experience of the role and what recommendations they would make for future practitioners. Design Qualitative, case study approach. Setting Scottish National Health Service. Participants Four physiotherapists working as extended scope practitioners. Measures Data was collected using tape-recorded semi-structured interviews and investigated five main areas: training, responsibilities, support, satisfaction and recommendations. Results The results suggested that success and satisfaction in post is dependent on the relationship with the consultant and the medical team; most extended scope practitioners experienced similar difficulties and had the same outstanding training needs. Conclusions The overall impression from the findings was that although the job can be stressful it is also very satisfying. By ensuring a good relationship with the medical team, providing adequate ongoing training and support, many of the difficulties encountered by the participants could be minimised.

Assessment and Diagnosis of Knee Injuries: The value of an experienced physiotherapist

Summary A range of titles now reflects emerging roles in physiotherapy: clinical specialists, extended scope practitioners, and more recently consultant therapists. While each role is essentially different, what people in these roles have in common is experience. There is a move to cut down patient waiting times both for operations and for orthopaedic consultant outpatient appointments. An experienced physiotherapist with additional skills would help achieve a reduction in patient waiting times, being able to triage patients for either conservative treatment or a consultant appointment. This study investigates physiotherapists' diagnostic accuracy of acute knee injuries and answers the question: ‘Can a physiotherapist manage the diagnosis of patients presenting with an acute knee injury safely and effectively?’ This is a prospective study investigating the agreement between physiotherapists' clinical diagnoses and arthroscopic diagnosis of the knee. Fifty consecutive new patients referred to one consultant's acute knee clinic were recruited into the study. Assessment was by a consultant knee surgeon and two experienced physiotherapists in random order. An initial diagnosis was then made. This was compared to final diagnosis, which was mainly based on arthroscopic findings and special investigations. The results show that experienced physiotherapists are able to diagnose acute knee injuries with a high rate of accuracy, sensitivity and specificity. A range of titles now reflects emerging roles in physiotherapy: clinical specialists, extended scope practitioners, and more recently consultant therapists. While each role is essentially different, what people in these roles have in common is experience. There is a move to cut down patient waiting times both for operations and for orthopaedic consultant outpatient appointments. An experienced physiotherapist with additional skills would help achieve a reduction in patient waiting times, being able to triage patients for either conservative treatment or a consultant appointment. This study investigates physiotherapists' diagnostic accuracy of acute knee injuries and answers the question: ‘Can a physiotherapist manage the diagnosis of patients presenting with an acute knee injury safely and effectively?’ This is a prospective study investigating the agreement between physiotherapists' clinical diagnoses and arthroscopic diagnosis of the knee. Fifty consecutive new patients referred to one consultant's acute knee clinic were recruited into the study. Assessment was by a consultant knee surgeon and two experienced physiotherapists in random order. An initial diagnosis was then made. This was compared to final diagnosis, which was mainly based on arthroscopic findings and special investigations. The results show that experienced physiotherapists are able to diagnose acute knee injuries with a high rate of accuracy, sensitivity and specificity.

Physiotherapists working as extended scope practitioners

This qualitative study investigates how orthopaedic specialist registrars perceive the role of the physiotherapist working as an extended scope practitioner. The study uses in-depth interviews in a ‘grounded theory’ approach to generate data and analysis. Respondents provided viewpoints relating to impressions of ability, supervision and risk of litigation. Results indicate that staff promote the role.

The Developing Role of Hand Therapists within the Hand Surgery and Medicine Services: An Exploration of Doctors’ Views

Extended scope practitioners (ESPs) are specialist occupational therapists and physiotherapists working beyond their recognised scope of practice. Thirty-five hand therapists were identified as working in this role in Britain, primarily in pre- and post-operative settings. A postal survey of the 31 consultants with whom they worked investigated their views on the nature of this role and service; the facilitating and constraining factors to this development; and on required qualifications, training and supervision. Seventeen consultants, all hand surgeons, replied. They reported that the principle reasons for the development of ESPs were the need to reduce the waiting list and the consultants’ workload. A variety of roles had been created, reflecting the different service needs and the skills of the therapists. Training was largely experiential. Extended scope practitioners had had a significant impact on waiting lists. There was variation in the surgeons’ views regarding further development of these posts. Concerns were identified regarding these posts, such as professional isolation, the transferability of skills, inappropriate extension of the role and the potential for litigation.

An Exploration of the Developing Role of Hand Therapists as Extended Scope Practitioners

Extended scope practitioners (ESPs) are specialist occupational therapists and physiotherapists working beyond their recognised scope of practice. The aims of this study were to identify the number, training and scope of practice of hand therapists working as ESPs. Thirty-five ESPs were identified and sent a questionnaire examining aspects of their practice. Thirty-two ESPs (91%) replied. The findings show that the ESPs worked in four models of practice: own clinic environment, rheumatology, preoperative and post-operative clinics. Their activities included making diagnoses, injections, joint aspirations and wound care. ESPs referred patients for surgery, investigative procedures and therapy. Training was largely experiential and there were unmet training needs. It can be concluded from this study that ESPs are undertaking aspects of care that traditionally have been undertaken by doctors and nurses. The development of ESPs has training implications.

Spinal Clinics : Extended Scope Practitioners

Spinal Clinics : Extended Scope Practitioners