Outpatient Physiotherapy Services Research Articles

Physiotherapy management of acute perineal trauma: a patient satisfaction survey

Pelvic floor muscle (PFM) training is recommended in the immediate postpartum period because it can restore PFM function and prevent pelvic floor dysfunction. There are no national physiotherapy guidelines on how to deliver this intervention in the acute period. There is also no consensus on the need for outpatient follow-up to treat pelvic floor dysfunction that arises from perineal trauma, or as a preventative strategy in the long term. The aim of this study was to evaluate a current service provided for women with acute perineal trauma. The authors assessed patient satisfaction and compliance with physiotherapy advice, and identified preferences for future service development. One hundred and thirty patients completed satisfaction questionnaires after receiving inpatient physiotherapy treatment. Thirty consented to completing a retrospective telephone consultation about their care at 6–8 weeks postpartum. The questionnaire found high levels of satisfaction, and recorded a National Health Service Friends and Family Test score of 93. In the telephone consultation, 87% of the women reported that they were complying with ongoing PFM training. Eighty-five per cent of women who completed the questionnaire suggested that outpatient physiotherapy follow-up would be useful. Fifty per cent stated that options inclusive of outpatient follow-up would be useful for onward service development. Because of the high levels of satisfaction recorded and high compliance with the information provided in the acute postpartum period, it was concluded that the service should continue as it is. It is hoped that this service evaluation can be utilized as a benchmark for other acute and outpatient pelvic health physiotherapy services.

Racial Disparities in Outpatient Physical Therapy Use After Hip Fracture: A Retrospective Cohort Study

INTRODUCTION: The objective of our study was to examine whether there is a racial disparity among Medicare beneficiaries in the likelihood of using outpatient PT services following a hip fracture. METHODS: Our retrospective descriptive cohort study analyzed administrative claims data for 51,781 Medicare beneficiaries post-hip fracture. We examined the association between race and physical therapy (PT) use within the first 6 months post-fracture using hierarchical logistic regression, adjusting for demographics, medical complexity, and socioeconomic factors. We used Poisson regression to examine the association between race and the number of PT visits. RESULTS: Only 31% of beneficiaries used outpatient PT after hip fracture with significant racial disparities. After controlling for demographics, medical complexity, and socioeconomic factors, Black beneficiaries had 42% lower odds of using PT [aOR = 0.58, 95% CI 0.51-0.66] compared to White beneficiaries. Among PT users, Black beneficiaries received fewer visits than White beneficiaries (RR = 0.85, 95% CI 0.82-0.88) with this disparity persisting after adjustments (RR = 0.88, 95% CI 0.85-0.91). CONCLUSION: Even after adjusting for demographic, medical, and socioeconomic factors, Black beneficiaries were less likely to use outpatient PT following hip fractures. Conditional on an initial PT evaluation, Black beneficiaries received fewer sessions.

Musculoskeletal patients’ preferences for care from physiotherapists or support workers: a discrete choice experiment

BackgroundDelegation of clinical tasks from physiotherapists to physiotherapy support workers is common yet varies considerably in musculoskeletal outpatient physiotherapy services, leading to variation in patient care. This study aimed to explore patients’ preferences and estimate specific trade-offs patients are willing to make in treatment choices when treated in musculoskeletal outpatient physiotherapy services.MethodsA discrete choice experiment was conducted using an efficient design with 16 choice scenarios, divided into two blocks. Adult patients with musculoskeletal conditions recruited from a physiotherapy service completed a cross-sectional, online questionnaire. Choice data analyses were conducted using a multinomial logit model. The marginal rate of substitution for waiting time to first follow-up physiotherapy appointment and distance from the physiotherapy clinic was calculated and a probability model was built to estimate the probability of choosing between two distinct physiotherapy service options under different scenarios.Results382 patient questionnaires were completed; 302 participants were treated by physiotherapists and 80 by physiotherapists and support workers. There was a significant preference to be seen by a physiotherapist, have more follow-up treatments, to wait less time for the first follow-up appointment, to be seen one-to-one, to see the same clinician, to travel a shorter distance to get to the clinic and to go to clinics with ample parking. Participants treated by support workers did not have a significant preference to be seen by a physiotherapist and it was more likely that they would choose to be seen by a support worker for clinic scenarios where the characteristics of the physiotherapy service were as good or better.ConclusionsFindings highlight that patients treated by support workers are likely to choose to be treated by support workers again if the other service characteristics are as good or better compared to a service where treatment is provided only by physiotherapists. Findings have implications for the design of physiotherapy services to enhance patient experience when patients are treated by support workers. The findings will contribute to the development of “best practice” recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers for patients with musculoskeletal conditions.

Agreeing priority categories and items for inclusion in a future best practice delegation framework for musculoskeletal outpatient physiotherapy services: A consensus groups study

PurposeDelegation of clinical tasks from physiotherapists to physiotherapy support workers varies considerably in musculoskeletal outpatient physiotherapy services leading to variation in patient care. This study aimed to develop consensus amongst physiotherapists, support workers and managers about what components should be included in a future framework to guide effective and safe delegation of clinical tasks to physiotherapy support workers in United Kingdom's National Health Service musculoskeletal outpatient physiotherapy services. MethodsA consensus study was carried out, using Nominal Group Technique. Seven physiotherapists, ten physiotherapy support workers and ten physiotherapy operational/clinical leads from 13 musculoskeletal physiotherapy services within United Kingdom's National Health Service were recruited through the Chartered Society of Physiotherapy's professional networks and social media. Three separate, role-specific consensus groups were convened, involving participants generating, discussing and rating on a Likert scale, components for inclusion in a future delegation framework. Results32 out of 38 generated items reached consensus of ≥70%, i.e. a mean of ≥4.9 on a 7-point Likert scale, across the three groups. Items were grouped under five main categories: 1) training/Continuous Professional Development for physiotherapists and support workers; 2) need for a clear delegation process; 3) competencies 4) defining the role of support workers and 5) safety net. ConclusionKey stakeholder groups were able to reach consensus on five priority areas which will be developed into a best practice framework to standardise delegation and guide physiotherapists when delegating clinical tasks to support workers.

Impact of the Comprehensive Care for Joint Replacement Bundled Payment Model on Postoperative Utilization of Home Health and Outpatient Physical Therapy Services

ObjectiveTo study the effect of the Comprehensive Care for Joint Replacement (CJR) bundled payment program on postoperative home health and outpatient physical therapy (PT) for total hip or knee arthroplasty (THA/TKA). DesignRetrospective cohort with national Medicare data (5% claims) using a difference-in-differences analysis comparing January 2013-September 2015 (before) versus October 2016-September 2019 (after). SettingAdministrative claims from hospitals in 34 metropolitan statistical areas with mandatory CJR participation as of 2018 and 42 control metropolitan statistical areas. ParticipantsEpisodes in fee-for-service Medicare beneficiaries (5% claims) undergoing elective THA (n=6327) or TKA (n=10,764) with community discharge. InterventionsImplementation of CJR bundled payment program. Main Outcome MeasuresHome health and outpatient PT, including any use and number of visits. ResultsProgram implementation was associated with an increased percentage of THA episodes using home health PT (+8.0 percentage-point change; 95% CI, +3.5 to +12.6; P=.001) but a decreased per-episode number of home health PT visits for THA (−1.1; 95% CI, −1.6 to −0.6; P<.001) and TKA (−1.1; 95% CI, −1.4 to −0.7; P<.001). The program was also associated with an increased per-episode number of outpatient PT visits for TKA in the primary but not sensitivity analyses (+0.8; 95% CI, +0.1 to +1.4; P=.02). ConclusionsFindings of increased home health PT may reflect an intentional shift in care from the inpatient postacute setting to the community to decrease costs. Alternatively, the limited effect of CJR, particularly on outpatient PT, could reflect challenges with care coordination in a retrospective bundle spanning multiple care settings.

Examining rehabilitation access disparities: an integrated analysis of electronic health record data and population characteristics through bivariate choropleth mapping.

Despite efforts to view electronic health records (EHR) data through an equity lens, crucial contextual information regarding patients' social environments remains limited. Integrating EHR data and Geographic Information Systems (GIS) technology can give deeper insights into the relationships between patients' social environments, health outcomes, and geographic factors. This study aims to identify regions with the fastest and slowest access to outpatient physical therapy services using bivariate choropleth maps to provide contextual insights that may contribute to health disparity in access. This was a retrospective cohort study of patients' access timelines for the first visit to outpatient physical therapy services (n = 10,363). The three timelines evaluated were (1) referral-to-scheduled appointment time, (2) scheduled appointment to first visit time, and (3) referral to first visit time. Hot and coldspot analyses (CI 95%) determined the fastest and slowest access times with patient-level characteristics and bivariate choropleth maps that were developed to visualize associations between access patterns and disadvantaged areas using Area Deprivation Index scores. Data were collected between January 1, 2016 and January 1, 2020. EHR data were geocoded via GIS technology to calculate geospatial statistics (Gi∗ statistic from ArcGIS Pro) in an urban area. Statistically significant differences were found for all three access timelines between coldspot (i.e., fast access group) and hotspot (i.e., slow access group) comparisons (p < .05). The hotspot regions had higher deprivation scores; higher proportions of residents who were older, privately insured, female, lived further from clinics; and a higher proportion of Black patients with orthopaedic diagnoses compared to the coldspot regions. Our study identified and described local areas with higher densities of patients that experienced longer access times to outpatient physical therapy services. Integration of EHR and GIS data is a more robust method to identify health disparities in access to care. With this approach, we can better understand the intricate interplay between social, economic, and environmental factors contributing to health disparities in access to care.

Analysis of Marketing Strategies in Outpatient Services, Inpatient and Physiotherapy Services by Method Mix Marketing at RSU Royal Prima Marelan Medan

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;The increasing number of hospitals every year causes competition between hospitals in providing health services to patients. Because that's the need to implement a marketing strategy. This study aims to analyze the marketing strategy of Royal Prima Marelan Hospital with the marketing mix strategy (4P), namely product, price, place/distribution, and promotion. This study used a qualitative approach, conducted by interviewing 14 informants, namely 1marketing and public relations management, 1 general practitioner, 1 head of administration, 1 head of inpatient room, 1 head of outpatient room, 1 physiotherapist, and 8 patients. From the research results it is known that a specialist urologist and neurosurgeon are needed, and the number of nurses needs to be increased. The advantage of this hospital in the field of service products is that even though it is a type C hospital, it has quite a lot of specialist doctors. This hospital focuses on excellent trauma services, but still requires specialists in neurosurgery and urology. Royal Prima Marelan Hospital is also located on the side of the road which is very quickly accessible, but it needs to expand or expand the entrance and exit. In the field of promotion quite a lot and often done by the management and employees. However, more promotion is needed in the physiotherapy service product section&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keyword: Hospital manangement, Marketing mix&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Reported Experience of Women Who Received a New Self-management Physical Therapy Instruction before Breast Cancer Surgery - A Case Series

Objective: The need to provide information and instruction for patients post breast cancer (BC) surgery is highly supported. Several studies have shown pre-surgery instruction to be beneficial. However, as information about the experience of patients receiving pre-surgery instruction is limited, this case series aims to describe the experience of nine individual women who received newly developed, updated, self-management physical therapy (PT) instruction before BC surgery. Methods: Participant interviews were conducted by telephone using a list of questions prepared in advance about their personal experience. Medical files provided demographic and medical data. Interviews were performed by one physical therapist, transcribed, and analysed by two co-authors. Similarities and differences between transcripts were summarized. Results: Most participants found the instruction content to be easily understood and beneficial. They also expressed the value of receiving instruction before BC surgery. Nine felt that the instruction should be routinely provided. Criticism was mainly for lack of instruction regarding pain control, dealing with exercise fear avoidance, and that women unfamiliar with self-management and independent exercise may benefit less. Conclusion: Most participants found the new instruction understandable and beneficial when provided pre-surgery. However, this may not be suitable practice for all women as some may need personalized post-surgery instruction. Therefore, in addition to pre-surgical instruction provision, a post BC surgery PT visit would identify those requiring individualized instruction. Information about outpatient PT services should be added to pre-surgery instruction. Future studies should examine content and provision timing in a large sample of participants.

P99 Barriers to outpatient physical therapy services and the role of these services in patients with neuromuscular diseases

P99 Barriers to outpatient physical therapy services and the role of these services in patients with neuromuscular diseases

Goal setting in physiotherapy-led adult musculoskeletal care: A scoping review.

Goal setting is a key part of rehabilitation across various fields of physiotherapy. It is less clear what evidence exists to underpin its effectiveness and to practically guide its use within musculoskeletal physiotherapy. This scoping review provides an overview of current research regarding goal setting in adult physiotherapy-led musculoskeletal care with three aims: 1) to identify and analyse any gaps in the literature, 2) to identify relevant features of goal setting theory and 3) to make recommendations for future research. The principal research question was what does the literature tell us about the role of goal setting for adults over the age of 18 with musculoskeletal pain accessing outpatient physiotherapy services? The population, concept and context framework was used to define the inclusion criteria. Key definitions were adults over the age of 18 with musculoskeletal conditions, goal setting, and physiotherapy-led interventions. This scoping review followed the guidance set out by the Joanna Briggs Institute Manual for Evidence Synthesis. Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, MEDLINE, American Psychological Association PsycInfo and the Cochrane Database of Systematic Reviews, Protocols and Trials were searched using pre-defined search criteria. Data were extracted from screened full-text articles and presented in basic statistical and narrative form. 41 articles were included in the review. Several broad themes and research methods were identified. The nature of the studies suggested that the clinical application of goal setting is complex and the depth of understanding is limited. Most studies suggested that goal setting is feasible and has a positive impact on outcomes. A common finding was a lack of clear definitions regarding goal setting terminology and approaches. Study samples were generally defined by biomedical categories, suggesting a pathoanatomical approach to researching a cognitive construct. Theoretical underpinning was lacking in many studies. No frameworks guiding goal setting in physiotherapy-led musculoskeletal rehabilitation have been identified. Goal setting is a popular tool within musculoskeletal outpatient physiotherapy. Further research is required to clarify its efficacy and provide guidance on its role and application in clinical practice.

The Prevalence of Cognitive Impairment Among Medicare Beneficiaries Who Use Outpatient Physical Therapy.

The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice. This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) ≤1×/week, and sleep disturbance frequency using multinomial logistic regression. Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3% (CIND:15.2%, dementia:5.1%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8%, difficulty walking 1 block was 25.9%, difficulty walking several blocks was 20.8%, and no difficulty walking was 16.3%. Additionally, prevalence of cognitive impairment among those with MVPA ≤1×/week was 27.1% and MVPA >1×/week was 14.1%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance. One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity. Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient's ability to remember and process rehabilitation recommendations.

Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy.

Fragility fractures are common among adults with cerebral palsy (CP), but clinical rehabilitation use after fracture and its effect on long-term health outcomes have not been sufficiently studied. The objectives of this study were to identify patterns of the use of physical therapy, occupational therapy, or both in the 6-month postfracture period and the association with 3-year mortality in adults with CP. This retrospective cohort study included adults who were ≥18years old, had CP, and had sustained an incident fragility fracture between January 1, 2014, and December 31, 2016, as identified from a random 20% Medicare fee-for-service dataset. Six-month outpatient physical therapy or occupational therapy use patterns after fracture were identified using group-based trajectory modeling. Cox regression determined the association between physical therapy or occupational therapy use trajectory patterns and mortality from 6months to 3years after fracture, adjusting for confounders. Effect modification by key characteristics was tested, including age, sex, and the modified Whitney Comorbidity Index (mWCI), which is a CP-specific comorbidity index that better captures overall medical complexity. Of the 2429 participants included, the majority (73.2%) were characterized as having little to no probability of physical therapy or occupational therapy use, whereas 16.0 and 10.7% were characterized as having early initiation and later initiation, respectively. Compared to the mortality rate for the little to no physical therapy or occupational therapy group, the mortality rates were 26% lower for the early physical therapy or occupational therapy initiation group (hazard ratio [HR] = 0.74; 95% CI = 0.55-1.00) and were 20% lower for the later initiation group (HR = 0.80; 95% CI = 0.57-1.12). There was effect modification by the mWCI. The mortality rate was lower when the early initiation and later initiation groups were compared to the little to no initiation group across all mWCI values examined (median and interquartile range), but the effect was stronger (ie, lower mortality rate) for lower mWCI values for both early initiation and later initiation groups. Most adults with CP underutilize outpatient physical therapy or occupational therapy services within 6months postfracture. Early or later initiation versus little to no physical therapy or occupational therapy use was associated with a lower HR of mortality, although the effect was stronger and statistically significant among those with less medical complexity. Throughout their lives, the use of rehabilitation services in individuals with CP, including physical therapy and occupational therapy, dramatically declines despite the need for continued rehabilitation across their lifespans. This study characterized longitudinal physical therapy or occupational therapy use patterns in the 6months following a fragility fracture among adults with CP and found that nearly 3 in 4 adults with CP had little to no physical therapy or occupational therapy use during this critical window to optimize postfracture health and function. Further, those who more regularly used physical therapy or occupational therapy services, regardless of the timing of initiation (early vs later), had significantly improved survival up to 3years after fracture, suggesting the need for greater access to and delivery of clinical rehabilitation services.

Developing a best practice framework for musculoskeletal outpatient physiotherapy delegation: the MOPeD mixed-methods research study protocol

IntroductionPhysiotherapy assistants/support workers are an important part of the physiotherapy workforce in the UK. Many of them work in National Health Service (NHS) physiotherapy outpatient services treating patients with musculoskeletal...

Patients' Perceptions of Physical Therapists Addressing Opioid Misuse.

In the US, rising numbers of patients who misuse illicit or prescribed opioids provides opportunities for physical therapists (PTs) to be engaged in their care. Prior to this engagement, it is necessary to understand the perceptions of patients who access physical therapy services about their PTs playing such a role. This project examined patients' perceptions of PTs addressing opioid misuse. We surveyed patients, newly encountering outpatient physical therapy services in a large University-based healthcare setting, via anonymous, web-based survey. Within the survey, questions were rated on a Likert scale (1 = completely disagree to 7 = completely agree) and we evaluated responses of patients who were prescribed opioids versus those who were not. Among 839 respondents, the highest mean score was 6.2 (SD = 1.5) for "It is OK for physical therapists to refer their patients with prescription opioid misuse to a specialist to address the opioid misuse." The lowest mean score was 5.6 (SD = 1.9) for "It is OK for physical therapists to ask their patient why they are misusing prescription opioids." Compared to those with no prescription opioid exposure while attending physical therapy, patients with prescription opioid exposure had lower agreement that it was OK for the physical therapist to refer their patients with opioid misuse to a specialist (β = -.33, 95% CI = -0.63 to -0.03). Patients attending outpatient physical therapy seem to support PTs addressing opioid misuse and there are differences in support based on whether the patients had exposure to opioids.

A service evaluation of the management of patients with suspected cauda equina syndrome from an outpatient physiotherapy service in the United Kingdom

BackgroundThe expanding scope of physiotherapists worldwide has come with an increased responsibility to identify serious pathologies such as fracture, infection, tumour and cauda equina syndrome (CES). Guidelines recommend a low threshold for emergency MRI to avoid the potentially devastating consequences of CES, but a balanced approach is required to prevent excessive strain on emergency resources. AimTo evaluate the management of patients presenting to an outpatient physiotherapy service with suspected cauda equina syndrome. DesignService evaluation with an embedded case series of patients with radiological CES. MethodThe records of patients who were identified by their outpatient physiotherapists as having suspected CES (n-231) over a 27-month period were included. Data was extracted from patients’ medical records by a team of Advanced Clinical Practitioners (ACPs). The lead author further analysed the records of patients with clinical and radiological CES, in order to present the embedded case series. ResultsIn 79% of cases, it was decided that emergency referral was not required. The remaining 21% of patients were referred to the emergency department and 49% of these had an emergency MRI. In the case series of seven patients with cauda equina compression on MRI, four patients had a disc bulge and underwent emergency surgery. One patient had non-emergency surgery for a disc bulge combined with anterolisthesis and scoliosis. Two patients had stenosis and decided against surgical intervention. ConclusionsFindings from this service evaluation suggest support for the use of safety netting and an effective communication chain to facilitate effective management of patients with suspected CES.

Analysis of Patient Satisfaction on the Quality of Physiotherapy Services in the Pandemic Era at the SHC

The present study about Satisfaction is the perception of a product or service that has metexpectations. The customer satisfaction is the result of the accumulation of consumers or customers in using products or services. The quality of health services is the degree to which the needs of the community or individuals are meet for healthcare in accordance with good professional standardswith the use of resources fairly, efficiently, effectively within the limited capacity of the government and the community, and is carried out safely and satisfies customers in accordance with accepted good norms and ethics. Based on observations made by distributing customer feedback questionnaires at the Sasana Husada Clinic (SHC), Jakarta Indonesia patient satisfaction in outpatient physiotherapy services from January to March 2021. Result for patient satisfactionobtained 76%, of which there were about 24% who were dissatisfied with the physiotherapy servicesprovided at the SHC Jakarta Indonesia. The purpose of this study was to determine the analysis of patientsatisfaction with the quality of physiotherapy services in the covid-19 pandemic era at the SHC. Thestudy used a descriptive observational method with a cross sectional research design. The sample in this study was 62 people with sampling technique using simple random sampling. This research was conducted by filling out a questionnaire by the patient. Data analysis was performed by univariate test analysis. The results of the study indicate that patient satisfaction inside pandemic and based on thequality dimension of reliability 79.61%, patient satisfaction based on the assurance dimension 80.06%, patient satisfaction based on the tangibility quality dimension 81.67%, patient satisfaction based on the empathy quality dimension 78.12%, satisfaction patients based on responsiveness 77.80% and general patient satisfaction 78.06%.

Strategies to Increase Access to Outpatient Physiotherapy Services: A Scoping Review.

Purpose: Multiple Canadian jurisdictions have curtailed public funding for outpatient physiotherapy services, impacting access and potentially creating or worsening inequities in access. We sought to identify evaluated organizational strategies that aimed to improve access to physiotherapy services for community-dwelling persons. Method: We used Arksey and O'Malley's scoping review methods, including a systematic search of CINAHL, MEDLINE, and Embase for relevant peer-reviewed texts published in English, French, or German, and we performed a qualitative content analysis of included articles. Results: Fifty-one peer-reviewed articles met inclusion criteria. Most studies of interventions or system changes to improve access took place in the United Kingdom (17), the United States (12), Australia (9), and Canada (8). Twenty-nine studies aimed to improve access for patients with musculoskeletal conditions; only five studies examined interventions to improve equitable access for underserved populations. The most common interventions and system changes studied were expanded physiotherapy roles, direct access, rapid access systems, telerehabilitation, and new community settings. Conclusions: Studies evaluating interventions and health system changes to improve access to physiotherapy services have been limited in focus, and most have neglected to address inequities in access. To improve equitable access to physiotherapy services in Canada, physiotherapy providers in local settings can implement and evaluate transferable patient-centred access strategies, particularly telerehabilitation and primary care integration.

A survey of patient opinions on long-term implementation of virtual physiotherapy consultations in the assessment and management of rheumatology conditions

Keywords: Remote consultation; Rheumatology; Choice Purpose: Due to the Coronavirus pandemic, outpatient physiotherapy services had no option but to cease face-to-face activity and implement virtual consultations for all. As infection rates decrease, and we come out of the pandemic, there is a need to see which changes to consultation in physiotherapy might be worth keeping longer-term. Rheumatology physiotherapy is a smaller area of practice and benefits from being considered as different from general musculoskeletal physiotherapy. The physiotherapy consultation method preferences of people living with long-term health conditions such as those managed by rheumatologists may be different to those with acute musculoskeletal issues. Methods: Throughout March and April 2021, forty follow up patients under the care of the rheumatology physiotherapy team at a large university teaching hospital were approached to complete a short phone call survey. Informed consent was sought and granted by all 40 participants. The following questions were asked:•How would you like the Rheumatology Physiotherapy service to look moving forwards beyond COVID?•Should it revert to face to face only, continue with virtual only or have a combination of both virtual and face to face?•What are the reasons behind your answers? Data were analysed for patterns and then considered in diagnostic groups to guide future set up of the rheumatology physiotherapy service. Results: 62.5% of participants preferred a virtual consultation. Ten per cent preferred face-to-face. 27.5% preferred a combined approach of virtual and face-to-face in their physiotherapy management. All respondents living with a diagnosis of Inflammatory Arthritis expressed a preference for virtual (6/6). There was a moderate preference for virtual in those living with a diagnosis of Fibromyalgia (10/17) and of Osteoarthritis (3/6). There was a preference for a face-to-face consultation amongst those living with a diagnosis of Hypermobility (4/5). Reasons for a preference for a virtual physiotherapy consultation included: not having to travel, saving time and money, easier to fit around work, medical appointment fatigue, and being happy with the progress over virtual consultations. Reasons for a preference for a face-to-face physiotherapy consultation included a chance to be told or shown that an exercise technique is correct and finding a face-to-face appointment more personal. Conclusion(s): Patient preference for the method of physiotherapy consultation is different for those living with different rheumatology conditions. Service provision should change to allow pathways for both virtual-first and face-to-face-first input. Each person referred for rheumatology physiotherapy should have a chance to express their own preference, but from this small survey there is some generalisation of preference according to diagnosis and potential treatment offered. There should not be a return to face-to-face only provision of physiotherapy for people living with long-term health conditions such as those managed in rheumatology. Impact: Pathways for access to and management in rheumatology physiotherapy will be altered to allow access to a virtual consultation as a long-term change to practice post-coronavirus pandemic. Whilst undertaken as a local project, the conclusions should be considered for wider implementation, particularly in departments where there may not be specific rheumatology physiotherapists to campaign for maintaining a virtual consultation option for some. Funding acknowledgements: This work was not funded.

Service users evaluation of outpatient NHS physiotherapy services. Using SERVPERF and IPA tools for transforming provision

Keywords: Service-quality; SERVPERF; Transformation

An evaluation of a neuro out-patient physiotherapy service: Are we helping our patients to self-manage?

An evaluation of a neuro out-patient physiotherapy service: Are we helping our patients to self-manage?