title: A single group follow-up study of non-surgical patients seen by physiotherapists working in expanded roles in orthopaedic departments: recall of recommendations, change in exercise and self-efficacy.
abstract: BACKGROUND
  Specially trained physiotherapists (advanced practice physiotherapists (APP)) are working in orthopaedic clinics to improve access to orthopaedic services and support chronic disease management. Little attention has been paid to the impact APPs may have on non-surgical patients. In non-surgical patients with hip or knee arthritis consulting an APP in an orthopaedic clinic, the objectives were to: 1) describe patients' recall of APP recommendations, use of self-management strategies, and barriers to management six weeks following consultation; and, 2) compare exercise behaviour and self-efficacy at baseline and six weeks.
  
  
  RESULTS
  This was a single group pre-and post-intervention study of patients who saw an APP when consulting the orthopaedic departments of two hospitals. At baseline and six weeks participants completed the adapted Stanford Exercise Behaviour Scale (response options: none, < 60 minutes/week, 1-3 hours/week or > 3 hours/week), and the Chronic Disease Self-efficacy Scale (range 1-10; higher scores indicate higher self-efficacy). At follow-up participants completed questions on recall of APP recommendations, use of self-management strategies and barriers to management. Seventy three non-surgical patients with hip or knee arthritis participated, a response rate of 89% at follow-up. Seventy one percent of patients reported that the APP recommended exercise, of whom 83% reported exercising to manage their arthritis since the visit. Almost 50% reported an increase in time spent stretching; over 40% reported an increase in time spent walking or doing strengthening exercises at follow-up. Common barriers to arthritis management were time, cost and other health problems. Mean chronic disease self-efficacy scores significantly improved from 6.3 to 7.2 (p < 0.001). The mean difference was 0.95 (95% CI 0.43, 1.62); the effect size was 0.51.
  
  
  CONCLUSIONS
  This pilot study of an APP intervention for non-surgical patients referred for orthopaedic consultation showed promising results, particularly for enhancing use of conservative management strategies such as exercise.
authors.affiliation: Division of Health Care and Outcomes Research and Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Toronto, ON, Canada. cmackay@uhnres.utoronto.ca
authors.forename: Crystal
authors.initials: C
authors.lastname: MacKay
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Mahomed
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006621:Hip Joint / Q000503:physiopathology; D006784:Hospitals, Teaching; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009864:Ontario; D009985:Orthopedics; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D010361:Patients / Q000523:psychology*; D059825:Physical Therapists; D010865:Pilot Projects; D024382:Professional Role; D011369:Professional-Patient Relations; D011446:Prospective Studies; D012017:Referral and Consultation; D012648:Self Care; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D000078329:Workforce; D055815:Young Adult