title: Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic.
abstract: BACKGROUND
  In Canada, new models of orthopaedic care involving advanced practice physiotherapists (APP) are being implemented. In these new models, aimed at improving the efficiency of care for patients with musculoskeletal disorders, APPs diagnose, triage and conservatively treat patients. Formal validation of the efficiency and appropriateness of these emerging models is scarce. The purpose of this study is to assess the diagnostic agreement of an APP compared to orthopaedic surgeons as well as to assess treatment concordance, healthcare resource use, and patient satisfaction in this new model.
  
  
  METHODS
  120 patients presenting for an initial consult for hip or knee complaints in an outpatient orthopaedic hospital clinic in Montreal, Canada, were independently assessed by an APP and by one of three participating orthopaedic surgeons. Each health care provider independently diagnosed the patients and provided triage recommendations (conservative or surgical management). Proportion of raw agreement and Cohen's kappa were used to assess inter-rater agreement for diagnosis, triage, treatment recommendations and imaging tests ordered. Chi-Square tests were done in order to compare the type of conservative treatment recommendations made by the APP and the surgeons and Student t-tests to compare patient satisfaction between the two types of care.
  
  
  RESULTS
  The majority of patients assessed were female (54%), mean age was 54.1 years and 91% consulted for a knee complaint. The raw agreement proportion for diagnosis was 88% and diagnostic inter-rater agreement was very high (κ=0.86; 95% CI: 0.80-0.93). The triage recommendations (conservative or surgical management) raw agreement proportion was found to be 88% and inter-rater agreement for triage recommendation was high (κ=0.77; 95% CI: 0.65-0.88). No differences were found between providers with respect to imaging tests ordered (p≥0.05). In terms of conservative treatment recommendations made, the APP gave significantly more education and prescribed more NSAIDs, joint injections, exercises and supervised physiotherapy (p<0.05). Patient satisfaction was significantly higher for APP care than for the surgeons care (p<0.05).
  
  
  CONCLUSIONS
  The diagnoses and triage recommendations for patients with hip and knee disorders made by the APP were similar to the orthopaedic surgeons. These results provide evidence supporting the APP model for orthopaedic care.
authors: School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada. f.desmeules@umontreal.ca
authors: François
authors: F
authors: Desmeules
authors: Panagiota
authors: P
authors: Toliopoulos
authors: Jean-Sébastien
authors: JS
authors: Roy
authors: Linda June
authors: LJ
authors: Woodhouse
authors: Marc
authors: M
authors: Lacelle
authors: Manon
authors: M
authors: Leroux
authors: Steven
authors: S
authors: Girard
authors: Debbie E
authors: DE
authors: Feldman
authors: Julio C
authors: JC
authors: Fernandes
mesh_terms: D000554:Ambulatory Care Facilities; D005081:Exercise Therapy; D005260:Female; D006621:Hip Joint / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000534:rehabilitation*; D009985:Orthopedics / Q000379:methods* / Q000458:organization & administration; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D014218:Triage
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