title: Evaluation of an advanced-practice physical therapist in a specialty shoulder clinic: diagnostic agreement and effect on wait times.
abstract: OBJECTIVE
  To examine the role of an advanced-practice physiotherapist (APP) with respect to (1) agreement with an orthopaedic surgeon on diagnosis and management of patients with shoulder problems; (2) wait times; and (3) satisfaction with care.
  
  
  METHODS
  This prospective study involved patients with shoulder complaints who were referred to a shoulder specialist in a tertiary care centre. Agreement was examined on seven major diagnostic categories, need for further examination and surgery, and type of surgical procedure. Wait times were compared between the APP- and surgeon-led clinics from referral date to date of initial consultation, date of final diagnostic test, and date of confirmed diagnosis and planned treatment. A modified and validated version of the Visit-Specific Satisfaction Instrument assessed satisfaction in seven domains. Kappa (κ) coefficients and bias- and prevalence-adjusted kappa (PABAK) values were calculated, and strength of agreement was categorized. Wait time and satisfaction data were examined using non-parametric statistics.
  
  
  RESULTS
  Agreement on major diagnostic categories varied from 0.68 (good) to 0.96 (excellent). Agreement with respect to indication for surgery was κ=0.75, p<0.001; 95% CI, 0.62-0.88 (good). Wait time for APP assessment was significantly shorter than wait time for surgeon consultation at all time points (p<0.001); the surgeon's wait time was significantly reduced over 3 years. High satisfaction was reported in all components of care received from both health care providers.
  
  
  CONCLUSIONS
  Using experienced physiotherapists in an extended role reduces wait times without compromising patient clinical management and overall satisfaction.
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Physical Therapy.
authors.forename: Helen
authors.initials: H
authors.lastname: Razmjou
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Physical Therapy.
authors.forename: Susan
authors.initials: S
authors.lastname: Robarts
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Physical Therapy ; School of Rehabilitation Science, McMaster University, Hamilton, Ont.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kennedy
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre.
authors.forename: Cheryl
authors.initials: C
authors.lastname: McKnight
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Macleod
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto.
authors.forename: Richard
authors.initials: R
authors.lastname: Holtby
keywords: advanced practice; diagnosis; physiotherapist; shoulder