title: Agreement between a physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain.
abstract: BACKGROUND
  Physiotherapists increasingly manage shoulder referrals in place of orthopaedic doctors. Better understanding the agreement between these professionals will help inform the safety, quality and potential costs of these care models.
  
  
  OBJECTIVE
  To establish the level of agreement between a physiotherapist and an orthopaedic surgeon regarding diagnosis, management and corticosteroid injection, in a representative sample of orthopaedic shoulder referrals.
  
  
  METHODS
  Blinded inter-rater agreement study.
  
  
  METHODS
  274 public orthopaedic shoulder patients were independently assessed by a physiotherapist and an orthopaedic surgeon. Management, subacromial corticosteroid injection, diagnosis and investigation decisions were compared using inter-rater reliability statistics.
  
  
  RESULTS
  Agreement between the physiotherapist and the orthopaedic surgeon was near perfect for surgical versus nonsurgical management (Gwets agreement coefficient AC1 = 0.93, 95%CI: 0.90-0.93), safety of injection (AC1 = 0.85, CI: 0.79-0.91) and investigations requested (AC1 = 0.87, CI: 0.83-0.91); substantial for the presence of subacromial pain (AC1 = 0.74, CI: 0.66-0.81) and diagnosis (AC1 = 0.72, CI: 0.66-0.78); and moderate regarding delivery of subacromial corticosteroid injection as an immediate treatment (AC1 = 0.48, CI 0.33-0.53), with the physiotherapist less inclined to select corticosteroid injection as the first intervention.
  
  
  CONCLUSIONS
  In this study a physiotherapist with prescribing and injection training made decisions analogous to those of an orthopaedic surgeon at initial consultation for orthopaedic shoulder pain, including the safe identification of patients for subacromial injection, without prior screening of referrals by orthopaedic doctors.
  
  
  BACKGROUND
  Australia and New Zealand Clinical Trials Registry, number 12612000532808.
authors.affiliation: Gold Cost Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, 4215, Gold Coast, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia. Electronic address: darryn.marks@health.qld.gov.au.
authors.forename: Darryn
authors.initials: D
authors.lastname: Marks
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia; Metro North Hospital and Health Service, 112 Alfred Street, Fortitude Valley, QLD 4006, Brisbane, Australia.
authors.forename: Tracy
authors.initials: T
authors.lastname: Comans
authors.affiliation: Gold Cost Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, 4215, Gold Coast, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia.
authors.forename: Shu Kay
authors.initials: SK
authors.lastname: Ng
authors.affiliation: School of Health and Rehabilitation Sciences, University of Queensland, Brisbane St Lucia, QLD 4072, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4006, Australia.
authors.forename: Shaun
authors.initials: S
authors.lastname: O'Leary
authors.affiliation: Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, LS7 4SA, UK.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Conaghan
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Parklands Drive Southport, QLD 4222, Gold Coast, Australia.
authors.forename: Leanne
authors.initials: L
authors.lastname: Bisset
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D000072161:Orthopedic Surgeons; D009985:Orthopedics / Q000592:standards*; D059825:Physical Therapists; D026741:Physical Therapy Modalities / Q000592:standards*; D015203:Reproducibility of Results; D020069:Shoulder Pain / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Corticosteroid injection; Orthopaedic; Physiotherapy; Shoulder