Enhancing Musculoskeletal Patient Care Delivery using Advanced Practice Physiotherapists

A new role for Advanced Practice Physiotherapists (APPs) in caring for patients with hip and knee arthritis has now been expanded to patients with shoulder and spine conditions. In response to the Ontario Wait Time Strategy, the Holland Centre pioneered a team-based model of care with the development of the Hip and Knee Arthritis Program in 2006. Integral to this model was the introduction of Advanced Practice Physiotherapists (APPs) in patient triage, assessment and post-operative follow-up care. The development of the role for APPs in musculoskeletal care improves patient access and fosters an interprofessional team approach. Introduction of the role was based on a body of research conducted in England, Scotland, the United States, Australia and Canada. The research validates that physiotherapists working alongside orthopaedic surgeons develop expert assessment skills comparable to their surgeon counterparts. In addition, physiotherapists are more likely to recommend comprehensive evidence-based interventions, including exercise and weight loss, as well as refer to other healthcare providers. By extending the physiotherapist’s scope of practice, through Medical Directives, many patients are managed conservatively and do not require any surgical consultation (30% of knee patients, 50% of shoulder patients, and 70% of spine patients). APPs add value to the patient experience through enhanced access to care (including reducing wait times for clinic visits), comprehensive assessments, individualized education and their focus on optimizing function (both for patients who do and do not undergo surgery). Medical directives, decision-making algorithms and a Practice Development Program support the advanced practice role. Patient satisfaction is high: a sample of over 800 patients completed the validated Visit-Specific Questionnaire (VSQ-9) after joint replacement in both surgeon and APP clinics. APPs scored either significantly higher (p < 0.004) or similarly to surgeons. This high satisfaction is similarly found in the Shoulder and Spine APP-led Clinics. Physiotherapists have a unique foundation and skill set in orthopaedics that can be leveraged to improve patient access, wait times, physician shortages and system inefficiencies. As part of the Hospital’s interprofessional education program, this Program now offers musculoskeletal rotations for family practice residents. The role of Advanced Practice Physiotherapists has been fully integrated into the interprofessional team and the Holland Centre model of care. To date we have trained 8 APPs and one Advanced Practice Occupational Therapist.