Purpose: 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.
- Content Type Journal Article
- Category Advance Online Article
- Pages 1-10
- DOI 10.3138/ptc.2011-56
- Authors
- Helen Razmjou, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Susan Robarts, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Deborah Kennedy, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Cheryl McKnight, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Anne Marie MacLeod, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Richard Holtby, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto
- Journal Physiotherapy Canada
- Online ISSN 1708-8313
- Print ISSN 0300-0508
Source: http://www.metapress.com/content/y784n5v333n5tr72/
chiropractor chiropractic back pain solution neck pain solution
Walang komento:
Mag-post ng isang Komento