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Please use this identifier to cite or link to this item: http://hdl.handle.net/1807/32058

Title: Expanding Roles in Orthopaedic Care: A Comparison of Physiotherapist and Orthopaedic Surgeon Recommendations for Triage
Authors: MacKay, Crystal
Davis, Aileen M
Mahomed, Nizar
Badley, Elizabeth M
Keywords: Clinical decision making, Physiotherapy, Arthritis, Orthopaedics, Extended role, Models of care
Issue Date: Feb-2009
Publisher: Journal of Evaluation and Clinical Practice
Citation: J Eval Clin Pract 2009 Feb;15(1):178-83
Abstract: Rationale, aims and objectives: Innovative service delivery models are emerging using physiotherapists in the assessment and management of patients referred for orthopaedic consultation. The primary objective of this study was to compare the clinical recommendations of specially trained physiotherapists to those of an orthopaedic surgeon on: 1) appropriateness to be seen by an orthopaedic surgeon; and 2) candidacy and willingness to undergo total joint replacement (TJR) for patients with hip or knee problems. A secondary objective was to examine their recommendations for non-surgical management and agreement on clinical diagnosis. Methods: Physiotherapists and orthopaedic surgeons independently assessed patients with hip and knee problems referred for consideration for TJR and completed a standardized form on treatment recommendations. Agreement between providers was determined using the kappa coefficient and percent agreement. Results: Two physiotherapists and three orthopaedic surgeons participated in the study that included 45 and 17 patients with knee and hip problems, respectively. In 91.8% (56/61) of cases, physiotherapists and orthopaedic surgeons agreed on the recommendation of appropriateness for the patient to see a surgeon (kappa 0.69). In discordant cases, the physiotherapists tended to refer for consultation. There was 85.5% (53/62) agreement on whether a patient was a candidate and willing to have TJR (kappa 0.70). The physiotherapists commonly recommended exercise and education for non-surgical patients. Orthopaedic surgeons most commonly referred patients to rehabilitation services. Conclusions: Patients with hip or knee pain referred to orthopaedic surgeons can be appropriately referred for orthopaedic consultation by physiotherapists working in extended roles. Further research is required to evaluate the value-added and the most appropriate use of extended role physiotherapists.
URI: http://hdl.handle.net/1807/32058
Appears in Collections:UofT Faculty publications

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