Volume 188 - Issue 5
Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care
Authors: Leonie B Oldmeadow, Harvinda S Bedi, Hugh T Burch, Jenni S Smith, Edmund S Leahy and Miron Goldwasser
Med J Aust 2008; 188 (5): 318-319. || doi: 10.5694/j.1326-5377.2008.tb01638.x
Published online: 3 March 2008
Published online: 3 March 2008
In reply: The proportion of patients who, after being referred to specialist orthopaedic surgeons by general practitioners, are then listed for surgery, is around 20%–30%.1-3 In our trial, the diagnostic and management concordance between the physiotherapists and surgeon for this group was very high. It was also high for the 63% for whom evidence-based physiotherapy was appropriate. Management discordance occurred when surgical treatments that are controversial, and variously used by surgeons (as noted by Brand and colleagues), were recommended. It is important to note that the 74% agreement between the surgeon and physiotherapists in our trial was achieved under research conditions, with the physiotherapists screening independently. We suggest that the physiotherapist clinic be co-located with that of the surgeons, to facilitate further investigations, enhance the pathway to surgery and manage safety concerns.
The advantages of a physiotherapist screening clinic are in (i) triaging out from waiting to see a surgeon, patients predicted to benefit from non-surgical interventions (including those not willing to consider surgery at the time) and (ii) triaging patients in to the appropriate non-surgical care. We agree that patients with degenerative, osteoarthritic conditions, for whom joint replacement surgery may be the eventual treatment, will be best managed through multidisciplinary care.
References
- Queensland Health Systems Review. Final report. September 2005. http://www.health.qld.gov.au/health_sys_review/final/qhsr_final_report.pdf (accessed Nov 2007).<eMJA full text>
- Hourigan P, Weatherley C. Initial assessment and follow-up by a physiotherapist of patients with back pain referred to a spinal clinic. J R Soc Med 1994; 87: 213-214. 0_pgfId-1582974
- Oldmeadow LB, Bedi HS, Burch HT, et al. Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care. Med J Aust 2007; 186: 625-628. 0_CBBBIICA