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Gross D1, Emery D2, Long A3, Reese H4, Whittaker J1,5
1University of Alberta, Physical Therapy, Edmonton, Canada, 2University of Alberta, Radiology and Diagnostic Imaging, Edmonton, Canada, 3Bonavista Physiotherapy Clinic, Calgary, Canada, 4LifeMark at Academy Place Physiotherapy Clinic, Edmonton, Canada, 5University of Alberta, Glen Sather Sports Medicine Clinic, Edmonton, Canada
Background: In the context of physiotherapy (PT) practice diagnostic imaging (DI) is used as a tool to direct patient management, which may involve confirming a physiotherapy diagnosis, answering an explicit clinical question, or altering or advancing a client's treatment plan. Traditionally, PTs have been dependent on physicians and/or surgeons for DI referral. This reliance can lead to delays in patient care due to lengthy wait times. Providing PTs with the expertise and capacity to directly refer patients for DI has the potential to dramatically reduce delays for accurate diagnosis and subsequent treatment, which could lead to better clinical outcomes and cost savings to the health care system. In 2011 physiotherapists in Alberta, Canada, were authorized to refer for diagnostic imaging. To date, referral patterns for diagnostic imaging undertaken within Alberta's public health system by authorized physiotherapists have not been described.
Purpose: The purposes of this study were to:
1) describe the overall and modality-specific annual DI referrals by authorized PTs in the province of Alberta paid for by the public health system between 2012 and 2016; and
2) describe how these referrals vary across geographical region and body part.
Methods: This is a descriptive study of public health funding agency historical data on all PT-referred DI studies (e.g., x-ray, MRI, USI) between January 1, 2012 (inception) and December 31, 2016 from the province of Alberta, Canada. Data included: number of imaging studies/therapist/month, imaging modality, geographical region, and body part. Descriptive statistics summarized studies across year, modality, region, and body part. Yearly rates (exact 95% Confidence Interval) were calculated across modality and region.
Results: Over the study period 20,280 diagnostic imaging studies were conducted. The majority (94.1%) were performed at community imaging clinics, with the remaining 5.9% undertaken at hospitals and public health centres. X-ray (76.4%) was most common followed by ultrasound imaging (19.7%) and magnetic resonance imaging (3.5%). Regional variation was observed with one urban centre accounting for 76.7% of studies. The annual number per physiotherapist was 31.4 referrals/year (95%CI 24.8,38.0). The majority (99.95%) were of the musculoskeletal system including: spine (22.7%), knee (15.5%), and sacroiliac joint (12.0%) radiography. One urban centre accounted for 15,549 (76.7%) of the DI studies performed over the study period.
Conclusion(s): Physiotherapists typically request plain X-ray and ultrasound imaging ofthe musculoskeletal system, with less use of magnetic resonance imaging. Regional variations were observed across all DI modalities. Results provide regulators, educators, legislators, and funders an overview of practicing Albertan PT's usage of DI. Further research is needed related to appropriateness and cost-effectiveness of PT referral for DI.
Implications: Regulators in jurisdictions where PTs are authorized to refer for DI should implement methods for monitoring and providing feedback (i.e., scorecards) to individual PTs to allow them to reflect upon their referral patterns in the context of their peers, practice setting, and existing practice guidelines. Regulators and professional associations should work together to gain a greater understanding of practice variation to ensure prudent use of public funds and evidence-based use of DI for the management of patients undergoing physiotherapy.
Keywords: Diagnostic imaging, Health Services, Musculoskeletal
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Purpose: The purposes of this study were to:
1) describe the overall and modality-specific annual DI referrals by authorized PTs in the province of Alberta paid for by the public health system between 2012 and 2016; and
2) describe how these referrals vary across geographical region and body part.
Methods: This is a descriptive study of public health funding agency historical data on all PT-referred DI studies (e.g., x-ray, MRI, USI) between January 1, 2012 (inception) and December 31, 2016 from the province of Alberta, Canada. Data included: number of imaging studies/therapist/month, imaging modality, geographical region, and body part. Descriptive statistics summarized studies across year, modality, region, and body part. Yearly rates (exact 95% Confidence Interval) were calculated across modality and region.
Results: Over the study period 20,280 diagnostic imaging studies were conducted. The majority (94.1%) were performed at community imaging clinics, with the remaining 5.9% undertaken at hospitals and public health centres. X-ray (76.4%) was most common followed by ultrasound imaging (19.7%) and magnetic resonance imaging (3.5%). Regional variation was observed with one urban centre accounting for 76.7% of studies. The annual number per physiotherapist was 31.4 referrals/year (95%CI 24.8,38.0). The majority (99.95%) were of the musculoskeletal system including: spine (22.7%), knee (15.5%), and sacroiliac joint (12.0%) radiography. One urban centre accounted for 15,549 (76.7%) of the DI studies performed over the study period.
Conclusion(s): Physiotherapists typically request plain X-ray and ultrasound imaging ofthe musculoskeletal system, with less use of magnetic resonance imaging. Regional variations were observed across all DI modalities. Results provide regulators, educators, legislators, and funders an overview of practicing Albertan PT's usage of DI. Further research is needed related to appropriateness and cost-effectiveness of PT referral for DI.
Implications: Regulators in jurisdictions where PTs are authorized to refer for DI should implement methods for monitoring and providing feedback (i.e., scorecards) to individual PTs to allow them to reflect upon their referral patterns in the context of their peers, practice setting, and existing practice guidelines. Regulators and professional associations should work together to gain a greater understanding of practice variation to ensure prudent use of public funds and evidence-based use of DI for the management of patients undergoing physiotherapy.
Keywords: Diagnostic imaging, Health Services, Musculoskeletal
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Topic: Service delivery/emerging roles; Professional practice: other; Musculoskeletal
Ethics approval required: Yes
Institution: University of Alberta
Ethics committee: Health Research Ethics Board
Ethics number: Pro00063843
All authors, affiliations and abstracts have been published as submitted.
