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Tan C1,2, Jiang B1, Fook-Chong S3, Chew E2, Lee YF2
1Singapore Health Services, Group Allied Health, Singapore, Singapore, 2Singapore General Hospital, Physiotherapy Department, Singapore, Singapore, 3Singapore General Hospital, Health Services Research Unit, Singapore, Singapore
Background: Singapore has one of most rapidly aging populations in Asia with concomitant increase in prevalence of complex chronic health conditions. Along with this demographic shift are numerous emerging issues, such as a burgeoning demand for quality health services, an escalation of patient expectations and a shortage of healthcare manpower. In response to these challenges, a paradigm shift in the existing therapy service delivery is required. One approach was through task shifting by introducing a new tier of support workforce, therapy assistant with advanced skills (referred to as Therapy Support Associate (TSA)), on the basis of staff mix analysis and responsibility mapping. It was anticipated that TSA could take over some routine activities relinquished by therapists.
Purpose: In this study, we aim to explore whether the trained TSA, compared with junior physiotherapists, was effective to deliver protocol-based standard physiotherapy care to patients following total knee arthroplasty (TKA) in a tertiary hospital in Singapore.
Methods: The study was comprised of two phases: (1) training the identified therapy assistant to be competent as TSA to deliver protocol-based standard physiotherapy care to TKA patients; (2) evaluating the effectiveness of TSA (intervention group), compared with junior physiotherapists (control group), in managing TKA patients in a pilot randomized controlled trial. The clinical competency of TSA was evaluated at pre-, post-training, as well as every other month subsequently. Patient data included demographics, functional outcomes (resting pain, knee flexion and extension range of motion, and the ability to perform an unassisted straight leg raise) and discharge outcomes (length of stay (LOS) and discharge destination). Qualitative feedback from patients, therapists and TSA was also collected by administering survey forms or asking open-ended questions.
Results: TSA was competent to perform TKA protocol independently after the completion of 4-week training. The study recruited 25 patients in the control group (mean age=67.5 years, male=28.0%) and 23 patients in the TSA group (mean age=68.1 years, male=30.4%). Patients in both groups had improvements in resting pain (control group: 1.8 to 0.9; TSA group: 1.7 to 0.6) and knee flexion range (control group: 59.6 to 82.9; TSA group: 61.7 to 92.4) from postoperative day 1 (POD1) to POD3. However, only those in the TSA group had significant improvements in knee extension range and straight leg raise from POD1 to POD3. There were no significant differences in patient discharge outcomes and satisfaction levels between groups.
Conclusion(s): The introduction of well-trained TSA to deliver protocol-based physiotherapy services to TKA patients did not compromise patient outcomes.
Implications: Results suggest that it is feasible to expand the role of therapy assistant to take over some aspects of the routine workload from therapists, which will enable therapists to prioritize their workload and focus on more patient-centered care activities or more complicated cases. Further studies with more rigorous design and a larger sample size are required before it can be generalized for implementation.
Keywords: Therapy Support Associate, competency, total knee arthroplasty
Funding acknowledgements: No funding for this study.
Purpose: In this study, we aim to explore whether the trained TSA, compared with junior physiotherapists, was effective to deliver protocol-based standard physiotherapy care to patients following total knee arthroplasty (TKA) in a tertiary hospital in Singapore.
Methods: The study was comprised of two phases: (1) training the identified therapy assistant to be competent as TSA to deliver protocol-based standard physiotherapy care to TKA patients; (2) evaluating the effectiveness of TSA (intervention group), compared with junior physiotherapists (control group), in managing TKA patients in a pilot randomized controlled trial. The clinical competency of TSA was evaluated at pre-, post-training, as well as every other month subsequently. Patient data included demographics, functional outcomes (resting pain, knee flexion and extension range of motion, and the ability to perform an unassisted straight leg raise) and discharge outcomes (length of stay (LOS) and discharge destination). Qualitative feedback from patients, therapists and TSA was also collected by administering survey forms or asking open-ended questions.
Results: TSA was competent to perform TKA protocol independently after the completion of 4-week training. The study recruited 25 patients in the control group (mean age=67.5 years, male=28.0%) and 23 patients in the TSA group (mean age=68.1 years, male=30.4%). Patients in both groups had improvements in resting pain (control group: 1.8 to 0.9; TSA group: 1.7 to 0.6) and knee flexion range (control group: 59.6 to 82.9; TSA group: 61.7 to 92.4) from postoperative day 1 (POD1) to POD3. However, only those in the TSA group had significant improvements in knee extension range and straight leg raise from POD1 to POD3. There were no significant differences in patient discharge outcomes and satisfaction levels between groups.
Conclusion(s): The introduction of well-trained TSA to deliver protocol-based physiotherapy services to TKA patients did not compromise patient outcomes.
Implications: Results suggest that it is feasible to expand the role of therapy assistant to take over some aspects of the routine workload from therapists, which will enable therapists to prioritize their workload and focus on more patient-centered care activities or more complicated cases. Further studies with more rigorous design and a larger sample size are required before it can be generalized for implementation.
Keywords: Therapy Support Associate, competency, total knee arthroplasty
Funding acknowledgements: No funding for this study.
Topic: Service delivery/emerging roles
Ethics approval required: Yes
Institution: Singapore Health Services
Ethics committee: Centralised Institutional Review Board
Ethics number: 2016/2498
All authors, affiliations and abstracts have been published as submitted.
