Madsen MN1, Kirkegaard ML1, Klebe TM1, Linnebjerg CL1, Due SJ1, Villumsen SMR1, Trøstrup J1, Mikkelsen LR1
1Silkeborg Regional Hospital, Elective Surgery Centre, Silkeborg, Denmark
Background: Traditionally, patients with musculoskeletal disorders referred to an orthopedic outpatient clinic were examined by an orthopedic surgeon (OS). In recent years, extended scope physiotherapists (ESP) are increasingly used to perform this examination instead of an OS. Previous studies have indicated satisfactory results regarding diagnostic agreement, costs and patient satisfaction when comparing ESP and OS. However, methodological quality of available studies is generally low.
Purpose: To evaluate agreement on diagnosis and treatment plan between ESPs and OSs examining patients with shoulder disorders
Methods: A prospective cohort study was conducted. Patients were recruited from an orthopedic outpatient shoulder clinic at a public, regional hospital in Denmark. Three ESPs and four OSs participated in the study. Patients were examined twice the same day by both an ESP and an OS in random order. Each health care provider independently registered diagnosis (9 predefined categories) and treatment plan (5 predefined categories). Raw agreement on diagnosis and treatment plan were estimated in percent between ESP and OS. Diagnostic agreement was defined as having registered the same primary diagnosis or having registered the same combination of diagnoses, but with a different priority of primary/secondary diagnosis. Partial agreement was defined as ESP and OS having one diagnosis in common, but one have considered it to be the primary and the other a secondary diagnosis. Total agreement on treatment plan was defined as full concordance between categories chosen, while it was considered partial agreement if health providers had at least one treatment recommendation in common.
Results: 69 patients (55 % males) with a median age of 54 years were included. 67 % were diagnosed with either impingement, periarthritis humeroscapularis or rotator cuff injury. 77 % of patients received a steroid injection, 55 % were referred to physiotherapy and 4 % were scheduled for surgery. Diagnostic agreement between ESP and OS was 79 % (95% CI: [70 %; 89 %]). In a further 16 % of patients, partial diagnostic agreement was present. 13 different treatment combinations were used. Total agreement between ESP and OS on treatment plan was 43 % (95 % CI: [31 %; 54 %]) and partial agreement 96 % (95 % CI: [91 %; 100]).
Conclusion(s): Regardless of whether the examination was performed by an ESP or an OS, more than 90 % of patients received the same or partly the same diagnosis and treatment plan. Our results support the use of ESP to examine patients with shoulder disorders referred to an orthopedic clinic. However, for a more thorough evaluation of the ESP's performance, randomized trials comparing results of treatment initiated by an ESP or an OS are needed.
Implications: More widespread use of ESPs in orthopedic outpatient clinics could potentially optimize use of health care resources.
Keywords: Extended scope, shoulder
Funding acknowledgements: The present study was partly funded by Association of Danish Physiotherapists
Purpose: To evaluate agreement on diagnosis and treatment plan between ESPs and OSs examining patients with shoulder disorders
Methods: A prospective cohort study was conducted. Patients were recruited from an orthopedic outpatient shoulder clinic at a public, regional hospital in Denmark. Three ESPs and four OSs participated in the study. Patients were examined twice the same day by both an ESP and an OS in random order. Each health care provider independently registered diagnosis (9 predefined categories) and treatment plan (5 predefined categories). Raw agreement on diagnosis and treatment plan were estimated in percent between ESP and OS. Diagnostic agreement was defined as having registered the same primary diagnosis or having registered the same combination of diagnoses, but with a different priority of primary/secondary diagnosis. Partial agreement was defined as ESP and OS having one diagnosis in common, but one have considered it to be the primary and the other a secondary diagnosis. Total agreement on treatment plan was defined as full concordance between categories chosen, while it was considered partial agreement if health providers had at least one treatment recommendation in common.
Results: 69 patients (55 % males) with a median age of 54 years were included. 67 % were diagnosed with either impingement, periarthritis humeroscapularis or rotator cuff injury. 77 % of patients received a steroid injection, 55 % were referred to physiotherapy and 4 % were scheduled for surgery. Diagnostic agreement between ESP and OS was 79 % (95% CI: [70 %; 89 %]). In a further 16 % of patients, partial diagnostic agreement was present. 13 different treatment combinations were used. Total agreement between ESP and OS on treatment plan was 43 % (95 % CI: [31 %; 54 %]) and partial agreement 96 % (95 % CI: [91 %; 100]).
Conclusion(s): Regardless of whether the examination was performed by an ESP or an OS, more than 90 % of patients received the same or partly the same diagnosis and treatment plan. Our results support the use of ESP to examine patients with shoulder disorders referred to an orthopedic clinic. However, for a more thorough evaluation of the ESP's performance, randomized trials comparing results of treatment initiated by an ESP or an OS are needed.
Implications: More widespread use of ESPs in orthopedic outpatient clinics could potentially optimize use of health care resources.
Keywords: Extended scope, shoulder
Funding acknowledgements: The present study was partly funded by Association of Danish Physiotherapists
Topic: Musculoskeletal: upper limb; Orthopaedics
Ethics approval required: No
Institution: The Central Denmark Region Committees on Health Research Ethics
Ethics committee: The Central Denmark Region Committees on Health Research Ethics
Reason not required: According to inqury 78/2017, the etics committee has decided, that due to Danish law, ethics approval was not required
All authors, affiliations and abstracts have been published as submitted.
