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O Mir M1,2, Fennelly O1, Cunningham C1, O' Sullivan C2
1University College Dublin, Physiotherapy, Dublin, Ireland, 2Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
Background: Advanced Practice Physiotherapists (APP) are specialist physiotherapists who act as first-contact practitioners both in primary and tertiary care, providing care for patients who do not necessarily require a consultant review. The role is associated with improvements in service efficacy and efficiency; health outcomes for patients; waiting time and wait-list reduction; diagnostic accuracy; cost effectiveness and patient and referrer satisfaction. However, little attention has been paid to the experiences and perceptions of the consultants who champion and implement the role.
Purpose: The aim of this study is to examine in depth the perceptions of paediatric orthopaedic surgeons in implementing and developing an advanced practice physiotherapy service in paediatric orthopaedics
Methods: A cross-site phenomenological qualitative methodology was chosen using semi-structured interviews to explore paediatric orthopaedic consultants' views. Two researchers collected data, and all participants were paediatric orthopaedic consultants working in the public healthcare system, all of who were instrumental in implementing the APP service in their local institution. Data were analysed with NViVo software. To ensure rigour, thematic analysis as described by Braun and Clarke was performed, using an inductive approach. Data coding was performed independantly by both researchers, with the definition of the final themes occurring through consensus meeting. The procedure of the analysis was supported by reflection and critical discussion amongst the researchers to facilitate reflexivity.
Results: Five paediatric orthopaedic consultants at two sites participated in the semi-structured interviews. Seven themes and variety of subthemes that inform our understanding of the consultants' perception of the APP service were generated. These findings were consistent across both sites. The themes arising were: Clinic Set-up and Process; Education and Training; Skills and Competencies of the Physiotherapist; Communication; Health System Factors; Challenges and Benefits. Important sub-themes noted were: significance of experiential training; importance of co-location for support and clinical governance; clear caseload guidelines; impact on consultant workload and high quality clinical decision-making abilities of APPs.
Conclusion(s): This is the first paper, in adult and paediatric literature, to specifically explore the experiences of consultants in implementing an APP role as part of their service, and their consequent perceptions of the role. Consultants expressed broad support for the role, with significant positive impact on clinical services.
Implications: This paper highlights many of the factors that should be considered when implementing an APP role in an outpatient setting, some of which factors have not been highlighted in the literature previously. The experiences reported here highlight the positive impact of APP to orthopaedic services.
Keywords: Advanced Practice Physiotherapy, Paediatric Orthopaedics, Consultant Perceptions
Funding acknowledgements: This study was partly funded by the National Children's Research Centre, Dublin. The authors declare no conflict of interest.
Purpose: The aim of this study is to examine in depth the perceptions of paediatric orthopaedic surgeons in implementing and developing an advanced practice physiotherapy service in paediatric orthopaedics
Methods: A cross-site phenomenological qualitative methodology was chosen using semi-structured interviews to explore paediatric orthopaedic consultants' views. Two researchers collected data, and all participants were paediatric orthopaedic consultants working in the public healthcare system, all of who were instrumental in implementing the APP service in their local institution. Data were analysed with NViVo software. To ensure rigour, thematic analysis as described by Braun and Clarke was performed, using an inductive approach. Data coding was performed independantly by both researchers, with the definition of the final themes occurring through consensus meeting. The procedure of the analysis was supported by reflection and critical discussion amongst the researchers to facilitate reflexivity.
Results: Five paediatric orthopaedic consultants at two sites participated in the semi-structured interviews. Seven themes and variety of subthemes that inform our understanding of the consultants' perception of the APP service were generated. These findings were consistent across both sites. The themes arising were: Clinic Set-up and Process; Education and Training; Skills and Competencies of the Physiotherapist; Communication; Health System Factors; Challenges and Benefits. Important sub-themes noted were: significance of experiential training; importance of co-location for support and clinical governance; clear caseload guidelines; impact on consultant workload and high quality clinical decision-making abilities of APPs.
Conclusion(s): This is the first paper, in adult and paediatric literature, to specifically explore the experiences of consultants in implementing an APP role as part of their service, and their consequent perceptions of the role. Consultants expressed broad support for the role, with significant positive impact on clinical services.
Implications: This paper highlights many of the factors that should be considered when implementing an APP role in an outpatient setting, some of which factors have not been highlighted in the literature previously. The experiences reported here highlight the positive impact of APP to orthopaedic services.
Keywords: Advanced Practice Physiotherapy, Paediatric Orthopaedics, Consultant Perceptions
Funding acknowledgements: This study was partly funded by the National Children's Research Centre, Dublin. The authors declare no conflict of interest.
Topic: Service delivery/emerging roles; Paediatrics; Orthopaedics
Ethics approval required: Yes
Institution: Our Lady's Children's Hospital Crumlin
Ethics committee: Medical Research and Ethics Committee
Ethics number: GEN/433/15
All authors, affiliations and abstracts have been published as submitted.
