H. Morley1
1Gloucestershire Health and Care Services NHS Trust, Gloucestershire, United Kingdom
Background: Advanced Practice Physiotherapy (APP) is an expanding area of the physiotherapy profession internationally. Advanced physiotherapy is generally understood to be practised by clinicians working at the top of their scope of practice. However, there is no clear understanding of APP skills, education, governance or regulation within or between countries. APP remains an innovative area of physiotherapy practice which is developing in different places and in different ways therefore an exploration into current APP practice with comparison between nations may allow further development and learning in this important area of the profession.
Purpose: This study explores current APP practice, implementation, development and innovation. It seeks to understand best practice, successes, barriers and challenges in APP.
Methods: A qualitative ethnographic approach was used. This involved immersing the researcher in APP services in order to conduct participant observation in clinical and leadership environments. Triangulation was used to increase reliability. Site visits often involved meeting with teams, observing clinical interactions, training events and team meetings, touring facilities and sharing useful resources such as policies and curricula. Semi-structured interviews were also carried out with clinicians and leaders to supplement participant observational data. The research was conducted by the author at several sites over an 8 week period in January and February 2020. All interviews were recorded using dictation software. Interviews were transcribed and notes were kept during observational visits and conversations. Thematic analysis was uses to analyse data gathered and several themes emerged from this process.
Results: Themes emerging from the data included: clinical governance, regulation, education, digital and technology, leadership, research and barriers.
There was agreement between all countries that APPs should be at an educational Level 7 (MSc) and be involved in research. However there was a lack of agreement in how this level of education should be attained and how research should be supported. There were differences in regulation and governance of APP between the countries and sites visited. Leadership focused on the advanced practice agenda helped to improve opportunities and sustainability of services and roles but some sites leadership was spread across many professions.
Barriers to APP included a lack of clarity in the terminology widely used to describe APP. Another barrier was the perception physiotherapists had of their ability and opportunities and the perception other professionals and patients had of the potential of physiotherapy.
There was agreement between all countries that APPs should be at an educational Level 7 (MSc) and be involved in research. However there was a lack of agreement in how this level of education should be attained and how research should be supported. There were differences in regulation and governance of APP between the countries and sites visited. Leadership focused on the advanced practice agenda helped to improve opportunities and sustainability of services and roles but some sites leadership was spread across many professions.
Barriers to APP included a lack of clarity in the terminology widely used to describe APP. Another barrier was the perception physiotherapists had of their ability and opportunities and the perception other professionals and patients had of the potential of physiotherapy.
Conclusion(s): APP services and roles are valued in many areas of healthcare in the UK, New Zealand and Australia however there is a lack of consistency in regards to education, governance and regulation of APP across sites and between the three countries. This lack of consistency may impact on the barriers found to expansion and adoption of APP. These results highlight the successes and challenges of expanding APP and may be helpful for clinicians and leaders when developing and implementing these roles and services.
Implications: This research highlights similarities in the understanding and implementation of APP but it also highlights the barriers and challenges. These can be reflected upon and may help to support further development and implementation of APP internationally.
Funding, acknowledgements: This study was funded by a Fellowship from the Winston Churchill Memorial Trust
Keywords: Advanced Practice, Physiotherapy, Qualitative
Topic: Service delivery/emerging roles
Did this work require ethics approval? No
Institution: Gloucestershire Health and Care Services
Committee: Research and Development Department
Reason: The Health Research Authority decision tool was used to identify that ethics approval was not required.
All authors, affiliations and abstracts have been published as submitted.
