IMPACT OF AN INTERACTIVE WORKSHOP ABOUT A NEW CARE PATHWAY FOR MUSCULOSKELETAL CONDITIONS ON SPECIALIST PHYSIOTHERAPISTS’ KNOWLEDGE, OPINIONS AND PRACTICE

K. Kang¹, K. Evans¹, M. Simic¹, P. Ferreira¹, A.N. Bandong², S. Coates³, D. Beales⁴, T. Rebbeck¹

¹The University of Sydney, Faculty of Medicine and Health, Camperdown, Australia, ²University of Philippines, College of Allied Medical Professions, Manila, Philippines, ³Australian Catholic University, Discipline of Physiotherapy, Camperdown, Australia, ⁴Curtin University, School of Physiotherapy and Exercise Science, Bentley, Australia

Background: Stratified care pathways, where people receive care based on their prognosis, may improve health outcomes and reduce healthcare costs. In Australia, a new care pathway utilising specialist musculoskeletal (MSK) physiotherapists has been suggested. In this care pathway, people with MSK conditions with a favourable prognosis receive minimal care. However, those at risk of poor outcome undergo early comprehensive assessment by the specialist MSK physiotherapists and one of three care pathways (shared care, specialist care and referred care pathways) is recommended. Adoption of this risk-stratified care pathway may be influenced by beliefs and behaviours of specialist MSK physiotherapists.

Purpose: To evaluate whether an interactive educational workshop influences specialist MSK physiotherapists’ knowledge, beliefs and clinical practice and facilitates their understanding of their role in a risk-stratified care pathway.

Methods: Fifty specialist MSK physiotherapists were recruited from four Australian states. Participants attended a 2-day interactive workshop that included key guideline-based information, delivered by researchers and clinical opinion leaders, and peer review of complex cases to identify and address behaviours that did/did not align with the care pathway. Qualitative data, including reasons for decisions about each care pathway and barriers to implementation of the pathway of care, were analysed. Outcomes were assessed immediately and at 3-months using surveys and case vignettes.

Results: Knowledge about key guideline messages improved and was maintained at follow-up. Most participants agreed to provide more targeted interventions to people at risk of poor outcome than to those at low risk (92%, 95% CI: 81%–98%) and utilise risk screening tools (84%, 95% CI: 71 to 93). However, only 56% (95% CI: 39%–68%) of participants believed implementing a shared care pathway was easy. At follow-up, participants’ beliefs were more aligned with the proposed care pathway (i.e., shared care: 83%, 95% CI: 68%–93%). With respect to clinical practice, there were 16% more referrals back to the primary physiotherapist at 3-months than before the workshop. Qualitative analysis supported that specialist MSK physiotherapists had a better understanding of their role in the proposed clinical care pathway. Barriers, including lack of intra-professional collaboration, lack of trust and lack of awareness of their role, were reported.

Conclusions: An interactive educational workshop influenced specialist MSK physiotherapists’ knowledge, beliefs and clinical practice and improved their understanding of the proposed role in the risk-stratified care pathway. Successful implementation of the care pathway may improve health outcomes and reduce unnecessary healthcare costs in Australia primary care settings. However, barriers need to be overcome before widespread implementation.

Implications: An interactive workshop is an effective method to educate the proposed role of specialist MSK physiotherapists in a risk-stratified care pathway. Enhancing collaborative work with general physiotherapists and other allied health and medical professionals is necessary to facilitate implementation of the care pathway. Future research is needed to explore the perspectives of other healthcare professionals on the proposed care pathway and effective collaboration strategies.

Funding acknowledgements: This study is embedded within a randomised controlled trial (PACE MSK trial) supported by a NHRMC project grant (APP1141377).

Keywords:
Interactive educational workshop
Specialist musculoskeletal physiotherapist
Pathway of care

Topics:
Education

Did this work require ethics approval? Yes

Institution: USYD, UQ, UMEL, Curtin Uni, RNSH

Committee: USYD, UQ, UMEL, Curtin Uni, Northern Sydney Local Health District

Ethics number: 2018/926, 2019000700/2018/926, 1954239, HRE2019-0263 and 2019/ETH03632