PHYISOTHERAPISTS AS FIRST LINE OF MANAGEMENT FOR ADOLESCENTS WITH SPINAL DEFORMITIES IN THE HIGHLY SPECIALIZED DEPARTMENT FOR SPINAL SURGERY

E. Diarbakerli^1,2, P. Gerdhem^1,2

Background: Management of spinal deformities in the pediatric population is usually performed at highly specialized orthopaedic departments. In many cases, management consists of regular clinical and radiological follow-ups and in some cases treatment. Scoliosis, the most common type of spinal deformity, is treated in some cases with bracing which usually is initiated by a spine surgeon after examination, who is also responsible for the treatment and follow-ups. 

Purpose: We developed a novel program at the Karolinska university hospital where highly trained physiotherapists manage adolescents with spinal deformities in the same way as the spine surgeon usually does. The purpose with the program was to relieve the spine surgeons from a high number of out-patient visits and furthermore to utilize the competence of highly skilled physiotherapists.

Methods: The out-patient spine department at Karolinska university hospital, Sweden, is responsible for scoliosis management and treatment in the county of Stockholm, populated by two million inhabitants. School-screening programs in Sweden identifies children with spinal deformities and send them to the specialist clinic for further assessment and management. Since 2016, our spine unit includes highly trained physiotherapists managing adolescents coming for consultation from medical units in school, GPs or other physicians. Management includes 1) clinical and radiological examinations 2) assessments regarding treatment 3) assessing skeletal maturity 4) assessing the need for further investigations, e.g. MRI examinations and 5) assessing the frequency or termination of future follow-ups. This is a presentation of the program, no data has been gathered or analysed.

Results: The program has been successful and has been applied since the beginning of 2016. Adolescents are managed either by a spine surgeon or a physiotherapist. Patients with comorbitidies or severe scoliosis requiring surgery do usually see a spine surgeon in the beginning. In general, both clinicians and patients at our spine unit seem to be satisfied with the program. The program has enabled better accessibility to the spine unit for patients and shorter waiting-lists. Furthermore, spine surgeons at our department do get a relief of out-patient visits due to the physiotherapists higher volume of visits.

Conclusion(s): Physiotherapists have been successfully implemented as part of the out-patient consultation team at our highly specialized spine department, managing adolescents with spinal deformities independently in terms of treatment, investigations and follow-ups according to local routines.

Implications: Highly trained physiotherapists can manage spinal deformity patients independently and can be successfully implemented in specialized spine units together with spine surgeons. Such a program can decrease large number of out-patient visits for spine surgeons. 

Funding, acknowledgements: No funding has been received.

Keywords: Spine, Scoliosis, Pediatrics

Topic: Orthopaedics

Did this work require ethics approval? No

Institution: NA

Committee: NA

Reason: The implementation of our program has not changed treatment methods, assessments or in any other way affected the patients health-care.