PHYSIOTHERAPY MANAGERS VIEWS ON ADVANCED PRACTICE PHYSIOTHERAPY IN IRELAND. A MIXED METHODS STUDY

M. O Mir¹, M.-B. Casey², K. Smart³

¹ISCP, Dublin, Ireland, ²Trinity College, Dublin, Ireland, ³University College Dublin, Dublin, Ireland

Background: Advanced practice in physiotherapy is considered a ‘level of practice’ as opposed to a defined role and the tasks conducted vary depending on the scope of physiotherapy practice, the setting, and local and national policies . In Ireland, Advanced Practice Physiotherapy is not a salaried clinical grade, as it is in other jurisdictions such as the UK. A recent report from the Economic and Social Research Institute of Ireland included projections for an Advanced Practice Grade at 4% of the current Health and Social Care workforce, to be delivered from 2023. Within the current context of imminent implementation of a new grade nationally, this mixed methods study explores the views of Physiotherapy managers on Advanced Physiotherapy Practice progression of this career pathway.

Purpose: The overall aim of this mixed methods study was to explore the views of physiotherapy managers on the characteristics, role, competencies and management of Advanced Practice Physiotherapists (APPs) in Ireland.

Methods: Physiotherapy managers based in Irish primary and secondary care settings were invited to participate in a survey and/or online focus group in order to explore their views on the role, competencies and management of APPs in Ireland. Quantitative data from a custom designed online survey was analysed with descriptive statistics. Qualitative data from open-ended survey questions and transcribed semi-structured online focus groups was analysed using thematic analysis.

Results: Response rate to the survey was 32% (24/75). On average, respondents suggested that 54% (range: 15-80%) of an APPs time should be spent in clinical practice and between 17%-20% variously on managerial and leadership, teaching and education and research and development.
Ten physiotherapy managers participated in three separate focus groups from which three main themes and associated sub-themes were identified. 1) The professional identity of Advanced Physiotherapy Practitioners, with managers recognising the positive attributes of APPs but describing uncertainty with regards to role definition and reporting structures and governance. 2) Barriers to Advanced Physiotherapy Practice in Ireland were identified including lack of legislation to allow physiotherapists order clinical imaging and inconsistent protection of these roles within departments 3) Managers can support and enable the progression of these roles through mentoring, provision of time and resources and implementation of the Four Pillars framework.

Conclusions: Physiotherapy Managers recognised the value of Advanced Physiotherapy Practice to the Irish Health Service but suggest that the roles and reporting structures need to be clarified. They highlighted barriers preventing the full potential of these roles being realised and provided suggestions to enable the progression of these roles for the benefit of both healthcare professionals and patients.

Implications: This study highlights the need for

• legislative change to support the sustainability of the APP role and the overwhelming support of physiotherapy managers for the same
• clarity around governance arrangements, with national guidance frameworks to allow for local level delivery

development of appropriate training to support advanced tasks such as injection therapy and diagnostic imaging, but also to support the various non- clinical aspects of the role i.e. leadership, research and education.

Keywords:
Advanced Practice Physiotherapy
Barriers to practice
Physiotherapy Managers views

Topics:
Professional issues
Globalisation: health systems, policies & strategies
Professional practice: other

Did this work require ethics approval? Yes

Institution: UCD

Committee: UCD

Ethics number: LS-E-21-274