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Harris C1, Ignatowicz A1, Lasserson D1
1University of Birmingham, Institute of Applied Health Research, Birmingham, United Kingdom
Background: Ambulatory Care services - providing patients with acute healthcare using out-of-hospital components to replace inpatient care - help to meet the demand for urgent care within finite resources. Many of these services include therapists, whose presence on these teams has previously been highlighted as important. However, the optimal clinical, and most cost-effective, role of therapists in ambulatory care has yet to be determined.
Purpose: This review sought to answer three questions:
1) Are therapists (physiotherapists (PT) and/or occupational therapists (OT)) involved in ambulatory care services?
2) Is the therapist's role explicitly defined?
3) Can the impact of the therapist on outcomes be determined?
Methods: OVID, EMBASE, MEDLINE, PEDro and OTSeeker were searched, from each databases' earliest date to August 2018. Included studies related to ambulatory care (in which at least a portion of inpatient care was replaced by out-of-hospital care), and described the role of at least one therapist (PT or OT). There was no language restriction, and all study types except reviews were acceptable. Separate searches were run for adult and paediatric papers. All included papers were rated for quality using a relevant checklist (PEDRO, CASP, Murad et al.'s case series assessment).
Results: 17 studies fitting the specified criteria were included (16 adult, 1 paediatric). These covered both Admission Avoidance (complete substitution of in-hospital care) and Early Supported Discharge (partial replacement of in-hospital care) services. All reported services involved a multi-disciplinary team, often including nurses and doctors (either general practitioners/family physicians or hospital-based), alongside therapists and other health and social care professionals. Some community rehabilitation ambulatory care teams consisted exclusively of therapists. Notably, a considerable number of excluded papers mentioned having one or more therapists on the team, but did not explicitly describe their roles. Among those that did describe the therapists' contributions, a range of roles were described. Primarily, these focussed around the provision of rehabilitation, 'individualised' care and/or carrying out outcome measure assessments, at least one of which was mentioned in more than half of the included papers. Provision of respiratory physiotherapy, and therapists' input with patients' carers, were each reported in four studies, and seven studies reported therapist involvement in co-ordination of services. Most of those reporting therapists' involvement in providing 'rehabilitation' also gave some detail of what this entailed - such as mobilising, Activities of Daily Living practice, or exercise prescription. None of the included papers separated the impact of individual team members.
Conclusion(s): The literature suggests that therapists are a common component of ambulatory care teams, but their role is rarely described in sufficient detail such that it could be replicated by others wishing to implement a similar team. It is not possible from the literature identified in this systematic review to determine the impact that any individual therapist had on outcomes, either for service users or for the service as a whole.
Implications: Further research is required to describe and optimise the therapist's role on ambulatory care teams, and to identify the impact they are having on outcomes relevant to patients and health systems.
Keywords: Ambulatory Care, Physiotherapy, Occupational Therapy
Funding acknowledgements: None
Purpose: This review sought to answer three questions:
1) Are therapists (physiotherapists (PT) and/or occupational therapists (OT)) involved in ambulatory care services?
2) Is the therapist's role explicitly defined?
3) Can the impact of the therapist on outcomes be determined?
Methods: OVID, EMBASE, MEDLINE, PEDro and OTSeeker were searched, from each databases' earliest date to August 2018. Included studies related to ambulatory care (in which at least a portion of inpatient care was replaced by out-of-hospital care), and described the role of at least one therapist (PT or OT). There was no language restriction, and all study types except reviews were acceptable. Separate searches were run for adult and paediatric papers. All included papers were rated for quality using a relevant checklist (PEDRO, CASP, Murad et al.'s case series assessment).
Results: 17 studies fitting the specified criteria were included (16 adult, 1 paediatric). These covered both Admission Avoidance (complete substitution of in-hospital care) and Early Supported Discharge (partial replacement of in-hospital care) services. All reported services involved a multi-disciplinary team, often including nurses and doctors (either general practitioners/family physicians or hospital-based), alongside therapists and other health and social care professionals. Some community rehabilitation ambulatory care teams consisted exclusively of therapists. Notably, a considerable number of excluded papers mentioned having one or more therapists on the team, but did not explicitly describe their roles. Among those that did describe the therapists' contributions, a range of roles were described. Primarily, these focussed around the provision of rehabilitation, 'individualised' care and/or carrying out outcome measure assessments, at least one of which was mentioned in more than half of the included papers. Provision of respiratory physiotherapy, and therapists' input with patients' carers, were each reported in four studies, and seven studies reported therapist involvement in co-ordination of services. Most of those reporting therapists' involvement in providing 'rehabilitation' also gave some detail of what this entailed - such as mobilising, Activities of Daily Living practice, or exercise prescription. None of the included papers separated the impact of individual team members.
Conclusion(s): The literature suggests that therapists are a common component of ambulatory care teams, but their role is rarely described in sufficient detail such that it could be replicated by others wishing to implement a similar team. It is not possible from the literature identified in this systematic review to determine the impact that any individual therapist had on outcomes, either for service users or for the service as a whole.
Implications: Further research is required to describe and optimise the therapist's role on ambulatory care teams, and to identify the impact they are having on outcomes relevant to patients and health systems.
Keywords: Ambulatory Care, Physiotherapy, Occupational Therapy
Funding acknowledgements: None
Topic: Professional practice: other
Ethics approval required: No
Institution: n/a
Ethics committee: n/a
Reason not required: Ethics approval not required as this is a systematic review and does not include any patients, or their data
All authors, affiliations and abstracts have been published as submitted.
