Advanced physiotherapists offer a good alternative to the usual medical care in spinal clinics. But knowing how good it is depends on what question you are asking.
New models of care are developing and becoming commonplace in modern healthcare. This is due to the increasing pressure on resources, time and costs as well as a lack of medical personnel models. Advanced clinical practice is at the fore in several countries around the world, and for physiotherapy, musculoskeletal clinics are a natural specialty for us to expand our clinical skills and fill the void in the medical workforce.
The best known example of this is the first role as a contact practitioner in Great Britain and much work has been done to demonstrate the usefulness of these types of roles. The next natural step for MSK clinicians working in advanced roles could well be an alternative to a doctor in a spine clinic. A new systematic review published in the European Spine Journal has attempted to determine if this is a viable model for nursing.
Dive deep into the red flags of the spine with Laura Finucane
Methodology
Two reviewers were used to conduct the search strategy independently and to reach consensus on the included studies, with a third available if needed. Inclusion criteria were appropriate for the research question and are readily available in the article. PRISMA was followed and a solid data extraction and methodology was used. The project tool for effective public health practice was used to assess the risk of bias. This tool is poor at assessing the bias with diagnostic agreement, so the MacDermid tool was used where appropriate. Of the included studies, 1 was high quality, 14 moderate, and 3 poor quality.
A meta-analysis was performed and since different scales were used within the included evidence, a standardized mean difference was calculated. 18 studies were included (n = 9405) and of these 18 2 were RCTs and 16 were observational studies. If we break these participants down further, we can see that 8,900 lumbar spine disorders, 200 unspecified back problems, 151 cervical spine disorders, 146 thoracic spine disorders, and a very small number have multiple spine disorders.
The studies came from 5 different countries; 5 Irish, 4 Canadian, 4 UK, 2 Austrian and 1 Swedish court cases.
Clinical significance
The title of this systematic review is that physiotherapists in advanced practices offer an alternative to standard medical care when working in spinal clinics. The only significant difference is that waiting times with a physical therapist are shorter than with a doctor. This could explain the slight preference of patients to see a physical therapist rather than a doctor.
Self-reported patient results, pain-related disability measures, ED5D, pain disability index, SF-36 and Oswestry Diasbility Index were all the same, if not very similar, when viewed by a physiotherapist or a doctor. Clearly, if physical therapists were to offer a different type of service, it is clearly not a good result. If the “other model of care” was simply that a patient should see a physical therapist rather than a doctor, this is a good result as there has been no harm or difference to the patient.
Unfortunately, it is not too clear whether the physiotherapists involved provided a different service, since information, exercise, rehabilitation or diagnosis plans are not included in any detail. The same applies to training and development plans for the physiotherapists involved in these advanced exercise roles. This ambiguity in both education and treatment plans is a significant problem, as services will not change until standardization across care models can be achieved that allows for more accurate assessment of care. Until then, this type of service will always be discussed.
Red Flags Deep Dive with Laura Finucane
When evaluating patients in clinical practice, it is always important to consider a serious pathology as a differential diagnosis. Red flag screening questions have been developed to identify these pathologies. However, there is limited evidence for their use. How should clinicians use red flags and how do they know when to take action? This course is designed to give you a critical understanding of the red flags and how they can be used effectively in clinical practice.
Deep immersion in the red flags of the spine
