Advanced practice physiotherapy surgical triage and management of adults with spinal disorders referred to specialized spine medical care: a retrospective observational study

ABSTRACT

Introduction

In this novel advanced practice physiotherapy (APP) model of care, advanced practice physiotherapists (APPTs) assess, triage, and manage adults with spinal disorders to alleviate the growing demands in specialized spine medical care.

Objectives

To describe this APP model of care, to assess change in disability 3 months after rehabilitation care and to assess surgical triage and diagnostic concordance between APPTs and spine surgeons.

Methods

In this retrospective observational study, consecutive patients who completed the 3-month follow-up data were analyzed. Sociodemographic, clinical characteristics, and self-reported disabilities including the Oswestry Disability Index (ODI) and Neck Disability Index (NDI) at baseline and 3 months were extracted. Paired t-tests were used to assess changes in disability. Surgical triage and diagnostic concordance between APPTs and surgeons were measured with raw agreement, Cohen’s Kappa, and PABAK.

Results

In this model, trained APPTs triaged surgical candidates and provided rehabilitation care including education and exercises to patients with spinal disorders. The APPTs referred only 18/46 participants to spine surgeons. Surgical triage and diagnostic concordance were high with raw agreement of 94% and 89%. At the 3-month follow-up, significant improvements in disability were observed among nonsurgical candidates with back (mean difference (MD): −13.0/100 [95%CI: −19.8 to −6.3], n = 23) or neck disorders (MD: −16.0/100 [95%CI: −29.6 to −2.4], n = 5), but not among surgical candidates referred by APPTs to spine surgeons.

Conclusion

In this limited sample, adults with spinal disorders that were initially referred to a spine surgeon by family physicians were effectively assessed, triaged, and managed by an APPT.

KEYWORDS:

• Advanced practice
• physiotherapy
• spine surgery
• triage
• diagnosis

Acknowledgments

We are grateful to the CareAxis network for sharing their database and to Imane Zahouani for contacting potential participants to obtain their consent. The project was funded with Dr. Desmeules’ Canadian Institutes of Health Research Program New Investigator Salary and Research Award in Clinical Rehabilitation (201609NCR-375311-130299) and Simon Lafrance, PhD, scholarships (Fonds de Recherche du Québec - Santé (FRQS), Fondation de l’Hôpital Maisonneuve-Rosemont, REPAR, Réseau Provincial de Recherche en Adaptation-Réadaptation, and Fonds Léopold-Renaud from Société inclusive).

Disclosure statement

Carlo Santaguida declared being the Chief Medical Officer for CareAxis. He did not receive any payments from CareAxis. All the other authors declared no conflict or appearance of conflict of interest..

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09593985.2022.2158699

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research, 201609NCR-375311-130299, Fonds de Recherche du Québec – Santé, PhD scholarship, Réseau Provincial de Recherche en Adaptation-Réadaptation, PhD scholarship, Fonds Léopold-Renaud from Société inclusive, PhD scholarship, Fondation de l’Hôpital Maisonneuve-Rosemont, PhD scholarship