Content area
Full Text
Background rationale
Managing demand for patients with orthopaedic conditions is ever increasing due to the ageing population causing a higher prevalence of these conditions. Pressure has increased further due to reductions in working hours for medical staff. Many of these conditions do not require acute secondary care management with long term care possible in other settings ([30] Naylor et al. , 2013). Some public health services are trialling service redesign, with a general push for more community based services to cope with demand ([25] MacKay et al. , 2009; [9] DoH, 2000; [31] Oldmeadow et al. , 2007; [34] Speed and Crisp, 2005; [11] DoH, 2006; [20] Hattam and Smeatham, 1999; [1] Akbari et al. , 2009; [12] Durrel, 1996; [32] Rashid et al. , 1996).
One possible solution is utilising physiotherapists with extended skills either within a medical model (i.e. part of orthopaedic team) or a separate triage based service/referral management service ([21] Imison and Naylor, 2010; [36] Webb, 2009).
These roles have been in existence for over 30 years but there has been an increase especially in the UK over the last 10-15 years with many government drivers around having a more flexible workforce to manage health service demands ([10] DoH, 2003). Further changes are also occurring in Australia and Canada but to a lesser extent ([38] Woodhouse, 2006; [33] Schoch, 2012; [35] Stanhope et al. , 2012; [25] MacKay et al. , 2009, [26] 2012; [6] Desmeules et al. , 2012; [7] Desmeules et al. , 2013). Despite the large number of physiotherapists working in these roles, there is surprisingly a dearth of quality research investigating effectiveness. In 2012, two systematic reviews were completed investigating research quality and quantity. [35] Stanhope et al. (2012) found only 12 articles investigating orthopaedic outpatient roles with only two being of a gold standard while [6] Desmeules et al. (2012) found 16 articles meeting a minimum standard criterion.
Possibly one reason for this is that many of the roles have developed out of local frameworks and as such roles and responsibilities have been agreed locally rather than nationally. There is therefore the possibility of significant variation in what constitutes extended roles between countries, with even more variation internally.
The definition of an extended scope physiotherapist (ESP)...