SHOULD EXTENDED SCOPE PHYSIOTHERAPISTS PLACE PATIENTS DIRECTLY ON ARTHROSCOPY LISTS?

Abstract

Introduction: Knee arthroscopy is a common orthopaedic procedure. Growing demand on orthopaedic services has led to the introduction of new initiatives to reduce waiting lists and streamline services. Recently extended scope physiotherapists have placed patients directly on arthroscopy waiting lists without prior assessment by an orthopaedic surgeon.

Aim: To determine if extended scope physiotherapists perform to the same standards as their orthopaedic colleagues with regards to diagnosing knee pathology and making appropriate referrals for arthroscopy.

Method: Data was collected prospectively from Aug 2005. Patients were seen either in the physiotherapy led acute knee clinic or in orthopaedic outpatients by a consultant or registrar. Any patient placed onto a waiting list for knee arthroscopy was considered for the study. The clinical indications and diagnoses were recorded as well as demographic data. The arthroscopies were performed by one surgeon. The arthroscopic findings were compared with the clinical findings.

Results: 300 patients were included in the study – 100 in each of the groups. The physiotherapists saw fewer patients per clinic and had longer time-slots per patient. All three groups had similar presenting complaints, indications for surgery and demographics. The Consultant performed best with 87% agreement with his initial diagnosis. The physiotherapists had 77% agreement and the registrars 68% agreement. No unnecessary arthroscopies were performed in any group.

Conclusions: Extended scope physiotherapists perform a useful role in orthopaedic outpatients. They perform as well as their orthopaedic colleagues with regards to the selection of patients for arthroscopy and making appropriate diagnoses.