The Severity Scoring System (SSS) is a guide to interpreting findings across clinical, functional, and radiological findings, used by qualified, specially trained physiotherapists in the advanced practice role in order to provide consistency in determining the severity of the patient's condition and need for surgical consultation. The system has been utilized for over 14 years as a part of standardized assessment and management care and was incorporated into virtual care in 2020 following the pandemic restrictions. The present study examined the validity of the modified SSS in virtual care. Patients who were referred to the Rapid Access Clinic (RAC), were contacted via phone by two experienced advanced practice practitioners (APPs) from May to July 2020, when in-person care was halted due to the pandemic. The virtual interview included taking history, completing self-reported measures for pain and functional ability and reviewing the radiological reports. A total of 63 patients were interviewed (mean age 68, SD=9), 34 (54%) females. Of 63 patients, 33 (52%) were considered a candidate for total knee arthroplasty (TKA). Men and women were comparable in age, P4 and LEFS scores. The TKA candidates had a significantly higher SSS (p<0.0001) and pain scores (p=0.024). The variability of the total SSS score explained by the functional, clinical and radiological components of the tool were 55%, 48% and 4% respectively, highlighting the more important role of patient's clinical history and disability in the total SSS. The virtual SSS is a valid tool in directing patients for surgical management when used by highly trained advanced practice physiotherapists. A large component of the SSS is based on clinical data and patient disability and the APP's skillset rather than severity of pathology found on imaging.
The introduction of alternate care provider roles is at the forefront of many new health human resource strategies and is one of the key approaches in reducing orthopaedic wait times in Canada. The present study was part of a formal evaluation of an expanded role for physiotherapists which included referral triage, comprehensive assessment and development of a management plan and post-surgical follow-ups. Specifically, we examined the efficacy and role of an Advanced Practice Physiotherapist (APP) with respect to reduction in wait times to care for patients with shoulder complaints referred to an orthopaedic surgeon with subspecialty in shoulder reconstruction. We used data of 100 consecutive patients seen by an APP in 2010 to examine the following: 1) type of diagnosis, 2) number of new investigations ordered, percentage of patients who needed a consultation with the surgeon, 3) and indication for surgery. Patients who were sent for a second surgical opinion, had a failed surgery in the affected side, had a motor vehicle accident or were a surgical candidate for stabilization or superior labral repairs were not included in the study and were directly booked for the orthopaedic surgeon. To compare change in waiting times, a random sample of 100 charts of patients seen in 2008 by an orthopaedic surgeon with a subspecialty in shoulder reconstruction were reviewed. The following time frames were compared between the surgeon and APP: T1: time from date of referral to date of consultation, T2: time from date of consultation to date of final diagnostic test, T3: time from date of consultation to confirmed diagnosis. Parametric and non-parametric analyses were performed as indicated by the distribution of data.Purpose
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