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Evaluation of an advanced-practice physiotherapist in triaging patients with lumbar spine pain: surgeon-physiotherapist level of agreement and patient satisfaction.

Abstract Surgery for lumbar spine pain is indicated for specific etiologies. Given the majority of individuals referred to spine surgeons are not surgical candidates, care delivery is inefficient, with consultations being of limited value for most. Using specially trained physiotherapists in triage is a human resource strategy that may optimize surgeons' time and the patient experience.
PMID
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Authors

Mayor MeshTerms

Patient Satisfaction

Keywords
Journal Title canadian journal of surgery. journal canadien de chirurgie
Publication Year Start




PMID- 28730987
OWN - NLM
STAT- MEDLINE
DA  - 20170721
DCOM- 20170731
LR  - 20170731
IS  - 1488-2310 (Electronic)
IS  - 0008-428X (Linking)
VI  - 60
IP  - 4
DP  - 2017 Aug
TI  - Evaluation of an advanced-practice physiotherapist in triaging patients with
      lumbar spine pain: surgeon-physiotherapist level of agreement and patient
      satisfaction.
PG  - 266-272
AB  - BACKGROUND: Surgery for lumbar spine pain is indicated for specific etiologies.
      Given the majority of individuals referred to spine surgeons are not surgical
      candidates, care delivery is inefficient, with consultations being of limited
      value for most. Using specially trained physiotherapists in triage is a human
      resource strategy that may optimize surgeons' time and the patient experience.
      METHODS: An advanced-practice physiotherapist (APP) and a surgeon assessed
      consecutive patients with lumbar spine pain presenting at an academic health
      centre's spine surgery clinic. The second assessor was blinded to the outcome of 
      the first. We used the kappa statistic to evaluate surgeon-APP level of
      chance-corrected agreement concerning patients' need for a surgical consultation.
      To assess satisfaction with the APP, patients completed a modified version of the
      validated Visit-specific Questionnaire. RESULTS: The sample included 102
      participants (54 women) with a mean age of 54.3 +/- 14.3 years and a mean
      Oswestry Disability Index score of 35.4 +/- 16.6. The assessors' overall
      agreement was 86%. The kappa coefficient for the need for a surgical consultation
      was 0.69 (95% confidence interval 0.54-0.84). The APP identified that 77% of
      patients did not require a surgical consultation. Twenty-one patients underwent
      surgery. Satisfaction scores for the APP were very high (mean score 92 out of
      100). CONCLUSION: In triaging patients with lumbar spine pain, the APP and
      surgeon had a high level of agreement. An APP performing triage at a surgical
      centre can effectively reduce wait lists by 70%, reserving surgical consultations
      for those patients in whom they are indicated.
FAU - Robarts, Susan
AU  - Robarts S
AD  - From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and
      Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation 
      Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department
      of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom,
      Finkelstein); and the Department of Surgery, Faculty of Medicine, University of
      Toronto, Ont. (Finkelstein).
FAU - Stratford, Paul
AU  - Stratford P
AD  - From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and
      Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation 
      Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department
      of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom,
      Finkelstein); and the Department of Surgery, Faculty of Medicine, University of
      Toronto, Ont. (Finkelstein).
FAU - Kennedy, Deborah
AU  - Kennedy D
AD  - From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and
      Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation 
      Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department
      of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom,
      Finkelstein); and the Department of Surgery, Faculty of Medicine, University of
      Toronto, Ont. (Finkelstein).
FAU - Malcolm, Barry
AU  - Malcolm B
AD  - From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and
      Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation 
      Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department
      of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom,
      Finkelstein); and the Department of Surgery, Faculty of Medicine, University of
      Toronto, Ont. (Finkelstein).
FAU - Finkelstein, Joel
AU  - Finkelstein J
AD  - From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and
      Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation 
      Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department
      of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom,
      Finkelstein); and the Department of Surgery, Faculty of Medicine, University of
      Toronto, Ont. (Finkelstein).
LA  - eng
PT  - Evaluation Studies
PT  - Journal Article
PL  - Canada
TA  - Can J Surg
JT  - Canadian journal of surgery. Journal canadien de chirurgie
JID - 0372715
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - Humans
MH  - Low Back Pain/*diagnosis/surgery
MH  - Male
MH  - Middle Aged
MH  - Orthopedic Surgeons/*standards
MH  - *Patient Satisfaction
MH  - Physical Therapists/*standards
MH  - Single-Blind Method
MH  - Triage/*standards
EDAT- 2017/07/22 06:00
MHDA- 2017/08/02 06:00
CRDT- 2017/07/22 06:00
AID - 10.1503/cjs.013416 [pii]
PST - ppublish
SO  - Can J Surg. 2017 Aug;60(4):266-272.