物理治疗师在门诊骨科诊所诊断和管理肩部疾病的能力：一致性研究的结果。

Physiotherapists' ability to diagnose and manage shoulder disorders in an outpatient orthopedic clinic: results from a concordance study.

机构信息

Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada; Faculty of Medicine, School of Rehabilitation, University of Montréal, Montréal, QC, Canada.

出版信息

J Shoulder Elbow Surg. 2020 Aug;29(8):1564-1572. doi: 10.1016/j.jse.2019.11.030. Epub 2020 Mar 18.

DOI:10.1016/j.jse.2019.11.030

PMID:32199757

Abstract

BACKGROUND

Advanced practice physiotherapy has emerged as a promising solution to improve health care access because access to orthopedic care is limited in several countries. However, evidence supporting advanced practice physiotherapy models for the management of shoulder pain remains scarce. The purpose of this study was to establish diagnostic, surgical triage, and medical imaging agreement between advanced practice physiotherapists (APPs) and orthopedic surgeons (OSs) for the management of patients with shoulder disorders in an outpatient orthopedic clinic.

METHODS

Patients referred to an OS for shoulder complaints were recruited and independently assessed by an OS and an APP. Each provider completed a standardized form indicating diagnosis, imaging test requests, and triage of surgical candidates. Patient satisfaction with care was recorded with the 9-item Visit-Specific Satisfaction Questionnaire (VSQ-9). Inter-rater concordance was calculated with the Cohen κ, prevalence-adjusted bias-adjusted κ, and associated 95% confidence interval (CI). We used χ tests to compare differences between providers in terms of treatment plan options and Student t tests to compare patient satisfaction between providers.

RESULTS

Fifty participants were evaluated. Good diagnostic agreement was observed between providers (κ, 0.80; 95% CI, 0.67-0.93). Agreement for triage of surgical candidates was moderate (κ, 0.46; 95% CI, 0.21-0.71) as APPs tended to refer patients more often to OSs for further evaluation. Imaging test request agreement was moderate as well (κ, 0.42; 95% CI, 0.19-0.66). Patient satisfaction with care was high, with no significant differences found between providers (P = .70).

CONCLUSION

APPs could improve access to orthopedic care for shoulder disorders by safely initiating patient care without compromising satisfaction. These results support further development and evaluation of APP care for orthopedic patients presenting with shoulder disorders.

摘要

背景

高级实践物理治疗已成为改善医疗保健可及性的有前途的解决方案，因为在一些国家，骨科护理的可及性有限。然而，支持高级实践物理治疗模式管理肩痛的证据仍然很少。本研究的目的是在一家门诊骨科诊所中，为管理肩部疾病的患者，在高级实践物理治疗师（APP）和骨科医生（OS）之间建立诊断、手术分诊和医学影像协议。

方法

招募因肩部不适而转介给 OS 的患者，并由 OS 和 APP 分别进行评估。每位提供者都填写一份标准化表格，注明诊断、影像检查请求和手术候选人的分诊。使用 9 项就诊满意度问卷（VSQ-9）记录患者对护理的满意度。使用 Cohen κ、调整后偏倚一致性 κ 和相关 95%置信区间（CI）来计算组内一致性。我们使用 χ ²检验比较提供者在治疗计划选择方面的差异，使用学生 t 检验比较提供者之间的患者满意度差异。

结果

共评估了 50 名参与者。观察到提供者之间具有良好的诊断一致性（κ，0.80；95%CI，0.67-0.93）。手术候选人分诊的一致性为中度（κ，0.46；95%CI，0.21-0.71），因为 APP 倾向于将更多患者转介给 OS 进行进一步评估。影像检查请求的一致性也为中度（κ，0.42；95%CI，0.19-0.66）。患者对护理的满意度很高，提供者之间没有发现显著差异（P =.70）。