Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences AUT University, PO Box 92006, Auckland 1142, New Zealand.
Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences AUT University, PO Box 92006, Auckland 1142, New Zealand.
Physiotherapy. 2021 Dec;113:116-130. doi: 10.1016/j.physio.2021.08.005. Epub 2021 Aug 8.
There are increasing demands for orthopaedic specialist services due to the increasing burden of musculoskeletal (MSK) disorders. This situation creates a barrier for patients to access appropriate health care. Advanced practitioner physiotherapists (APP) may provide an alternative service for patients with MSK disorders.
To evaluate the evidence on whether APPs are accurate at diagnosis, can triage appropriately and improve patient treatment outcomes and access to care for patients with musculoskeletal disorders.
CINAHL, MEDline, Web of Science, SPORTdiscus, SCOPUS and AMED between January 2000 and March 2020.
Systematic reviews evaluating the efficacy of APPs, in any healthcare setting, treating patients of any age range with MSK disorders, in comparison to orthopaedic surgeons or doctors.
Two researchers independently extracted and synthesised data according to the inclusion and exclusion criteria. Methodological quality was independently assessed by two reviewers using the AMSTAR tool. A third reviewer resolved discrepancies.
Thirteen systematic reviews met the inclusion criteria. The evidence consistently found APPs are accurate at diagnosis, can triage appropriately, and improve patient treatment outcomes and access to care. There was a lack of high-quality primary studies in the included reviews, however, the highest quality studies had similar findings.
A meta-analysis was not possible due to heterogeneity of outcome measures. There was an overlap of primary studies which may cause bias.
The evidence of varying quality consistently shows that APPs can accurately diagnose, appropriately triage and effectively manage patients with musculoskeletal disorders in various clinical settings.
由于肌肉骨骼（MSK）疾病负担不断增加，对骨科专家服务的需求也在不断增加。这种情况为患者获得适当的医疗保健设置了障碍。高级执业物理治疗师（APP）可为 MSK 疾病患者提供替代服务。
评估 APP 在诊断准确性、适当分诊以及改善患者治疗结果和获得 MSK 疾病患者护理方面的证据。
2000 年 1 月至 2020 年 3 月，CINAHL、MEDline、Web of Science、SPORTdiscus、SCOPUS 和 AMED。
系统评价评估 APP 在任何医疗保健环境中治疗任何年龄范围的 MSK 疾病患者的疗效，与骨科医生或医生相比。
两名研究人员根据纳入和排除标准独立提取和综合数据。两名评审员使用 AMSTAR 工具独立评估方法学质量。第三位评审员解决了差异。
13 项系统评价符合纳入标准。证据一致表明，APP 在诊断、适当分诊以及改善患者治疗结果和获得护理方面是准确的。纳入的综述中缺乏高质量的初级研究，但质量最高的研究有类似的发现。
由于结果测量的异质性，无法进行荟萃分析。初级研究存在重叠，可能导致偏倚。
不同质量的证据一致表明，APP 可以在各种临床环境中准确诊断、适当分诊和有效管理 MSK 疾病患者。
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