School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Maisonneuve-Rosemont Hospital Research Center, Université de Montréal Affiliated Research Center, Montreal, QC, Canada.
Physiother Theory Pract. 2024 Apr;40(4):704-713. doi: 10.1080/09593985.2022.2158699. Epub 2023 Jan 3.
In this novel advanced practice physiotherapy (APP) model of care, advanced practice physiotherapists (APPTs) assess, triage, and manage adults with spinal disorders to alleviate the growing demands in specialized spine medical care.
To describe this APP model of care, to assess change in disability 3 months after rehabilitation care and to assess surgical triage and diagnostic concordance between APPTs and spine surgeons.
In this retrospective observational study, consecutive patients who completed the 3-month follow-up data were analyzed. Sociodemographic, clinical characteristics, and self-reported disabilities including the Oswestry Disability Index (ODI) and Neck Disability Index (NDI) at baseline and 3 months were extracted. Paired -tests were used to assess changes in disability. Surgical triage and diagnostic concordance between APPTs and surgeons were measured with raw agreement, Cohen's Kappa, and PABAK.
In this model, trained APPTs triaged surgical candidates and provided rehabilitation care including education and exercises to patients with spinal disorders. The APPTs referred only 18/46 participants to spine surgeons. Surgical triage and diagnostic concordance were high with raw agreement of 94% and 89%. At the 3-month follow-up, significant improvements in disability were observed among nonsurgical candidates with back (mean difference (MD): -13.0/100 [95%CI: -19.8 to -6.3], n = 23) or neck disorders (MD: -16.0/100 [95%CI: -29.6 to -2.4], n = 5), but not among surgical candidates referred by APPTs to spine surgeons.
In this limited sample, adults with spinal disorders that were initially referred to a spine surgeon by family physicians were effectively assessed, triaged, and managed by an APPT.
在这种新型的高级实践物理治疗（APP）护理模式中，高级实践物理治疗师（APPT）对患有脊柱疾病的成年人进行评估、分诊和管理，以缓解专业脊柱医疗保健日益增长的需求。
描述这种 APP 护理模式，评估康复护理 3 个月后的残疾变化，并评估 APPT 与脊柱外科医生之间的手术分诊和诊断一致性。
在这项回顾性观察研究中，分析了完成 3 个月随访数据的连续患者。提取基线和 3 个月时的社会人口统计学、临床特征以及自我报告的残疾情况，包括 Oswestry 残疾指数（ODI）和颈部残疾指数（NDI）。使用配对检验评估残疾变化。使用原始一致性、Cohen's Kappa 和 PABAK 测量 APPT 和外科医生之间的手术分诊和诊断一致性。
在这种模式中，经过培训的 APPT 对手术候选人进行分诊，并为患有脊柱疾病的患者提供康复护理，包括教育和锻炼。APPT 仅将 18/46 名参与者转诊给脊柱外科医生。手术分诊和诊断一致性较高，原始一致性为 94%，89%。在 3 个月的随访中，非手术候选人的残疾状况显著改善，背部疾病患者的平均差异（MD）为-13.0/100（95%CI：-19.8 至-6.3），n=23）或颈部疾病（MD：-16.0/100（95%CI：-29.6 至-2.4），n=5），但 APPT 转诊给脊柱外科医生的手术候选者除外。
在这个有限的样本中，最初由家庭医生转介给脊柱外科医生的脊柱疾病成年人，由 APPT 进行了有效的评估、分诊和管理。
