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Acceptability of advanced practice physiotherapists and physiotherapists as primary care practitioners in the treatment of patients with musculoskeletal disorders
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
cacy of capsular mobilisations or manipulations compared to a placebo intervention or in addition to another intervention for pain reduction and a significant effect was observed (10 cm VAS MD: 0.67; 95%CI: 0.17 to 1.2). For all the above analyses treatment effects of MT can be considered small and may not be clinically important. In term function, qualitative analyses of seven RCTs (n = 212) suggest that MT alone or in addition to exercises is not effective. Conclusion(s): Positive trends in treatment outcomes are observed with MT, but the magnitude of the effects are most likely not clinically important. Therefore, there is low to moderate evidence that MT either alone or in conjunction to other modalities is not effective in reducing pain and that MT intervention alone or added to an exercises program is not effective in reducing pain or improving function in the treatment of RC tendinopathy. Implications: Until more methodologically sound studies confirm the efficacy or the absence of efficacy of MT for RC tendinopathy, clinicians should prioritize treatments that have already been proven effective such as exercise therapy. To be more representative of current clinical practice, future RCTs should compare MT interventions specifically tailored to treat impairments found in subgroups of patients with RC tendinopathy that may benefit from these approaches. Keywords: Manual therapy; Rotator cuff; Tendinopathy Funding acknowledgements: Financial support has been provided by the IRSS, the REPAR and the OPPQ. Ethics approval: Ethics approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.508
Research Report Poster Presentation Number: RR-PO-20-23-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 ACCEPTABILITY OF ADVANCED PRACTICE PHYSIOTHERAPISTS AND PHYSIOTHERAPISTS AS PRIMARY CARE PRACTITIONERS IN THE TREATMENT OF PATIENTS WITH MUSCULOSKELETAL DISORDERS A. Desjardins-Charbonneau 1 , J.-S. Roy 2,3 , J. Thibault 4 , V.T. Ciccone 4 , F. Desmeules 4,5 1 Maisonneuve-Rosemont
Hospital, University of Montreal Affiliated, Research Center, Orthopaedic Clinical Research Unit, Montreal, Chad; 2 Faculty of Medicine, Laval University, School of Rehabilitation, Quebec, Canada; 3 Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada; 4 University of Montreal, School of Rehabilitation, Montreal, Canada; 5 Maisonneuve-Rosemont Hospital, University of Montreal Affiliated, Research Center, Orthopaedic Clinical Research Unit, Montreal, Canada Background: Throughout the world, physiotherapists in primary care and advance practice physiotherapy (APP) have improved access to care, patients’ health outcomes and costeffectiveness of the health care system. In the province of Quebec (Canada), physiotherapists with more autonomous role in primary care and APPs are now being implemented. Although patient acceptance and satisfaction with health professionals in new autonomous roles has been reported, acceptability of these new roles for physiotherapists in the province of Quebec has not been investigated. Purpose: To assess perceptions of a sample of the Quebec’s population on physiotherapists as a primary care practitioners and APPs in the treatment of patients with musculoskeletal disorders. Methods: An electronic survey was available via a web platform for the community of Laval University’s staff and students (52 100 recipients) for a two week period in February 2014. The questionnaire addressed: (1) demographics (2) appreciation of previous physiotherapy experiences (3) perception of the physiotherapists’ skills as a primary care practitioner (4) perceptions of the safety, applicability and benefits of APP. Data from the survey was analysed with the Statistical Package for Social Sciences (SPSS 20.0). Results: A total of 513 participants completed the questionnaire. Nine-one percent of respondents say they trust the physiotherapists’ treatments in their current roles and 84%
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
of people who had recently received treatment from a physiotherapist were satisfied with care. According to 85% of respondents, the ability of a physiotherapist, in its usual role, to diagnose musculoskeletal disorder is equivalent if not better than a GP or an ER doctor. A total of 90% of respondents supported the introduction of the APPs for the treatment of musculoskeletal disorders and 96% believed that these models of care are safe. A large majority, 75%, of those surveyed said they were confident or very confident to be that they could be treated by an advanced practice physiotherapists without having to see a doctor and 73% said they were confident or very confident that advanced practice physiotherapist would refer them to a doctor if their condition required it. As for the delegation of medical acts to increase the autonomy of advanced practice physiotherapist, over 90% of the respondents were in favour of the delegation of medical diagnosis, imaging prescription, surgical triage and the prescription of analgesics and non steroidal drugs. Twenty percent of respondents did not support the delegation of articular injections. In terms of access to care, the majority of respondents believe that the advanced physiotherapy practice could help reduce wait times in the health care system. Conclusion(s): Respondents are quite satisfied and confident in physiotherapy and they are receptive to the introduction of PAP in the health care system. Implications: Our results suggest that in this limited sample of Quebecers, people appear satisfied with physiotherapists as primary care practitioners and are favourable to the implementation of APP for the treatment of patients with musculoskeletal disorders in the province of Quebec. Keywords: Advance practice; Physiotherapy; Musculoskeletal Funding acknowledgements: This project was not funded by a third party. Ethics approval: The Laval’s University ethics comity approved this project. (2014-007/07-02-2014). http://dx.doi.org/10.1016/j.physio.2015.03.509
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Research Report Poster Presentation Number: RR-PO-11-24-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 LONGITUDINAL MEDIAN NERVE EXCURSION IS SIMILAR BETWEEN PEOPLE WITH CARPAL TUNNEL SYNDROME AND HEALTHY CONTROLS: A QUANTITATIVE ULTRASOUND IMAGING STUDY P. Paquette 1,2 , M. Lamontagne 2 , F. Desmeules 3,4 , D. Gagnon 1,2 1 Université
de Montréal and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, School of Rehabilitation, Faculty of Medicine, Montreal, Canada; 2 Gingras-Lindsay Institute of Rehabilitation, Montreal, Canada; 3 Université de Montréal, Montreal, Canada; 4 Centre de Recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Canada Background: Upper limb neurodynamic techniques are frequently used by physiotherapists to treat people with carpal tunnel syndrome (CTS). Upper limb neurodynamic techniques combining distal joint movements (i.e., wrist) with proximal joint movements (i.e., shoulder or neck), which either add nerve tension (i.e., tensioner) or release nerve tension (i.e., slider) are expected to elicit a different amount of longitudinal peripheral nerve excursion in healthy people. Surprisingly, the effects of upper limb neurodynamic techniques involving combinations of distal and proximal joint movements on median nerve excursion have yet to be tested since only the effects of isolated wrist and finger movements have been reported to date in people with CTS. Whether longitudinal excursion of the median nerve differs in people with CTS compared to healthy controls is a subject of debate in the literature. Moreover, if a difference was to be confirmed, identifying the best upper limb neurodynamic techniques to illustrate this difference would be a valuable information for physiotherapists. Hence, developing and strengthening evidence on median nerve excursion during upper limb neurodynamic techniques using quantitative ultrasound imaging in people with CTS is warranted. Purpose: This study compares magnitudes of median nerve excursion produced by three upper limb neurodynamic techniques between people with CTS and healthy controls. Methods: Seven participants with unilateral or bilateral CTS (N = 12 wrists) and 11 healthy controls (N = 22 wrists) were randomly tested with three upper limb neurodynamic techniques using a standardized protocol:
(A) isolated wrist extension; (B) combined wrist extension and contralateral neck side flexion (tensioner); and
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
cacy of capsular mobilisations or manipulations compared to a placebo intervention or in addition to another intervention for pain reduction and a significant effect was observed (10 cm VAS MD: 0.67; 95%CI: 0.17 to 1.2). For all the above analyses treatment effects of MT can be considered small and may not be clinically important. In term function, qualitative analyses of seven RCTs (n = 212) suggest that MT alone or in addition to exercises is not effective. Conclusion(s): Positive trends in treatment outcomes are observed with MT, but the magnitude of the effects are most likely not clinically important. Therefore, there is low to moderate evidence that MT either alone or in conjunction to other modalities is not effective in reducing pain and that MT intervention alone or added to an exercises program is not effective in reducing pain or improving function in the treatment of RC tendinopathy. Implications: Until more methodologically sound studies confirm the efficacy or the absence of efficacy of MT for RC tendinopathy, clinicians should prioritize treatments that have already been proven effective such as exercise therapy. To be more representative of current clinical practice, future RCTs should compare MT interventions specifically tailored to treat impairments found in subgroups of patients with RC tendinopathy that may benefit from these approaches. Keywords: Manual therapy; Rotator cuff; Tendinopathy Funding acknowledgements: Financial support has been provided by the IRSS, the REPAR and the OPPQ. Ethics approval: Ethics approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.508
Research Report Poster Presentation Number: RR-PO-20-23-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 ACCEPTABILITY OF ADVANCED PRACTICE PHYSIOTHERAPISTS AND PHYSIOTHERAPISTS AS PRIMARY CARE PRACTITIONERS IN THE TREATMENT OF PATIENTS WITH MUSCULOSKELETAL DISORDERS A. Desjardins-Charbonneau 1 , J.-S. Roy 2,3 , J. Thibault 4 , V.T. Ciccone 4 , F. Desmeules 4,5 1 Maisonneuve-Rosemont
Hospital, University of Montreal Affiliated, Research Center, Orthopaedic Clinical Research Unit, Montreal, Chad; 2 Faculty of Medicine, Laval University, School of Rehabilitation, Quebec, Canada; 3 Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada; 4 University of Montreal, School of Rehabilitation, Montreal, Canada; 5 Maisonneuve-Rosemont Hospital, University of Montreal Affiliated, Research Center, Orthopaedic Clinical Research Unit, Montreal, Canada Background: Throughout the world, physiotherapists in primary care and advance practice physiotherapy (APP) have improved access to care, patients’ health outcomes and costeffectiveness of the health care system. In the province of Quebec (Canada), physiotherapists with more autonomous role in primary care and APPs are now being implemented. Although patient acceptance and satisfaction with health professionals in new autonomous roles has been reported, acceptability of these new roles for physiotherapists in the province of Quebec has not been investigated. Purpose: To assess perceptions of a sample of the Quebec’s population on physiotherapists as a primary care practitioners and APPs in the treatment of patients with musculoskeletal disorders. Methods: An electronic survey was available via a web platform for the community of Laval University’s staff and students (52 100 recipients) for a two week period in February 2014. The questionnaire addressed: (1) demographics (2) appreciation of previous physiotherapy experiences (3) perception of the physiotherapists’ skills as a primary care practitioner (4) perceptions of the safety, applicability and benefits of APP. Data from the survey was analysed with the Statistical Package for Social Sciences (SPSS 20.0). Results: A total of 513 participants completed the questionnaire. Nine-one percent of respondents say they trust the physiotherapists’ treatments in their current roles and 84%
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
of people who had recently received treatment from a physiotherapist were satisfied with care. According to 85% of respondents, the ability of a physiotherapist, in its usual role, to diagnose musculoskeletal disorder is equivalent if not better than a GP or an ER doctor. A total of 90% of respondents supported the introduction of the APPs for the treatment of musculoskeletal disorders and 96% believed that these models of care are safe. A large majority, 75%, of those surveyed said they were confident or very confident to be that they could be treated by an advanced practice physiotherapists without having to see a doctor and 73% said they were confident or very confident that advanced practice physiotherapist would refer them to a doctor if their condition required it. As for the delegation of medical acts to increase the autonomy of advanced practice physiotherapist, over 90% of the respondents were in favour of the delegation of medical diagnosis, imaging prescription, surgical triage and the prescription of analgesics and non steroidal drugs. Twenty percent of respondents did not support the delegation of articular injections. In terms of access to care, the majority of respondents believe that the advanced physiotherapy practice could help reduce wait times in the health care system. Conclusion(s): Respondents are quite satisfied and confident in physiotherapy and they are receptive to the introduction of PAP in the health care system. Implications: Our results suggest that in this limited sample of Quebecers, people appear satisfied with physiotherapists as primary care practitioners and are favourable to the implementation of APP for the treatment of patients with musculoskeletal disorders in the province of Quebec. Keywords: Advance practice; Physiotherapy; Musculoskeletal Funding acknowledgements: This project was not funded by a third party. Ethics approval: The Laval’s University ethics comity approved this project. (2014-007/07-02-2014). http://dx.doi.org/10.1016/j.physio.2015.03.509
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Research Report Poster Presentation Number: RR-PO-11-24-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 LONGITUDINAL MEDIAN NERVE EXCURSION IS SIMILAR BETWEEN PEOPLE WITH CARPAL TUNNEL SYNDROME AND HEALTHY CONTROLS: A QUANTITATIVE ULTRASOUND IMAGING STUDY P. Paquette 1,2 , M. Lamontagne 2 , F. Desmeules 3,4 , D. Gagnon 1,2 1 Université
de Montréal and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, School of Rehabilitation, Faculty of Medicine, Montreal, Canada; 2 Gingras-Lindsay Institute of Rehabilitation, Montreal, Canada; 3 Université de Montréal, Montreal, Canada; 4 Centre de Recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Canada Background: Upper limb neurodynamic techniques are frequently used by physiotherapists to treat people with carpal tunnel syndrome (CTS). Upper limb neurodynamic techniques combining distal joint movements (i.e., wrist) with proximal joint movements (i.e., shoulder or neck), which either add nerve tension (i.e., tensioner) or release nerve tension (i.e., slider) are expected to elicit a different amount of longitudinal peripheral nerve excursion in healthy people. Surprisingly, the effects of upper limb neurodynamic techniques involving combinations of distal and proximal joint movements on median nerve excursion have yet to be tested since only the effects of isolated wrist and finger movements have been reported to date in people with CTS. Whether longitudinal excursion of the median nerve differs in people with CTS compared to healthy controls is a subject of debate in the literature. Moreover, if a difference was to be confirmed, identifying the best upper limb neurodynamic techniques to illustrate this difference would be a valuable information for physiotherapists. Hence, developing and strengthening evidence on median nerve excursion during upper limb neurodynamic techniques using quantitative ultrasound imaging in people with CTS is warranted. Purpose: This study compares magnitudes of median nerve excursion produced by three upper limb neurodynamic techniques between people with CTS and healthy controls. Methods: Seven participants with unilateral or bilateral CTS (N = 12 wrists) and 11 healthy controls (N = 22 wrists) were randomly tested with three upper limb neurodynamic techniques using a standardized protocol:
(A) isolated wrist extension; (B) combined wrist extension and contralateral neck side flexion (tensioner); and