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The use of standardised data collection in private physiotherapy practice to provide information for clinicians, clinics and private practice organisations
Abstracts / Musculoskeletal Science and Practice 28 (2017) e3ee27
M. O'Mahony 1, H. Purtill 2, K. O'Sullivan 1, *. 1 Clinical Therapies, University of Limerick, Limerick, Ireland; 2 Mathematics and Statistics, University of Limerick, Limerick, Ireland * Corresponding author.
Background: A proportion of patients report suboptimal outcomes in terms of pain and function after total knee replacement (TKR) surgery. Several non-musculoskeletal symptoms (i.e. non-painful somatic (e.g. fatigue, dizziness, palpitations) and psychological symptoms (e.g. depression and anxiety)) have been linked to poor prognosis and poor outcomes for a range of painful musculoskeletal conditions, including osteoarthritis. However, the influence of non-musculoskeletal symptoms on outcomes following TKR is unclear. Purpose: To establish the impact of non-musculoskeletal symptoms on the outcome, in terms of pain and function, of TKR surgery. Methods: Data were prospectively collected at three different time points; (i) routine pre-operative assessment, (ii) day of discharge post-operatively and (iii) three months post-operatively. Patient reported measures included the Oxford Knee Score (OKS), Pain intensity Numeric Rating Scale (PainNRS), number of painful regions (Standardised Nordic Musculoskeletal Pain Questionnaire) and non-musculoskeletal symptom severity (Subjective Health Complaints Inventory-SHCI). Patients were dichotomised into two groups (satisfactory or unsatisfactory outcome) based on their scores on the primary outcome (OKS) at three-month follow-up. Results: 74 consenting patients underwent TKR surgery, with OKS values available for 64 patients at the three-month follow-up. Significant improvements in OKS (p¼0.05) and PainNRS (p<0.001) were observed from pre to post surgery. 70.3% of the patients were classified as having a satisfactory outcome. There was a statistically significant (p<0.001) difference in baseline SHCI values between those who did and did not report a satisfactory value on the OKS after three months. After controlling for baseline OKS and PainNRS, SHCI scores remained significantly associated with poor outcome at three months (OR¼1.435, 95% CI:1.142,1.80, p¼0.002). Conclusion: The extent to which patients are burdened by non-musculoskeletal symptoms pre-operatively, is a statistically significant predictor of outcome three months after TKR surgery. Implications: These non-musculoskeletal symptoms can be assessed easily using a short, clinically feasible questionnaire like the SHCI. This may help guide preoperative management to optimise post-operative outcome following TKR surgery. Funding acknowledgements: Not applicable. Ethics approval: Approved by the Cork Clinical Research Ethics Committee. Disclosure of interest: None declared. Keywords: Comorbidity, Non-musculoskeletal symptoms, Total knee replacement Intergrating Research into practice RA-AP-006 TRUNK LATERALITY RECOGNITION TASKS AND MOTOR IMAGERY: TESTING THE EXACT MATCH CONFIRMATION HYPOTHESIS L. Alazmi*, G. Gadsby, N. Heneghan, D. Punt. School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom * Corresponding author.
Background: The use of laterality recognition tasks (LRTs) in clinical practice is predicated on their ability to elicit motor imagery. When asked to complete limb-based LRTs, it is established that individuals mentally match their own limb to the one depicted; a process known as Exact Match Confirmation. Recently, trunk-based LRTs have been introduced on the basis that a similar matching process occurs for movements of the trunk. However, as currently conceived, trunk LRTs conflate the requirement to mentally match the whole body with that of a lateralised posture of the trunk. For trunk LRTs to be considered to have therapeutic value, they must require individuals to mentally match their own trunk with the images depicted.
e5
Purpose: The study aimed to establish whether data from a standard trunk LRT are indicative of participants engaging in a mental matching process for the specific lateralised trunk postures presented, regardless of the position of the whole body. Methods: Thirty unimpaired participants completed a trunk laterality recognition task. Images used showed human figures oriented to different degrees and along different axes. Each figure’s trunk was either rotated or side-flexed to the left or right. Importantly, images depicted postures reflecting three different amplitudes of movement from neutral. In line with the ‘exact match confirmation’ hypothesis, it was predicted that pictures depicting postures requiring larger amplitudes of movement would lead to longer response times. Data (accuracy and response times) were analysed via a 3 5 3 (Axis: X, Y, Z x Orientation: 0 , 45 , 90 , 135 , 180 x Amplitude: small, medium, large) ANOVA with repeated measures. Results: Importantly , while significant main effects (accuracy and response time) emerged for Amplitude (p < 0.001), the direction of these effects were opposite to those predicted by the exact match confirmation hypothesis; accuracy was higher and response times were faster for postures reflecting larger deviations from neutral. Axis and Orientation effects for the whole body were consistent with previous studies in cognitive psychology that are not indicative of selective motor imagery of trunk movements. Conclusion: Findings do not support the ability of trunk LRTs to elicit motor imagery for lateralised trunk movements. Data suggest that once an individual has undertaken a matching process for the whole body, the subsequent laterality judgment is relatively simplistic and made easier by the salience of visual cues. A matching process for lateralised trunk movements (i.e. motor imagery) is not elicited. Implications: Trunk-based LRTs do not appear to elicit motor imagery for lateralised trunk movements, the theoretical basis for their use in clinical practice. This may account for recently reported results in a clinical study of people with chronic low back pain showing normal performance on the task. The study presented here questions the value of trunk LRTs in clinical practice. Funding acknowledgements: LA is supported by a scholarship from the Kuwait Government. Ethics approval: The study was approved by the University of Birmingham's Research Ethics Committee. Disclosure of interest: None declared. Keywords: Laterality Recognition Tasks, Motor Imagery, Back Pain Intergrating Research into practice RA-AP-007 THE USE OF STANDARDISED DATA COLLECTION IN PRIVATE PHYSIOTHERAPY PRACTICE TO PROVIDE INFORMATION FOR CLINICIANS, CLINICS AND PRIVATE PRACTICE ORGANISATIONS E. Bryant 1, A. Moore 1, *, G. Olivier 2, S. Murtagh 1, E. Defever 1, S. Lewis 3, P. Simpson 3, K. Winrow 3, E. Lewis 3, P. Donnelly 3. 1 Centre for Health Research, University of Brighton, Eastbourne, United Kingdom; 2 School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom; 3 Physio First, Northampton, United Kingdom * Corresponding author.
Background: Clinicians are becoming increasingly aware of the need to be able to demonstrate and account for the delivery and quality of their clinical services. Online standardised data collection systems can be used by clinicians to gather this information in a robust and accessible way. Physio First (the Organisation for Chartered Physiotherapists in Private Practice) have commissioned several data collection projects in the UK. Purpose: To provide Physio First and participating practitioners with detailed information about current practice, patient demographics and outcome of care within physiotherapy private practices in the UK. Methods: All Physio First members were invited to participate in this study. 229 practitioners were recruited to the study. Practitioners were asked to input data on a random selection of newly referred patients attending their clinic using the online data collection system. Data collected included patient details; diagnosis; body site & symptoms; referral source; treatment and discharge information (i.e. outcome of referral, goal achievement).
e6
Abstracts / Musculoskeletal Science and Practice 28 (2017) e3ee27
Results: 5619 patient data sets were uploaded onto the online data collection system during the period of November 2014 to September 2015. There was a wide variety in the number of patient data sets input per practitioner from 1 to 410 data sets. The mean age of all patients was 52.3 years ± 17.8 years. Whilst the majority of patients were in paid employment, 28% of patients were retired. The largest source of referral was ‘selfreferral’ patients (77.2%), and the majority of patients (78.2%) paid for their own treatment. More than half the patients (62.8%) were treated within 2 days of referral and almost all (94.5%) were treated within one week of referral. The most frequently reported general body sites were “lower limb” (31.1%) and the “lumbar spine & pelvis” (28.7%). The number of treatments provided per episode ranged between 1 and 10. Goal achievement at discharge was significantly achieved for 72.6% of patients; goals were not achieved in 6.1% of patients. Improvements in physical/ functional outcome scores were observed with a reduction in the mean score. Only 1.7% of patients were unable to return to work following treatment. Conclusion: Standardised data collection provides useful information to all involved, in terms of patient profiling, marketing, evidence of outcomes, benchmarking and identifying areas for personal learning and professional development. Future work will include the introduction of a validated PROM which will provide additional information about efficiency, effectiveness and quality of care. Implications: Physio First and their clinicians have a growing database of patient data showing how efficient, timely and equitable their services are which will help support them in the ever changing healthcare market. Funding acknowledgements: This project was commissioned by Physio First and funded by the Private Practitioners Education Foundation. Ethics approval: Ethics approval was provided by University of Brighton. Disclosure of interest: None declared. Keywords: Private practice, Standardised data collection Teaching, Learning and Professional Development RA-AP-008 THE DEVELOPMENT OF AN ASSESSMENT TOOL TO MEASURE THE CLINICAL REASONING UTILIZED DURING A LIVE PATIENT EXAMINATION S. Cunningham*, R. Jackson, K. Herbel. Physical Therapy, Radford University, Roanoke, United States * Corresponding author.
Background: In all healthcare professions, the development and progression of clinical reasoning skills is perceived as a key factor in distinguishing expert from novice clinicians. However, the complex nature of clinical reasoning makes it difficult to objectively assess. The challenge is the ability to assess mental processes, which are not directly observable. An assessment tool has been developed to assess clinical reasoning development in post-graduate physical therapy education. The tool utilizes the skills and behaviors outlined in the American Board of Physical Therapy Specialties Dimensions of Specialty Practice (DSP) in Orthopaedics. The aptitudes assessed include the ability to perform an examination, evaluation, diagnosis, prognosis, and intervention. Purpose: The purpose of this study was determine the psychometric properties of an assessment tool designed to measure clinical reasoning development. Methods: The study sample included 12 graduating residents and 10 physiotherapists entering an 18- month manual therapy residency program in Kenya. The physiotherapists completed a live patient practical examination to assess the knowledge, clinical reasoning, and psychomotor skills related to the examination, evaluation, and treatment of musculoskeletal conditions. Inclusion criteria included participation in or acceptance to the residency program, practice as a physiotherapist between 3 and 25 years, and 50% of work- day being involved in direct patient care. The examinations were performed over a 5-day period in Nairobi, Kenya at the Kenya Medical Training College. Results: Cronbach's alpha for internal consistency of the five aptitudes measured by the tool was determined as examination 0.871, evaluation 0.818, diagnosis 0.836, prognosis 0.603, and intervention 0.824. Inter and intra- rater reliability was determined for each of the 76 items assessed. Inter rater and intra- rater reliability was found to be significant at the 0.05
level for 42 of the items. Inter- rater reliability on overall pass or fail of the exam at a 75% was 0.730 with a 2- tail significance level of 0.001. Furthermore, the assessment was able to distinguish graduating from entering residents. Graduating residents achieved an average score of 83.4% on the live patient examination with an overall pass rate of 92.3%. Physiotherapists entering the residency program achieved an average score of 38.2% with an overall passing rate of 0.00%. The computed chisquare value was 19.30 with an associated p-value less than 0.001. A Fisher’s exact test demonstrated a two-tailed P value less than 0.0001. In those skills in which there was poor agreement between scores, the difficulty appeared to be in determining adequate performance in the physiotherapists waiting to enter the program. These items are being revised with more specific descriptions of the competence level required. Psychometric properties of the revised assessment should be completed in March 2016. Conclusion: This pilot study was an attempt to develop an effective assessment tool for the evaluation of clinical reasoning development in post- graduate physical therapy education. The assessment of integration of knowledge into the therapists' working hypothesis was difficult to consistently assess requiring revision of items to specifically describe expected components of the skill and what would determine adequate performance. Implications: The results of this study demonstrate the difficulty in assessing clinical reasoning, however, it is a significant first step in developing a tool to track progression of these skills in individuals seeking to become advanced clinicians. Funding acknowledgements: Funding was provided by the Institute for Global Enterprise Global Scholars Program. Ethics approval: This research was approved by the University of Evansville Institutional Review Board. Disclosure of interest: S. Cunningham: None Declared, R. Jackson Conflict with: Founder of the Jackson Clinics Foundation providing funding for the residency program, K. Herbel: None declared. Keywords: Clinical Reasoning Assessment, Residency Program Changing roles and scope of practice RA-AP-009 THE ROLE OF THE PHARMACIST MUSCULOSKELETAL PHYSIOTHERAPY MULTIDISCIPLINARY SERVICE
WITHIN AN ADVANCED SCREENING CLINIC AND
P. Swete Kelly 1, *, L. Busuttin 2, N. Walton 2. 1 Physiotherapy, Performance Rehab, Annerley, Australia; 2 Pharmacy, Royal Brisbane and Women's Hospitals, Brisbane, Australia * Corresponding author.
Background: Advanced scope physiotherapists (ASP) undertake the assessment and case management of complex patients referred to Neuroand Orthopaedic Surgery Specialist Outpatient departments but in many situations have limited knowledge of appropriate medication use. The use of medicines is a common intervention in the holistic multidisciplinary management of patients with musculoskeletal conditions. Patients frequently present with poor understanding of their prescribed medicines, inadequate or inappropriate analgesia for their presenting condition/s and/or polypharmacy with high risk of actual or potential medicines related problems (MRP). Assessment and review of individual medicine regimens is a primary role of a clinical pharmacist despite this, this profession is not well represented in outpatient multidisciplinary teams. Purpose: The project purpose was to assess if, within a cohort of patients presenting to an ASP, there were patients with actual and/or potential MRP and the potential benefits from a pharmacist review. Secondary aims included identification of strategies to best utilise this profession’s expertise and scope of practice in this setting. Methods: Patients presenting to an ASP clinic underwent usual assessment and were also provided a questionnaire (completed by the patient and Physiotherapist) to stratify the patient risk for MRP. Appropriate patients were referred to a pharmacist who undertook a comprehensive medication assessment interview with the patient. Data recorded included opiate usage, identification of adverse effects, inappropriate medicines and
M. O'Mahony 1, H. Purtill 2, K. O'Sullivan 1, *. 1 Clinical Therapies, University of Limerick, Limerick, Ireland; 2 Mathematics and Statistics, University of Limerick, Limerick, Ireland * Corresponding author.
Background: A proportion of patients report suboptimal outcomes in terms of pain and function after total knee replacement (TKR) surgery. Several non-musculoskeletal symptoms (i.e. non-painful somatic (e.g. fatigue, dizziness, palpitations) and psychological symptoms (e.g. depression and anxiety)) have been linked to poor prognosis and poor outcomes for a range of painful musculoskeletal conditions, including osteoarthritis. However, the influence of non-musculoskeletal symptoms on outcomes following TKR is unclear. Purpose: To establish the impact of non-musculoskeletal symptoms on the outcome, in terms of pain and function, of TKR surgery. Methods: Data were prospectively collected at three different time points; (i) routine pre-operative assessment, (ii) day of discharge post-operatively and (iii) three months post-operatively. Patient reported measures included the Oxford Knee Score (OKS), Pain intensity Numeric Rating Scale (PainNRS), number of painful regions (Standardised Nordic Musculoskeletal Pain Questionnaire) and non-musculoskeletal symptom severity (Subjective Health Complaints Inventory-SHCI). Patients were dichotomised into two groups (satisfactory or unsatisfactory outcome) based on their scores on the primary outcome (OKS) at three-month follow-up. Results: 74 consenting patients underwent TKR surgery, with OKS values available for 64 patients at the three-month follow-up. Significant improvements in OKS (p¼0.05) and PainNRS (p<0.001) were observed from pre to post surgery. 70.3% of the patients were classified as having a satisfactory outcome. There was a statistically significant (p<0.001) difference in baseline SHCI values between those who did and did not report a satisfactory value on the OKS after three months. After controlling for baseline OKS and PainNRS, SHCI scores remained significantly associated with poor outcome at three months (OR¼1.435, 95% CI:1.142,1.80, p¼0.002). Conclusion: The extent to which patients are burdened by non-musculoskeletal symptoms pre-operatively, is a statistically significant predictor of outcome three months after TKR surgery. Implications: These non-musculoskeletal symptoms can be assessed easily using a short, clinically feasible questionnaire like the SHCI. This may help guide preoperative management to optimise post-operative outcome following TKR surgery. Funding acknowledgements: Not applicable. Ethics approval: Approved by the Cork Clinical Research Ethics Committee. Disclosure of interest: None declared. Keywords: Comorbidity, Non-musculoskeletal symptoms, Total knee replacement Intergrating Research into practice RA-AP-006 TRUNK LATERALITY RECOGNITION TASKS AND MOTOR IMAGERY: TESTING THE EXACT MATCH CONFIRMATION HYPOTHESIS L. Alazmi*, G. Gadsby, N. Heneghan, D. Punt. School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom * Corresponding author.
Background: The use of laterality recognition tasks (LRTs) in clinical practice is predicated on their ability to elicit motor imagery. When asked to complete limb-based LRTs, it is established that individuals mentally match their own limb to the one depicted; a process known as Exact Match Confirmation. Recently, trunk-based LRTs have been introduced on the basis that a similar matching process occurs for movements of the trunk. However, as currently conceived, trunk LRTs conflate the requirement to mentally match the whole body with that of a lateralised posture of the trunk. For trunk LRTs to be considered to have therapeutic value, they must require individuals to mentally match their own trunk with the images depicted.
e5
Purpose: The study aimed to establish whether data from a standard trunk LRT are indicative of participants engaging in a mental matching process for the specific lateralised trunk postures presented, regardless of the position of the whole body. Methods: Thirty unimpaired participants completed a trunk laterality recognition task. Images used showed human figures oriented to different degrees and along different axes. Each figure’s trunk was either rotated or side-flexed to the left or right. Importantly, images depicted postures reflecting three different amplitudes of movement from neutral. In line with the ‘exact match confirmation’ hypothesis, it was predicted that pictures depicting postures requiring larger amplitudes of movement would lead to longer response times. Data (accuracy and response times) were analysed via a 3 5 3 (Axis: X, Y, Z x Orientation: 0 , 45 , 90 , 135 , 180 x Amplitude: small, medium, large) ANOVA with repeated measures. Results: Importantly , while significant main effects (accuracy and response time) emerged for Amplitude (p < 0.001), the direction of these effects were opposite to those predicted by the exact match confirmation hypothesis; accuracy was higher and response times were faster for postures reflecting larger deviations from neutral. Axis and Orientation effects for the whole body were consistent with previous studies in cognitive psychology that are not indicative of selective motor imagery of trunk movements. Conclusion: Findings do not support the ability of trunk LRTs to elicit motor imagery for lateralised trunk movements. Data suggest that once an individual has undertaken a matching process for the whole body, the subsequent laterality judgment is relatively simplistic and made easier by the salience of visual cues. A matching process for lateralised trunk movements (i.e. motor imagery) is not elicited. Implications: Trunk-based LRTs do not appear to elicit motor imagery for lateralised trunk movements, the theoretical basis for their use in clinical practice. This may account for recently reported results in a clinical study of people with chronic low back pain showing normal performance on the task. The study presented here questions the value of trunk LRTs in clinical practice. Funding acknowledgements: LA is supported by a scholarship from the Kuwait Government. Ethics approval: The study was approved by the University of Birmingham's Research Ethics Committee. Disclosure of interest: None declared. Keywords: Laterality Recognition Tasks, Motor Imagery, Back Pain Intergrating Research into practice RA-AP-007 THE USE OF STANDARDISED DATA COLLECTION IN PRIVATE PHYSIOTHERAPY PRACTICE TO PROVIDE INFORMATION FOR CLINICIANS, CLINICS AND PRIVATE PRACTICE ORGANISATIONS E. Bryant 1, A. Moore 1, *, G. Olivier 2, S. Murtagh 1, E. Defever 1, S. Lewis 3, P. Simpson 3, K. Winrow 3, E. Lewis 3, P. Donnelly 3. 1 Centre for Health Research, University of Brighton, Eastbourne, United Kingdom; 2 School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom; 3 Physio First, Northampton, United Kingdom * Corresponding author.
Background: Clinicians are becoming increasingly aware of the need to be able to demonstrate and account for the delivery and quality of their clinical services. Online standardised data collection systems can be used by clinicians to gather this information in a robust and accessible way. Physio First (the Organisation for Chartered Physiotherapists in Private Practice) have commissioned several data collection projects in the UK. Purpose: To provide Physio First and participating practitioners with detailed information about current practice, patient demographics and outcome of care within physiotherapy private practices in the UK. Methods: All Physio First members were invited to participate in this study. 229 practitioners were recruited to the study. Practitioners were asked to input data on a random selection of newly referred patients attending their clinic using the online data collection system. Data collected included patient details; diagnosis; body site & symptoms; referral source; treatment and discharge information (i.e. outcome of referral, goal achievement).
e6
Abstracts / Musculoskeletal Science and Practice 28 (2017) e3ee27
Results: 5619 patient data sets were uploaded onto the online data collection system during the period of November 2014 to September 2015. There was a wide variety in the number of patient data sets input per practitioner from 1 to 410 data sets. The mean age of all patients was 52.3 years ± 17.8 years. Whilst the majority of patients were in paid employment, 28% of patients were retired. The largest source of referral was ‘selfreferral’ patients (77.2%), and the majority of patients (78.2%) paid for their own treatment. More than half the patients (62.8%) were treated within 2 days of referral and almost all (94.5%) were treated within one week of referral. The most frequently reported general body sites were “lower limb” (31.1%) and the “lumbar spine & pelvis” (28.7%). The number of treatments provided per episode ranged between 1 and 10. Goal achievement at discharge was significantly achieved for 72.6% of patients; goals were not achieved in 6.1% of patients. Improvements in physical/ functional outcome scores were observed with a reduction in the mean score. Only 1.7% of patients were unable to return to work following treatment. Conclusion: Standardised data collection provides useful information to all involved, in terms of patient profiling, marketing, evidence of outcomes, benchmarking and identifying areas for personal learning and professional development. Future work will include the introduction of a validated PROM which will provide additional information about efficiency, effectiveness and quality of care. Implications: Physio First and their clinicians have a growing database of patient data showing how efficient, timely and equitable their services are which will help support them in the ever changing healthcare market. Funding acknowledgements: This project was commissioned by Physio First and funded by the Private Practitioners Education Foundation. Ethics approval: Ethics approval was provided by University of Brighton. Disclosure of interest: None declared. Keywords: Private practice, Standardised data collection Teaching, Learning and Professional Development RA-AP-008 THE DEVELOPMENT OF AN ASSESSMENT TOOL TO MEASURE THE CLINICAL REASONING UTILIZED DURING A LIVE PATIENT EXAMINATION S. Cunningham*, R. Jackson, K. Herbel. Physical Therapy, Radford University, Roanoke, United States * Corresponding author.
Background: In all healthcare professions, the development and progression of clinical reasoning skills is perceived as a key factor in distinguishing expert from novice clinicians. However, the complex nature of clinical reasoning makes it difficult to objectively assess. The challenge is the ability to assess mental processes, which are not directly observable. An assessment tool has been developed to assess clinical reasoning development in post-graduate physical therapy education. The tool utilizes the skills and behaviors outlined in the American Board of Physical Therapy Specialties Dimensions of Specialty Practice (DSP) in Orthopaedics. The aptitudes assessed include the ability to perform an examination, evaluation, diagnosis, prognosis, and intervention. Purpose: The purpose of this study was determine the psychometric properties of an assessment tool designed to measure clinical reasoning development. Methods: The study sample included 12 graduating residents and 10 physiotherapists entering an 18- month manual therapy residency program in Kenya. The physiotherapists completed a live patient practical examination to assess the knowledge, clinical reasoning, and psychomotor skills related to the examination, evaluation, and treatment of musculoskeletal conditions. Inclusion criteria included participation in or acceptance to the residency program, practice as a physiotherapist between 3 and 25 years, and 50% of work- day being involved in direct patient care. The examinations were performed over a 5-day period in Nairobi, Kenya at the Kenya Medical Training College. Results: Cronbach's alpha for internal consistency of the five aptitudes measured by the tool was determined as examination 0.871, evaluation 0.818, diagnosis 0.836, prognosis 0.603, and intervention 0.824. Inter and intra- rater reliability was determined for each of the 76 items assessed. Inter rater and intra- rater reliability was found to be significant at the 0.05
level for 42 of the items. Inter- rater reliability on overall pass or fail of the exam at a 75% was 0.730 with a 2- tail significance level of 0.001. Furthermore, the assessment was able to distinguish graduating from entering residents. Graduating residents achieved an average score of 83.4% on the live patient examination with an overall pass rate of 92.3%. Physiotherapists entering the residency program achieved an average score of 38.2% with an overall passing rate of 0.00%. The computed chisquare value was 19.30 with an associated p-value less than 0.001. A Fisher’s exact test demonstrated a two-tailed P value less than 0.0001. In those skills in which there was poor agreement between scores, the difficulty appeared to be in determining adequate performance in the physiotherapists waiting to enter the program. These items are being revised with more specific descriptions of the competence level required. Psychometric properties of the revised assessment should be completed in March 2016. Conclusion: This pilot study was an attempt to develop an effective assessment tool for the evaluation of clinical reasoning development in post- graduate physical therapy education. The assessment of integration of knowledge into the therapists' working hypothesis was difficult to consistently assess requiring revision of items to specifically describe expected components of the skill and what would determine adequate performance. Implications: The results of this study demonstrate the difficulty in assessing clinical reasoning, however, it is a significant first step in developing a tool to track progression of these skills in individuals seeking to become advanced clinicians. Funding acknowledgements: Funding was provided by the Institute for Global Enterprise Global Scholars Program. Ethics approval: This research was approved by the University of Evansville Institutional Review Board. Disclosure of interest: S. Cunningham: None Declared, R. Jackson Conflict with: Founder of the Jackson Clinics Foundation providing funding for the residency program, K. Herbel: None declared. Keywords: Clinical Reasoning Assessment, Residency Program Changing roles and scope of practice RA-AP-009 THE ROLE OF THE PHARMACIST MUSCULOSKELETAL PHYSIOTHERAPY MULTIDISCIPLINARY SERVICE
WITHIN AN ADVANCED SCREENING CLINIC AND
P. Swete Kelly 1, *, L. Busuttin 2, N. Walton 2. 1 Physiotherapy, Performance Rehab, Annerley, Australia; 2 Pharmacy, Royal Brisbane and Women's Hospitals, Brisbane, Australia * Corresponding author.
Background: Advanced scope physiotherapists (ASP) undertake the assessment and case management of complex patients referred to Neuroand Orthopaedic Surgery Specialist Outpatient departments but in many situations have limited knowledge of appropriate medication use. The use of medicines is a common intervention in the holistic multidisciplinary management of patients with musculoskeletal conditions. Patients frequently present with poor understanding of their prescribed medicines, inadequate or inappropriate analgesia for their presenting condition/s and/or polypharmacy with high risk of actual or potential medicines related problems (MRP). Assessment and review of individual medicine regimens is a primary role of a clinical pharmacist despite this, this profession is not well represented in outpatient multidisciplinary teams. Purpose: The project purpose was to assess if, within a cohort of patients presenting to an ASP, there were patients with actual and/or potential MRP and the potential benefits from a pharmacist review. Secondary aims included identification of strategies to best utilise this profession’s expertise and scope of practice in this setting. Methods: Patients presenting to an ASP clinic underwent usual assessment and were also provided a questionnaire (completed by the patient and Physiotherapist) to stratify the patient risk for MRP. Appropriate patients were referred to a pharmacist who undertook a comprehensive medication assessment interview with the patient. Data recorded included opiate usage, identification of adverse effects, inappropriate medicines and