Open Access Highly Accessed Research article

Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review

François Desmeules123*, Jean-Sébastien Roy56, Joy C MacDermid78, François Champagne2, Odette Hinse3 and Linda June Woodhouse49

Author Affiliations

1 School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada

2 University of Montreal Public Health Research Institute, University of Montreal, Montreal, Quebec, Canada

3 Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada

4 Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada

5 Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada

6 Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada

7 School of Rehabilitation Science, McMaster University, Hamilton, Quebec, Canada

8 Hand and Upper Limb Centre, London, Quebec, Canada

9 McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada

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BMC Musculoskeletal Disorders 2012, 13:107  doi:10.1186/1471-2474-13-107

Published: 21 June 2012



The convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals. Physiotherapists in advanced practice/extended scope roles have emerged as key providers in such new models, especially in settings providing services to patients with musculoskeletal disorders. However, evidence of the systematic evaluation of advance physiotherapy practice (APP) models of care is scarce. A systematic review was done to update the evaluation of physiotherapists in APP roles in the management of patients with musculoskeletal disorders.


Structured literature search was conducted in 3 databases (Medline, Cinahl and Embase) for articles published between 1980 and 2011. Included studies needed to present original quantitative data that addressed the impact or the effect of APP care. A total of 16 studies met all inclusion criteria and were included. Pairs of raters used four structured quality appraisal methodological tools depending on design of studies to analyse included studies.


Included studies varied in designs and objectives and could be categorized in four areas: diagnostic agreement or accuracy compared to medical providers, treatment effectiveness, economic efficiency or patient satisfaction. There was a wide range in the quality of studies (from 25% to 93%), with only 43% of papers reaching or exceeding a score of 70% on the methodological quality rating scales. Their findings are however consistent and suggest that APP care may be as (or more) beneficial than usual care by physicians for patients with musculoskeletal disorders, in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction.


The emerging evidence suggests that physiotherapists in APP roles provide equal or better usual care in comparison to physicians in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. There is a need for more methodologically sound studies to evaluate the effectiveness APP care.