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Open Access Short Report

A single group follow-up study of non-surgical patients seen by physiotherapists working in expanded roles in orthopaedic departments: recall of recommendations, change in exercise and self-efficacy

Crystal MacKay12*, Aileen M Davis1234, Nizar N Mahomed156 and Elizabeth M Badley137

Author Affiliations

1 Division of Health Care and Outcomes Research and Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Toronto, ON, Canada

2 Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

3 Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada

4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

5 Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada

6 Department of Surgery, University of Toronto, Toronto, ON, Canada

7 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

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BMC Research Notes 2012, 5:669  doi:10.1186/1756-0500-5-669

Published: 4 December 2012

Abstract

Background

Specially trained physiotherapists (advanced practice physiotherapists (APP)) are working in orthopaedic clinics to improve access to orthopaedic services and support chronic disease management. Little attention has been paid to the impact APPs may have on non-surgical patients. In non-surgical patients with hip or knee arthritis consulting an APP in an orthopaedic clinic, the objectives were to: 1) describe patients’ recall of APP recommendations, use of self-management strategies, and barriers to management six weeks following consultation; and, 2) compare exercise behaviour and self-efficacy at baseline and six weeks.

Findings

This was a single group pre-and post-intervention study of patients who saw an APP when consulting the orthopaedic departments of two hospitals. At baseline and six weeks participants completed the adapted Stanford Exercise Behaviour Scale (response options: none, < 60 minutes/week, 1–3 hours/week or > 3 hours/week), and the Chronic Disease Self-efficacy Scale (range 1–10; higher scores indicate higher self-efficacy). At follow-up participants completed questions on recall of APP recommendations, use of self-management strategies and barriers to management. Seventy three non-surgical patients with hip or knee arthritis participated, a response rate of 89% at follow-up. Seventy one percent of patients reported that the APP recommended exercise, of whom 83% reported exercising to manage their arthritis since the visit. Almost 50% reported an increase in time spent stretching; over 40% reported an increase in time spent walking or doing strengthening exercises at follow-up. Common barriers to arthritis management were time, cost and other health problems. Mean chronic disease self-efficacy scores significantly improved from 6.3 to 7.2 (p < 0.001). The mean difference was 0.95 (95% CI 0.43, 1.62); the effect size was 0.51.

Conclusions

This pilot study of an APP intervention for non-surgical patients referred for orthopaedic consultation showed promising results, particularly for enhancing use of conservative management strategies such as exercise.

Keywords:
Arthritis; Physiotherapists; Advanced practice; Non-surgical; Self-management behaviours; Orthopaedics