Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review

Abstract

Objective

Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities.

Methods

We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted.

Results

Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (n = 11), occupational therapy (n = 2), prosthetics (n = 1), exercise physiology (n = 1) and multidisciplinary (n = 4) services. The methodological quality varied (n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services.

Conclusions

This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.

Keywords

waiting times service redesign strategies rehabilitation

Get full access to this article

View all access options for this article.

References

Levesque

Harris

Russell

. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013; 12: 1–9.

Déry

Ruiz

Routhier

, et al. A systematic review of patient prioritization tools in non-emergency healthcare services. Syst Rev 2020; 9: 227.

Network GTAR . Measuring and Managing Supply and Demand: A Waiting List Information Management Proposal for Musculoskeletal Rehabilitation in the Greater Toronto Area. Toronto: The Network, 2003.

Deslauriers

Déry

Proulx

, et al. Effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders: a systematic review. Disabil Rehabil 2019; 43(5): 611–620. DOI: 10.1080/09638288.2019.1639222.

Hadorn

. Setting priorities for waiting lists: defining our terms. Steering Committee of the Western Canada Waiting List Project. Can Med Assoc J 2020; 163: 857–860.

Passalent

Landry

Cott

. Exploring wait list prioritization and management strategies for publicly funded ambulatory rehabilitation services in Ontario, Canada: further evidence of barriers to access for people with chronic disease. Healthc Pol 2010; 5: 139–156.

Passalent

Landry

Cott

. Wait times for publicly funded outpatient and community physiotherapy and occupational therapy services: implications for the increasing number of persons with chronic conditions in Ontario, Canada. Physiother Can 2009; 61: 5–14.

Deslauriers

Raymond

Laliberté

, et al. Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies. Disabil Rehabil 2017; 39: 2648–2656.

Rastall

Fashanu

. Hospital physiotherapy outpatient department waiting lists: a survey. Physiotherapy 2001; 87: 563–572.

10.

Adams

Jones

Lefmann

, et al. Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making. BMC Health Serv Res 2015; 27: 121.

11.

Lynch

Campbell

Clark

, et al. A systematic review of the effect of waiting for treatment for chronic pain. Pain 2008; 136: 97–116.

12.

Gibson

Martin

Singer

. Evidence, economics and ethics: resource allocation in health services organizations. Healthc Q 2005; 8: 50–59.

13.

Ming

Lai

Lau

. Can team triage improve patient flow in the emergency department? a systematic review and meta-analysis. Adv Emerg Nurs J 2016; 38: 233–250.

14.

van Leijen-Zeelenberg

Elissen

AMJ

Grube

, et al. The impact of redesigning care processes on quality of care: a systematic review. BMC Health Serv Res 2016; 16: 19.

15.

Stanhope

Grimmer-Somers

Milanese

, et al. Extended scope physiotherapy roles for orthopedic outpatients: an update systematic review of the literature. J Multidisciplin Healthc 2012; 5: 37–45.

16.

Galea

. Telemedicine in rehabilitation. Phys Med Rehabil Clin North America 2019; 30: 373–483.

17.

Harding

Leggat

Bowers

, et al. Reducing waiting times for community rehabilitation services: a controlled before-and-after trial. Arch Phys Med Rehabil 2013; 94: 23–31.

18.

Harding

Taylor

Leggat

, et al. Effect of triage on waiting times for community rehabilitation: a prospective cohort study. Arch Phys Med Rehabil 2012; 93: 441–445.

19.

Raymond

M-H

Feldman

Prud'homme

M-P

, et al. Who’s next? Referral prioritisation criteria for home care occupational therapy. Int J Ther Rehabil 2013; 20: 580–588.

20.

Camden

Swaine

Levasseur

. Did waiting times really decrease following a service reorganization? Results from a retrospective study in a pediatric rehabilitation program in Québec. Disabil Rehabil 2013; 35: 9.

21.

Standing

McDermott

, et al. The paradoxes of telehealth: a review of the literature 200P 2015. Syst Res Behav Sci 2016; 35: 90–101.

22.

Page

McKenzie

Bossuyt

, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.

23.

Stucki

Pollock

Engkasan

, et al. How to use the international classification of functioning, disability and health as a reference system for comparative evaluation and standardized reporting of rehabilitation interventions. Eur J Phys Rehabil Med 2019; 55: 384–394.

24.

Organization WH . Towards a Common Language for Functioning, Disability and Health—ICF, 2020. Available at: https://www.who.int/classifications/icf/icfbeginnersguide.pdf (accessed 25 November, 2020).

25.

Québec Gd . Services for Persons with a Physical or Intellectual Disability or an Autism Spectrum Disorder (ASD), 2020. Available at: https://www.quebec.ca/en/health/health-system-and-services/assistive-devices-disabilities-and-handicaps/services-for-persons-with-a-disability/#c2949 (accessed 20 September, 2020).

26.

Hong

Pluye

Fàbregues

, et al. Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study. J Clin Epidem 2019; 111: 49–59.

27.

Hollinghurst

Coast

Busby

, et al. A pragmatic randomised controlled trial of ‘PhysioDirect’ telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation. BMJ Open 2013; 3: e003406.

28.

Jarl

Hermansson

. A modified walk-in system versus scheduled appointments in a secondary-care prosthetic and orthotic clinic. Prosthetic Orthotic Intern 2017; 42: 483–489.

29.

Salisbury

Montgomery

Hollinghurst

, et al. Effectiveness of physiodirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial. BMJ 2013; 346.

30.

Bachmann

Klint

Jagoda

, et al. Group enrollment and open gym format decreases cardiac rehabilitation wait times. J Cardiopulm Rehabil Prev 2017; 37: 322–328.

31.

Barlow

Liu

Sekulic

. Wheelchair seating assessment and intervention: a comparison between telerehabilitation and face-to-face service. Int J Telerehab 2009; 1: 17–28.

32.

Bishop

Brott

. Why the wait? a new approach to community occupational therapy waiting list management. New Zealand J Occup Ther 2019; 66: 19.

33.

Boak

Dickens

Newson

, et al. Distributed leadership, team working and service improvement in healthcare. Leadersh Healt Serv 2015; 28: 332–344.

34.

Brennen

RA-O

Sherburn

Rosamilia

. Development, implementation and evaluation of an advanced practice in continence and women’s health physiotherapy model of care. ANZJOG 2019; 59: 450–456.

35.

Howard

Jackman

Bongers

, et al. Outcomes of a physiotherapy-led pelvic health clinic. Aust New Zealand Contin J 2018; 24: 43–50.

36.

Langstaff

Martin

Brown

, et al. Enhancing community-based rehabilitation for stroke survivors: creating a discharge link. Top Stroke Rehab 2014; 21: 510–519.

37.

Lee

Jones

Corcoran

, et al. A UK hospital based multidisciplinary balance clinic run by allied health professionals: first year results. The J Laryngol Otolog 2011; 125: 661–667.

38.

Mallett

Bakker

Burton

. Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting? Musculosk Care 2014; 12: 251–260.

39.

Phillips

Shoemaker

. Early access to physical therapy and specialty care management for American workers with musculoskeletal injuries. J Occup Environ Med 2017; 59: 402–411.

40.

Rymaszewski

Sharma

McGill

, et al. A team approach to musculo-skeletal disorders. Ann R Coll Surgeons Engl 2005; 87: 174–180.

41.

Holdsworth

Webster

McFadyen

. Are patients who refer themselves to physiotherapy different from those referred by GPs? Results of a national trial. Physiotherapy 2006; 92: 26–33.

42.

Brennen

RLE

MacRae

Irving

, et al.

Can a patient-focussed bookings approach reduce patient non-attendance in postnatal and continence physiotherapy?

J Pub Health 2020; 42: 155–160.

43.

Kasbekar

Mullin

Morrow

, et al. Development of a physiotherapy-led balance clinic: the Aintree model. J Laryngol Otolog 2014; 128: 966–971.

44.

Harding

Bottrell

. Specific timely appointments for triage reduced waiting lists in an outpatient physiotherapy service. Physiotherapy 2016; 102: 345–350.

45.

Harding

Taylor

Leggat

, et al. Effect of triage on waiting times for community rehabilitation: a prospective cohort study. Arch Phys Med Rehabil 2012; 93: 441–445.

46.

Ojha

Wyrsta

Davenport

, et al. Timing of physical therapy initiation for nonsurgical management of musculoskeletal disorders and effects on patient outcomes: a systematic review. J Orthopaedic Sports Phys Therap 2016; 46: 56–70.

47.

OCDE . Health at a glance 2019: OECD indicators. In: Access to Care Coverage for Health Care. Paris, France: OECD Publishing, 2019.

48.

Robert

Stevens

. Should general practitioners refer patients directly to physical therapists? Br J Gen Pract 1997; 47: 314–318.

49.

Lafrance

SA-O

Lapalme

Méquignon

, et al. Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis. Eur Spine J 2020; 30(4): 990–1003. DOI: 10.1007/s00586-020-06648-5.

, et al. Teledermatology for the diagnosis and management of skin cancer: a systematic review. JAMA Dermat 2017; 153: 319–327.

, et al. Telerehabilitation: review of the state-of-the-art and areas of application. JMIR Rehabil Assistive Tech 2017; 4: 7.

, et al. The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature. Disabil Rehabil 2019; 43(12): 1637–1648. DOI: 10.1080/09638288.2019.1674388.

. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther 2014; 94: 14–30.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.83 MB