Triage of knee pain by an Extended Scope Physiotherapist (ESP) in an orthopaedic clinic: A clinical audit

Abstract

BACKGROUND: Extended Scope Physiotherapist (ESP) posts have been set up to reduce long waiting lists in orthopaedic clinics. The purpose of this study was to evaluate the activity and outcomes of an ESP clinic within the Irish health care system. The specific aims were to: (i) examine the proportion of patients managed independently by the ESP, (ii) analyse the accuracy of an ESP's clinical diagnosis, and (iii) to calculate the conversion rate to surgery of patients referred for orthopaedic consultation. METHODS: All knee pain patients referred to the Knee Screening Clinic (KSC) from November 2010 to December 2011 were included in this audit. A prospective audit was carried out in relation to patient demographics, baseline clinical characteristics and a KSC clinical care pathway. Medical records were reviewed retrospectively of patients referred onward for orthopaedic consultation, to investigate their outcomes. RESULTS: 140 patients were included in the study. The ESP independently managed 59.3% of patients. The remaining 40.7% of patients were referred on for orthopaedic surgical consultation. Of these, 84% underwent surgery. ESP clinical diagnostic accuracy was ‘substantial’ (percentage agreement = 88%; κ = 0.795 (95% CI, 0.58–1.00)). CONCLUSIONS: The majority of patients (59.3%) referred to the orthopaedic clinic did not need to see an Orthopaedic Surgeon. The ESP clinical diagnostic accuracy was ‘substantial’ and the high conversion rate to surgery suggests that appropriate patients were referred on for orthopaedic consultation. The results of this study provide some evidence supporting the role of ESPs in orthopaedic triage.