In the face of chronic overcrowding and increasing wait times in Emergency Departments (EDs) globally, healthcare systems are actively seeking sustainable solutions. One of the most promising evolutions in orthopaedic care is the integration of Advanced Practice Physiotherapists (APPs) as first-contact practitioners. A recent qualitative study published in Musculoskeletal Care offers crucial insights into how patients perceive this shift in the care model, specifically within the province of Québec.
Addressing the MSK Burden in Emergency Care
Musculoskeletal disorders (MSKDs) constitute a significant percentage of ED visits. Traditionally, these patients wait hours to see an emergency physician, only to receive conservative management that a physiotherapist is often better equipped to provide. The study by Blondin et al. (2024) investigates the patient experience within a new APP-led model. This research serves as a qualitative component to a broader multicenter, pan-Canadian randomized controlled trial assessing the efficacy and cost-effectiveness of APP intervention.
The findings are particularly relevant for physiotherapists advocating for expanded scope of practice. The study revealed that patients are not merely tolerant of seeing a physiotherapist instead of a physician; they are highly receptive and satisfied with the care pathway.
Perceived Competence and Skill Set
One of the primary themes identified in the semi-structured interviews was the patients’ confidence in the APPs’ skill set. Participants acknowledged that for MSK complaints, physiotherapists possess specific, high-level expertise. Crucially, patients felt comfortable with APPs assuming medical-delegated tasks, such as ordering imaging or prescribing specific medications, which are hallmarks of the Advanced Practice model in Québec.
This challenges the historic apprehension that patients might feel "short-changed" if they do not see a doctor. Instead, the study suggests that the public recognizes physiotherapy as the gold standard for soft tissue and orthopaedic assessment in the acute setting.
Timely Access as a Key Determinant of Satisfaction
The study highlighted that timely access to care was a decisive factor in the acceptability of the APP model. In the chaotic environment of an ED, the ability of an APP to triage, assess, and manage minor MSKDs independently significantly expedites the patient journey. Participants viewed physiotherapists as appropriate first-contact practitioners because they facilitated a faster route to diagnosis and management strategies compared to the traditional physician-led queue.
Implications for the Profession
For the physiotherapy profession, these findings provide qualitative validation to support quantitative data on efficacy. The study suggests that successful implementation of APP models relies not just on clinical outcomes, but on the patient experience. Interestingly, one participant noted that the model could be improved by offering follow-up care, indicating a desire for continuity that physiotherapists are well-positioned to provide.
As healthcare systems evolve, the data supports the conclusion that APPs are a viable, safe, and highly acceptable solution for managing the influx of MSKDs in emergency settings.
References
Blondin, J., Desmeules, F., Matifat, E., & Kechichian, A. (2024). Patients presenting with musculoskeletal disorders in the emergency department: A qualitative study of their experiences when cared by advanced practice physiotherapists in the province of Québec. Musculoskeletal Care. https://pubmed.ncbi.nlm.nih.gov/38943044/
