Background/Purpose: An Advanced Physiotherapist Practitioner (APP) role was created in September 2020 at McMaster Children’s Hospital, Ontario, Canada to support the growing demand for service within Pediatric Rheumatology. The APP assesses musculoskeletal focused referrals, orders and interprets investigations and labs, and provides management of these cases under medical directives. The purpose of this study is to evaluate the characteristics and outcomes of patients assessed by the APP as well as to investigate access to care for patients referred to Pediatric Rheumatology.

Methods: A retrospective chart review of initial patient assessments by the APP was performed on patients referred to pediatric rheumatology and triaged to the APP from September 2020 to December 2021. Extracted data included demographic characteristics of patients, wait times, clinical outcomes, and frequency of investigations performed requiring a medical directive.

Results: Initial triage (urgent, semi-urgent or non-urgent) by a Pediatric Rheumatologist assigned 118 patients to the APP. Of these, 70% were female, 61% were 10-15 years old and 50% were referred by primary care providers. The most common reason for referral was joint pain (87%). The APP saw cases from all triage categories including 17 (14%) urgent, 76 (65%) semi-urgent, 25 (21%) non-urgent. Of 17 cases deemed urgent, 14 (82%) were seen within the national benchmark of 4 weeks. After assessment, 25 (21%) had a confirmed rheumatic disease and 93 (79%) were considered non-rheumatic and discharged. A physiotherapy diagnosis was provided in 76 (64%) cases and physiotherapy interventions were provided in 95 (80%) cases. All assigned medical directives were used with imaging most frequent at 67 requisitions.

Conclusion: The base knowledge of a physiotherapist is an asset in this advanced practice role, however medical directives are necessary for the APP to fully perform. Most patients seen by the APP did not have a rheumatic disease and were managed with minimal involvement from a pediatric rheumatologist, potentially decreasing their burden of care. Access to care was improved as wait time benchmarks were met in most cases and the patient journey was shortened by providing immediate physiotherapy interventions. An APP model of care is ideally suited to address workforce shortages in pediatric rheumatology.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-advanced-physiotherapist-practitioner-model-of-care-is-ideally-suited-to-address-workforce-concerns-in-pediatric-rheumatology-a-retrospective-chart-review/