Background/Purpose: Arthritis affects 4.6 million Canadians and is the leading cause of disability in Canada.  Many Canadians do not have access to a family physician. There are currently 353 rheumatologists practicing in Canada. Of these, 44% are 55 and older. The need for arthritis care in Canada, in the context of limited health human resources, has led to evolving models of care. Extended practice roles for physiotherapists, occupational therapists and nurses have been implemented to address access to care and wait times and thereby decrease the burden of illness. Within our setting, the Advanced Practice Physiotherapist role has expanded to ordering x-rays, laboratory tests and more recently to intra-articular joint injections of the knee and shoulder. The purpose of this study is to evaluate the impact of the Advanced Practice Physiotherapist role in Rheumatology clinics.

Methods: Patient Volumes, wait times, and diagnosis information was  collected from April 2009 using patient service information. Volumes of patients, seen by the Advanced Practice Physiotherapist,  requiring x-ray, laboratory tests and intra-articular joint injection were also collected. Patient satisfaction was collected from April 2009-Sept 2009 on consecutive patients.

Results: The Advanced Practice Physiotherapist had 1711 total patient visits. Wait times in the clinic have trended downward, while overall clinic volumes have remained stable. Diagnosis classification are: Osteoarthritis (40.33%), Inflammatory Arthritis (37.58%), non-articular rheumatism (14.32%), other (4.32%) and chronic pain (3.51%).Patient’s reported being “extremely satisfied” or “very satisfied” with the Advanced Practice Physiotherapist skills/knowledge, recommendations for care, explanation of assessment results and answers given to questions. Intra-articular joint injections have been required for 7.89% of visits, laboratory tests 23.38% of visits and x-rays 16.19% of visits.

Conclusion: The Advanced Practice Physiotherapist role has evolved since April 2009 by gradually expanding the scope of practice to ordering x-rays, laboratory tests and more recently intra-articular joint injections. There has been a positive trend towards decreasing wait times while maintaining overall Rheumatology clinic volumes. Patient satisfaction with the role has been high.  Further research is needed to demonstrate efficacy of intra-articular joint injections performed by the advanced practice physiotherapist as this is a new endeavour for our clinic. Cost effectiveness and efficiency of the model need to be addressed in future.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-an-advanced-practice-physiotherapist-role-in-rheumatology/