Authors, year | Country | Study design | Clinical setting | Aim/objective | Follow-up | Population, n | Intervention | Comparison | Outcomes |
---|---|---|---|---|---|---|---|---|---|
Ashmore et al., 2014 | Ireland | Prospective audit | Knee screening clinic | To examine the proportion of patients managed independently by the ESP; analyse the accuracy of an ESP’s clinical diagnosis; calculate conversion rate to surgery of patients referred for orthopaedic consultation. |  | Patients with knee problems referred from GP or ED, n = 140 (subgroup analysis of IRR n = 57). 46% women, mean age 46.2 (SD 15.9, range 15–85) years. | PT triage (clinical assessment, diagnosis, appropriate management) | Medical imaging and/or surgery | Proportion of patients independently managed by the ESP; clinical diagnostic accuracy; surgical conversion rate |
Daker-White et al., 1999 [23] | United Kingdom | RCT | Orthopaedic outpatient departments at two hospitals | To evaluate the effectiveness and cost effectiveness of specially trained PTs in assessment and management of defined referrals to hospital orthopaedic departments. | Mean (range) 5.5 (3–11) months | Patients with musculoskeletal problems referred from GP for orthopaedic consultation, n = 481 (complete data 191 + 192). 48% women in the PT group, 56% women in the OS group. Mean age (range) PT vs OS group 48.4 (17–87) years vs 48.6 (19–89) years. | Initial assessment + management by PT in extended role | Initial assessment + management by post-fellowship junior OS | Primary: Patient-centered measures of pain, functional disability, perceived handicap, self-efficacy, general health status, psychological status, health-related quality of life Secondary: Patient and GP satisfaction |
Desmeules et al., 2013 [20] | Canada | Prospective inter-rater agreement study | Orthopaedic outpatient hospital clinic | To assess the diagnostic agreement of an APP compared to OS as well as to assess treatment concordance, healthcare resource use and patient satisfaction with this model. |  | Patients with hip and knee complaints referred from GP for initial consultation n = 120. 54% women, mean age 54.1 years. | PT assessment, diagnosis, triage recommendations (conservative or surgical management) | OS assessment, diagnosis, triage recommendations (conservative or surgical management) | Primary: inter-rater agreement for diagnosis, triage, treatment recommendations and imaging tests ordered. Secondary: Patient satisfaction |
Dickens et al., 2003 [70] | United Kingdom | Prospective inter-rater agreement study | Outpatient knee clinic | To examine the ability of experienced PTs to make a correct diagnosis of patients presenting with acute knee injuries and to manage the diagnosis safely and effectively. |  | Patients with acute knee injuries, n = 50. 28% women, age 16–34 years. | PT assessment, diagnosis and management decisions (conservative/ surgical) | OS assessment, diagnosis and management decisions (conservative/ surgical) | Primary: Level of agreement between PT and OS. Secondary: Sensitivity, specificity and accuracy of clinicians’ diagnosis and management. |
Jovic et al., 2019 [68] | Australia | Prospective inter-rater agreement study | Orthopaedic department, Hospital | To correlate the clinical skills of an ASP with the clinical standard of an OS across several domains, including diagnostic accuracy and treatment plan concordance. |  | Patients referred for hip or knee pain, n = 87. 51% women, mean age 67 (range 50–84). | ASP clinical examination including history and clinical assessment, diagnosis and treatment decision (surgical/ conservative/ further review needed). | OS assessment, diagnosis and treatment decision (surgical/conservative or further review needed). | Primary: diagnostic and treatment ability of the ASP Secondary: benefits on clinic efficiency and patient satisfaction |
Lowry et al., 2020 [69] | Canada | Prospective cross-sectional concordance study | Orthopaedic outpatient clinic | To evaluate the diagnostic, surgical triage, and medical imaging agreement between APPs and OSs for the management of patients with shoulder pain; to compare patient satisfaction toward services provided by APPs and OSs. |  | Patients referred for shoulder pain, n = 50. 40% women, mean age 51.2 (yr +/−15.3). | APP clinical evaluation, diagnosis, further tests, treatment approach (conservative/ surgical/ referral to another medical specialist) | OS clinical evaluation, diagnosis, further tests, treatment approach (conservative/ surgical/ referral to another medical specialist) | Primary: diagnostic and treatment approach agreement. Secondary: imaging request agreement, patient satisfaction |
MacKay et al., 2009 [71] | Canada | Prospective inter-rater agreement study | Hospital | To compare the clinical recommendations of specially trained PTs with those of an OS on appropriateness to be seen by an OS; and candidacy and willingness to undergo TJR; to examine their recommendations for non-surgical management and agreement on clinical diagnosis. |  | Patients referred for hip and knee problems with a diagnosis of arthritis, n = 62. 59% women, mean age 59.7, (range 33–85) years. | PT clinical assessment, diagnostics, treatment recommendations. | OS clinical assessment, diagnostics, treatment recommendations. | Primary: recommendations for OS consultation, recommendations for undergoing TJR. Secondary: recommendations for non-surgical management and agreement on clinical diagnosis |
Marks et al., 2016 [67] | Australia | Blinded inter-rater agreement study | Orthopaedic outpatient setting | To establish the level of agreement between a PT and an OS regarding diagnosis, management and corticosteroid injection, in a representative sample of orthopaedic shoulder referrals |  | Patients with shoulder problems referred from GP to orthopaedic hospital, n = 274. 49% were women, mean age 57.9 (SD 13.0) years. | Clinical assessment by the PT, diagnosis, management plan | Clinical assessment by the OS, diagnosis, management plan | Primary: management and subacromial corticosteroid injection decisions. Secondary: level of diagnostic and investigation agreement. |
Napier et al., 2013 [66] | Canada | Prospective observational trial | Orthopaedic clinic | To investigate the effectiveness of a PT triage service for orthopaedic surgery referrals from primary care physicians. |  | Patients with shoulder or knee problems referred from GP or ED with shoulder or knee (n = 45). 58% women, median age 47 (range 21–75) years. | PT assessment and categorisation as surgical or non-surgical (could be managed conservatively), needing further investigation or tests. | OS assessment and categorisation as surgical, non-surgical (could be managed conservatively), needing further investigation or tests. | Level of agreement, surgical conversion rate (SCR). Patient satisfaction |
Oldmeadow et al., 2007 [19] | Australia | Prospective observational trial | Orthopaedic outpatient hospital department | To investigate the impact, quality and acceptability of a MSK screening clinic, provided by PT for patients referred to the outpatient orthopaedic department at a major metropolitan hospital |  | Patients with MSK related knee, shoulder or back pain (with or without leg-pain) referred from GPs, n = 45 (subgroup analysis n = 38). 60% women, mean age 58.6 (range 29–83) years. | PT screenings; comprehensive assessment, provisional diagnosis, management plan. | OS consultation; diagnoses and management decision | Level of agreement between the PT and OS on diagnoses and management decision. Levels of satisfaction (pt, GP, OS) |
Razmjou, 2013 [72] | Canada | Prospective observational trial | Tertiary care centre | To examine the role of an APP with respect to agreement with OS on diagnosis and management of patients with shoulder problems; wait times; and satisfaction with care |  | Patients with shoulder complaints referred to a shoulder specialist, n = 100. 37% women, mean age 57 (SD 14; range 19–92) years. For satisfaction with care, n = 247 (similar age distribution). | PT patient history, assessment, diagnosis, management plan | OS patient history from PT, assessment, diagnosis, management plan | Agreement on clinical diagnosis, management (investigations, indications for surgery). Wait time Satisfaction. |
Sweden | RCT | Primary care | To evaluate PT-led orthopaedic triage of patients referred for orthopaedic consultation compared with standard practice in primary care; to report a long-term evaluation of patient-reported health-related quality of life, pain-related disability, and sick leave; to evaluate patients’ perceived quality of care. | 3,6,12 months | Patients referred from GP with subacute or persistent MSK pain, n = 203. PT vs standard practice group 56% women, mean age 51 (range 18–67) years vs 55% women, mean age 53 (range 21–57) years. | PT-led orthopaedic triage; assessment, diagnosis, management pathway. Brief treatment. | OS assessment diagnosis, management pathway. Advice, prescriptions or injections, when appropriate. | Selection accuracy for orthopaedic intervention (i.e. surgical conversion rate) and other referrals, waiting time. PROMS; Self-reported health state (EuroQol VAS), health related quality of life (EQ-5D-3L) pain related disability (Pain Disability Index), sick leave. PREMS; perceived quality of care focusing on the caregivers’ medical-technical competence and identity-oriented approach; the extent to which patients’ expectations were met, patients’ intention to follow advice |