Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH FRONT

Advanced musculoskeletal physiotherapy clinical education framework supporting an emerging new workforce*

Paula Harding A C , Jonathan Prescott A , James Sayer A and Andrea Pearce B
+ Author Affiliations
- Author Affiliations

A Physiotherapy Department, The Alfred, PO Box 315, Prahran, Vic. 3181, Australia. Email: Jonathan.Prescott@health.vic.gov.au; j.sayer@alfred.org.au

B Physiotherapy Department, Monash Health, Casey Hospital, 52 Kangan Drive, Berwick, Vic. 3806, Australia. Email: Andrea.Pearce@monashhealth.org

C Corresponding author. Email: p.harding@alfred.org.au

Australian Health Review 39(3) 271-282 https://doi.org/10.1071/AH14208
Submitted: 29 October 2014  Accepted: 25 March 2015   Published: 15 June 2015

Abstract

Objective A project, funded by the Department of Health and Human Services, was conducted with the aim of developing a clinical education framework that included an agreed competency standard and credentialing process to support advanced musculoskeletal physiotherapy roles. This paper describes the process undertaken to achieve this and presents the outcomes of implementation.

Methods A multistep approach was taken. Initial steps included conducting a scoping review of the literature and focus groups of advanced musculoskeletal physiotherapists. The project team mapped out the structure of the framework. This was followed by a working party of subject matter experts developing an agreed competency standard. The framework was implemented at six hospitals across Australia and formally evaluated by an external evaluator.

Results The clinical education framework developed includes a competency-based training and assessment program supported by learning resources and a mentoring program. It was successfully implemented across a diverse range of hospitals and received a positive evaluation.

Conclusions As the prevalence of musculoskeletal conditions increases, a new workforce of advanced musculoskeletal physiotherapists is emerging. A clinical education framework has been developed to address the specific needs of the population, organisations and experienced musculoskeletal physiotherapists recruited to these roles. A competent workforce has direct benefits for the community, healthcare organisations and the physiotherapy profession.

What is known about the topic? The uptake and development of advanced musculoskeletal physiotherapy services have increased significantly and are now commonplace in many public hospitals across Australia. There is a need to ensure that physiotherapists working in these roles are suitably educated, trained and competent to perform these expanded roles. Although there has been some work undertaken in this area in the UK, there has been no consistent approach applied with respect to experience, clinical education, training and competency attainment to undertake these roles in Australia.

What does this paper add? This paper introduces a clinical education framework and describes the method undertaken to develop and implement a competency standard and credentialing process to support physiotherapists undertaking advanced musculoskeletal physiotherapy services roles. The clinical education framework was developed collaboratively with experienced clinicians across a range of health services and advanced musculoskeletal physiotherapy roles, ensuring a consistent but flexible approach for the wider implementation of advanced musculoskeletal physiotherapy roles.

What are the implications for practitioners? The clinical education framework provides a comprehensive, consistent and clearly articulated pathway to support physiotherapists undertaking various advanced musculoskeletal physiotherapy roles. The model uses adult learning principles and provides a standard approach for education and assessment. The model is designed to be flexible and adaptable to support the local context, as well as emerging areas of advanced practice.


References

[1]  Horton R. GBD 2010: understanding disease, injury, and risk. Lancet 2012; 380 2053–4.
GBD 2010: understanding disease, injury, and risk.Crossref | GoogleScholarGoogle Scholar | 23245595PubMed |

[2]  Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013; 380 2163–96.
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.Crossref | GoogleScholarGoogle Scholar |

[3]  Arthritis and Osteoporosis Victoria. A problem worth solving. Melbourne: Arthritis and Osteoarthritis Victoria; 2013. Available at: http://www.arthritisvic.org.au/Useful-Information/About-Us/Publications/Budget-Submission-2014/Pre-Budget-submission-December-2013-FINAL.aspx [verified 13 February 2015].

[4]  Victorian Department of Health. Outpatient physio roles expand across services. 2013. Available at: http://www.health.vic.gov.au/healthvictoria/nov13/physio.htm [verified 26 October 2014].

[5]  Australian Physiotherapy Association. Position statement: scope of practice. 2009. Available at: http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Scope_of_Practice_2009.pdf [verified 3 March 2015].

[6]  Brand C, Hunter D, Hinman R, March L, Osborne R, Bennell K. Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia? Int J Rheum Dis 2011; 14 181–90.
Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia?Crossref | GoogleScholarGoogle Scholar | 21518318PubMed |

[7]  Harding P. Easing the burden on orthopaedic outpatient clinics: introductions of a physiotherapy arthroplasty practitioner into a physiotherapy arthroplasty review clinic. Melbourne: Felice Rosemary Lloyd Scholarship; 2010. Available at: http://www.physiotherapy.asn.au/anztrustees [verified 22 April 2015].

[8]  Aitken LSP, Hakkenes S, Exton M, editors. Does the physiotherapy-led neurosurgery access service improve efficiency in the neurosurgical clinic? Proceedings of the Australian Physiotherapy Association Conference: New Moves; 17–20 October 2013; Melbourne. 2013; p. 4. Available at: http://www.physiotherapy.asn.au/DocumentsFolder/CONFERENCE%202013/APA%202013%20Conference%20Abstract%20e-Book%20revised%20with%20index.pdf [verified 22 April 2015].

[9]  Taylor NF, Norman E, Roddy L, Tang C, Pagram A, Hearn K. Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial. Physiotherapy 2011; 97 107–14.
Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 21497244PubMed |

[10]  Harding P, Prescott J. Advanced practice musculoskeletal physiotherapy: a clinical education and competency framework: summary of findings (Appendix 1). Melbourne: Victorian Department of Health; 2012.

[11]  Blackburn MS, Nall C, Cary B, Cowan SM. Physiotherapy-led triage clinic for low back pain. Aust Health Rev 2009; 33 663–70.
Physiotherapy-led triage clinic for low back pain.Crossref | GoogleScholarGoogle Scholar | 20166916PubMed |

[12]  Desmeules F, Roy JS, MacDermid JC, Champagne F, Hinse O, Woodhouse LJ. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord 2012; 13 107
Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22716771PubMed |

[13]  Oldmeadow LB, Bedi HS, Burch HT, Smith JS, Leahy ES, Goldwasser M. Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care. Med J Aust 2007; 186 625–8.
| 17576177PubMed |

[14]  Guengerich M, Brock K, Cotton S, Mancuso S. Emergency department primary contact physiotherapists improve patient flow for musculoskeletal patients. Int J Ther Rehabil 2013; 20 396–402.
Emergency department primary contact physiotherapists improve patient flow for musculoskeletal patients.Crossref | GoogleScholarGoogle Scholar |

[15]  Chehade MJ, Bachorski A. Development of the Australian Core Competencies in Musculoskeletal Basic and Clinical Science project: phase 1. Med J Aust 2008; 189 162–5.
| 18673105PubMed |

[16]  Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods 2014; 5 371–85.
A scoping review of scoping reviews: advancing the approach and enhancing the consistency.Crossref | GoogleScholarGoogle Scholar | 26052958PubMed |

[17]  Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods 2006; 18 59–82.
How many interviews are enough? An experiment with data saturation and variability.Crossref | GoogleScholarGoogle Scholar |

[18]  Strauss AL, Corbin JM. Basics of qualitative research: grounded theory procedures and techniques. Newbury Park, CA: Sage; 1990.

[19]  Lawlor D, Tovey M. Training in Australia, 4th edn. Sydney: Pearson; 2011.

[20]  Western Australian Government. Guidelines for assessing competence in VET. Brisbane: Department of Training and Workforce Development, Western Australian Government, 4th edn; 2012.

[21]  Grudzinskas K. Australian standards for physiotherapy. Canberra: Australian Physiotherapy Council; 2006.

[22]  Thompson C, Quinsey K, Gordon R, Williams K, Eckermann S, Andersen P, Snoek M, Eagar K. Health Workforce Australia expanded scopes of practice program: evaluation framework. 2012. Available at: http://ro.uow.edu.au/ahsri/355/ [verified 12 February 2015].

[23]  Stanhope J, Grimmer-Somers K, Milanese S, Kumar S, Morris J. Extended scope physiotherapy roles for orthopedic outpatients: an update systematic review of the literature. J Multidiscip Healthc 2012; 5 37–45.
| 22359462PubMed |

[24]  Suckley J. Core clinical competencies for extended-scope physiotherapists working in musculoskeletal (MSK) interface clinics based in primary care: a Delphi consensus study. Manchester: University of Salford; 2012. Available at: http://usir.salford.ac.uk/26989/ [verified 12 February 2015].

[25]  Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach 2007; 29 642–7.
The CanMEDS initiative: implementing an outcomes-based framework of physician competencies.Crossref | GoogleScholarGoogle Scholar | 18236250PubMed |

[26]  Manley K. A conceptual framework for advanced practice: an action research project operationalizing an advanced practitioner/consultant nurse role. J Clin Nurs 1997; 6 179–90.
A conceptual framework for advanced practice: an action research project operationalizing an advanced practitioner/consultant nurse role.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2szjt1Wrug%3D%3D&md5=3fee1625c95054da0fcb587a49ba0355CAS | 9188335PubMed |

[27]  CNO Directorate. Supporting the development of advanced nursing practice. CNO Directorate Scottish Government; 2008. Available at: http://www.aanpe.org/LinkClick.aspx?fileticket=giFsLijsCRw%3D [verified 12 February 2015].

[28]  Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, Harris P, Glasgow NJ, Campbell C, Dath D, Harden RM, Iobst W, Long DM, Mungroo R, Richardson DL, Sherbino J, Silver I, Taber S, Talbot M, Harris KA. Competency-based medical education: theory to practice. Med Teach 2010; 32 638–45.
Competency-based medical education: theory to practice.Crossref | GoogleScholarGoogle Scholar | 20662574PubMed |

[29]  Health Workforce Australia. National common health capability resource: shared activities and behaviours in the Australian health workforce. Adelaide: Health Workforce Australia; 2012.

[30]  Australian Qualifications Framework Council. Australian qualifications framework. 2013. Available at: http://www.voced.edu.au/content/ngv54804 [verified 12 February 2015].

[31]  Gonczi A. Competency based assessment in the professions in Australia. Asess Educ 1994; 1 27–44.
Competency based assessment in the professions in Australia.Crossref | GoogleScholarGoogle Scholar |

[32]  Knowles MS. The modern practice of adult education. New York: New York Association Press; 1970.

[33]  Thompson C, Williams K, Morris D, Bird S, Kobel C, Andersen P, Eckermann S, Quinsey K, Masso M. Health Workforce Australia expanded scopes of practice program evaluation: physiotherapists in the emergency department sub-project: final report. 2014. Available at: http://ahsri.uow.edu.au/chsd/projects/esop/index.html [verified 12 February 2015].

[34]  Harding P, Prescott J. Health workforce Australia: expanded scope of practice for physiotherapists in the emergency department: final report. Melbourne: Alfred Health; 2103.

[35]  Albanese MA, Mejicano G, Mullan P, Kokotailo P, Gruppen L. Defining characteristics of educational competencies. Med Educ 2008; 42 248–55.
Defining characteristics of educational competencies.Crossref | GoogleScholarGoogle Scholar | 18275412PubMed |

[36]  NPS. Better choices, better health. Competencies required to prescribe medicines: putting quality use of medicines into practice. Sydney: National Prescribing Service Limited; 2012. Available at: http://www.nps.org.au/health-professionals/cpd/prescribing-competencies-framework [verified 26 October 2014].

[37]  Frank JR. The CanMEDS 2005 physician competency framework: better standards, better physicians, better care. Ottawa: Royal College of Physicians and Surgeons of Canada; 2005.

[38]  Gruppen LD, Mangrulkar RS, Kolars JC. The promise of competency-based education in the health professions for improving global health. Hum Resour Health 2012; 10 43
The promise of competency-based education in the health professions for improving global health.Crossref | GoogleScholarGoogle Scholar | 23157696PubMed |

[39]  Hattam P, Smeathan A. Evaluation of an orthopaedic screening service in primary care. Br J Clin Govern 1999; 4 45–9.
Evaluation of an orthopaedic screening service in primary care.Crossref | GoogleScholarGoogle Scholar |

[40]  Robarts S, Kennedy D, MacLeod AM, Findlay H, Gollish J. A framework for the development and implementation of an advanced practice role for physiotherapists that improves access and quality of care for patients. Healthcare Quart 2008; 11 67–75.
A framework for the development and implementation of an advanced practice role for physiotherapists that improves access and quality of care for patients.Crossref | GoogleScholarGoogle Scholar |

[41]  Victorian Department of Health. Victorian clinical governance policy framework. Melboure: Victorian Department of Health; 2011. Available at: http://health.vic.gov.au/clinrisk/publications/clinical_gov_policy.htm [verified 12 February 2015].