Advanced scope physiotherapists are venturing into a new area - rheumatology.

While advanced scope physiotherapy roles have made their mark in Australia over the past 15 years in areas such as the emergency department and in orthopaedic and neurosurgery screening clinics, health providers have also begun expanding the dynamic role into rheumatology.

The Eastern States have led the way in implementing advanced scope physiotherapy model of care initiatives for rheumatology patients.

Now, Perth’s Sir Charles Gairdner Hospital in Western Australia has launched the state’s first advanced scope physiotherapy rheumatology screening clinic.

In this service, patients with musculoskeletal conditions who are referred to see a rheumatologist may be directed to an experienced musculoskeletal physiotherapist working in an advanced scope role. The advanced scope physiotherapist will undertake assessment and diagnosis of these patients and determine a management plan. 

Jennifer Persaud, clinical lead of the WA Musculoskeletal Health Network and an advanced scope physiotherapist in Sir Charles Gairdner Hospital’s orthopaedic outpatients department, says the initiative aims to reduce wait times, achieve high patient satisfaction, and improve health outcomes for patients, while freeing up space on the outpatients wait list for patients with rheumatic disease to access specialist rheumatolgist care.

Ms Persaud says the idea for the initiative came from a conversation at a meeting for the WA Musculoskeletal Health Network where Professor Hans Nossent, Head of the Department of Rheumatology at the hospital and member of the Network’s Executive Advisory Group, indicated that at least 40 per cent of patients on the rheumatology wait list had a general musculoskeletal condition, instead of a specific rheumatic disease.

“We were just having a conversation around the table about wait list pressures in general, along with some of the difficulty that patients experience with timely access to see a rheumatology specialist,” she says.

“The conversation developed and we spoke about the model that was occurring in Queensland and we were both keen to explore whether creation of a similar model might be possible in WA. 

“As lead of the network, I was able to connect the right key stakeholders together to enable the discussion to progress and to assist planning for the model to be implemented at its first site in WA.”

From that discussion, the process to launch the advanced scope physiotherapy rheumatology screening clinic took about a year.

The service has been operating two clinics a week since it launched in December. It will run until the end of March, when patient through-put and satisfaction data will be collated and analysed as part of a review into the new service delivery model.

Ms Persaud, who completed her primary physiotherapy degree in the United Kingdom and is a member of the Australian Physiotherapy Association, says advanced practice physiotherapy services offer multiple benefits - reducing waiting times for patients across a range of conditions to ensure timely access to appropriate care and treatment, which works to improve patient satisfaction and health outcomes.

“The benefit is that the advanced scope physiotherapist can assess the patient, direct treatment and link in directly with other clinicians to make advice and recommendations about the kind of treatment that the patient should be receiving,” she says.

“In addition, physiotherapists have expertise in delivering non-surgical/non-medical management, so if referral on for conservative care is indicated, the advanced practice physiotherapist is extremely well placed to be making recommendations around the type of treatment they should be having.

“To use an old phrase, it’s about the patient receiving ‘the right care, delivered at the right time by the right team/person’.

“For example, if a patient has an orthopaedic requirement, they wouldn’t necessarily want to wait a long time on a public hospital list to access a neurosurgeon only to be referred on to someone with expertise in orthopaedics to deliver care.

“Likewise, if a patient has a general musculoskeletal complaint that requires non-surgical and non-medical management, then the advanced scope physiotherapist is best placed to be able to assess and give advice and education right there, face to face, and then to guide treatment moving forwards.”

Ms Persaud says the initiative has received strong support from her medical and surgical colleagues.

“The doctors are patient-centred professionals who value initiatives that result in improvements for patients to access to appropriate care and they’ve really championed these services,” she says.

“It’s also a really useful opportunity for advanced scope physiotherapists to be able to liaise with very senior medical and surgical colleagues and for cross-fertilisation of learning to occur between professions.

“That inter-professional learning experience is a great opportunity in these clinics - where we can learn from each other.”

After witnessing advanced scope physiotherapy flourish in the United Kingdom, Ms Persaud says it’s exciting to see it being rolled out into emerging areas of need in Australia.

“I see patients at the interface who have been waiting a long time to see a medical or surgical specialist but don’t necessarily require that type of specialist management. To be in a position of influence to change that for the benefit of patients, clinicians and the system - is exciting for me,” Ms Persaud says.

“So, I can deliver patient care or assist others to set up similar services that improve access to the right care and streamline the patient journey. 

“Any high value improvement to assist patients has to be a winner.”