Thursday, March 19, 2020

Physical therapists as diagnosticians for shoulder disorders

Physiotherapists’ ability to diagnose and manage shoulder disorders in an outpatient orthopedic clinic: results from a concordance study

These authors evaluated the diagnostic, surgical triage, and medical imaging agreement between advanced practice physiotherapists (APPs) and orthopedic surgeons (OSs) for the management of patients with shoulder disorders in an outpatient orthopedic clinic.

50 patients referred to an OS for shoulder complaints were recruited and independently assessed by an OS and an APP. Each provider completed a standardized form indicating diagnosis, imaging test requests, and triage of surgical candidates.

Good diagnostic agreement was observed between the OSs and APPs  (k, 0.80; 95% CI, 0.67-0.93).

Agreement for triage of surgical candidates was moderate (k, 0.46; 95% CI, 0.21-0.71) as APPs tended to refer patients more often to OSs for further evaluation. 

Imaging test request agreement was moderate as well (k, 0.42; 95% CI, 0.19-0.66). 

Patient satisfaction with care was high, with no significant differences found between providers (P . .70).

Comment: There is a strong rationale for having physical therapists evaluate patients with non-acute shoulder conditions as shown in this study. The optimal situation is to have the physical therapists seeing patients concurrently with the shoulder surgeon so that surgical consultation can be obtained, if necessary, at the same patient visit. This concurrency also allows the therapist and the surgeon to learn from each other to optimize accuracy and efficiency of evaluation and management. It is comforting for patients to know of a close partnership between PT and MD. A further advantage of this partnership is that surgical patients will often benefit from preoperative and postoperative therapy; this is facilitated if the patient and the PT know each other from the start.

There is a group, known as the American Society of Shoulder and Elbow Therapists, from around the country ( that is built on the principles above.

To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

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