Patient experience of expanded-scope-of-practice musculoskeletal physiotherapy in the emergency department: a qualitative study
Authors: Harding Paula , Prescott Jonathan , Block Lenore , O'Flynn Anne Marie , Burge Angela T. 
Published: April 2015

Objective
The increasing number of people presenting to hospital with musculoskeletal conditions places pressure on existing services, and has resulted in expanding the scope of practice of musculoskeletal physiotherapists working in emergency departments (ED). The aim of the present study was to qualitatively explore the perspectives of patients presenting with an isolated musculoskeletal condition seen by a musculoskeletal physiotherapist in the ED of two Australian hospitals situated in contrasting geographical locations.

Methods
Semistructured interviews were conducted with nine participants from a major metropolitan hospital and 16 participants from a remote hospital. Interviews were transcribed, coded and analysed using a thematic approach.

Results
The emerging themes from the two datasets were remarkably similar, so the final themes were merged. The major themes were: (1) participants were satisfied with the process and service provided by the physiotherapist; (2) the personal attributes of the physiotherapists were important to participants; (3) participant confidence in the skills and attributes of the physiotherapist made them a suitable alternative to a doctor in these situations; and (4) the timing and efficiency of the physiotherapy service was better than expected and valued.

Conclusions
Participants from both settings described their experience in positive terms, reflecting satisfaction with their management by an expanded scope of practice musculoskeletal physiotherapist.

What is known about the topic?
To date, the literature evaluating expanded scope of practice by physiotherapists (or advanced musculoskeletal physiotherapy services) has consistently reported positive participant satisfaction. Participant satisfaction has been typically restricted to the use of standardised questionnaires.

What does this paper add?
To our knowledge, this is the first study to describe the participant experience and perception of being seen by an expanded-scope-of-practice physiotherapist. The study found that the perceptions of participants from two vastly different geographic locations were remarkably similar and that participants were very receptive to seeing a physiotherapist instead of a doctor. The emergent themes highlight what is important to people when they attend the ED and indicate that participants seen by a musculoskeletal physiotherapist had a positive experience regardless of whether it was in a metropolitan or remote hospital.

What are the implications for practitioners?
Patient-centred care should be an underlying principle of all models of service delivery in healthcare. Understanding what is important to patients is imperative to ensure they have a positive experience, particularly when new models of service are being introduced. This study provides valuable information for practitioners about what is important for the patient to have a positive experience when they visit the ED. Participants in this study valued receiving a timely and efficient service in addition to acknowledging the personal attributes, knowledge and expertise of the physiotherapist. The implications for practitioners are that an expanded scope of practice physiotherapy service in the ED can provide a positive patient experience.