Developing a competency profile for international standardization of Advanced Practice Physiotherapy
Creators: Tawiah, Andrews Kwabena
Publisher: name: University of Alberta Library
Year: 2022

<p>Background: Advanced practice physiotherapy has been developed as an innovative model of care to manage the rising impact of musculoskeletal conditions. There is evidence that advanced practice roles have improved patient outcomes, improved wait times for patients, and reduced the cost of care. However, there is currently no internationally agreed-upon competency framework to shape the direction and training of advanced practice physiotherapists. This lack of a competency framework has resulted in confusion and inconsistencies with the development and training of practitioners.</p>

<p>Objective: The overall aim of this thesis was to develop a competency profile as a framework to support the development of international competencies for advanced practice physiotherapy. The specific objectives were to investigate the status of advanced practice physiotherapy within the global physiotherapy community, identify the currently available literature (published or grey) on advanced practice physiotherapy competencies, seek the opinion of stakeholders on the competencies, and validate the competencies for advanced practice physiotherapist.</p>

<p>Method: The process of developing the competencies involved three distinct but interrelated studies. Study 1 was a scoping review of the available literature (published and grey) on the competencies of advanced practice physiotherapists. The scoping review followed the Arksey and O’Malley framework by searching four online databases (CINAHL plus, MEDLINE Ovid, PubMed and Scopus). Additionally, websites of national physiotherapy associations and government agencies were screened for additional documents. The scoping review resulted in a first draft of competencies.<br>
Study 2 was a qualitative study with four focus groups to generate feedback on the first draft of competencies. This study used a qualitative descriptive approach with a thematic analysis of the data. The findings from the focus groups led to the development of a refined version of the competencies (Second draft).<br>
The final study (Study 3) was a cross-sectional online survey to validate (face validity) the second draft of competencies. Participants rated the importance of each competency on a five-point agreement Likert scale (“strongly disagree”, “disagree”, “neither disagree nor agree”, “agree”, “strongly agree”). Each competency was then ranked as either “high”, “medium,” or “low” based on a cumulative ranking of participants who answered “agreed” or “strongly agreed”. All the competencies ranked as “high” were and considered validated. The survey produced a list of validated competencies. The competencies developed after each study were reviewed by subject matter experts before proceeding to the subsequent study.</p>

<p>Results: In Study 1, 19 documents were retrieved with 13 reports and 6 research papers. Six documents (4 reports, 1 research paper, and 1 doctoral thesis) were from England. One policy document each was from Northern Ireland, Scotland, and Wales. Five documents (3 research papers and 2 reports) were from Australia, and one report was from Wales. Finally, 3 documents (2 reports and 1 research paper) were from Canada. The similarities and differences between the documents retrieved were mapped out to develop the first draft of 27 competencies under 7 domains. <br>
In Study 2, 16 participants from the United Kingdom, Ireland, Australia, New Zealand, and Canada participated in the focus groups. Participants were advanced practice physiotherapists, researchers, and administrators. Five themes were generated from the analysis of the data: (1) Clinical expertise, (2) Experienced communicator, (3) Strong leadership skills, (4) Collaboration, and (5) Knowledge creation and dissemination. A refined version (second draft) of the competencies, comprised of 24 competencies grouped under 6 domains, was developed based on the findings from the focus groups.<br>
Study 3 had 99 participants, with 25% from Australia or Canada, 18% from New Zealand or the United Kingdom, 9% from Ireland, and 4% from other countries (Switzerland and Argentina). All the competencies presented were validated with a “high” ranking. Additionally, the competencies associated with patient care (i.e., clinical expertise, communicator, and collaborator) were ranked relatively higher than those not associated with patient care, such as leadership, advocacy, scholar and professional. </p>

<p>Conclusion: This thesis work provides 24 validated competencies under six domains (Clinical expertise; Communicator; Collaborator, Leader and Health Advocate; Scholar and Professional). Competencies directly related to clinical practice and patient care were central to the advanced practice role, compared to those not directly related to clinical care. The competencies developed from this thesis work can serve as a framework towards the international standardization of advanced practice physiotherapy.</p>