Impacts of an Advanced Practice Physiotherapy Model of Care for Adults With a Peripheral Musculoskeletal Disorders Referred to an Orthropaedic Outpatient Clinic

Study Overview
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Brief Summary
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The goal of this prospective observational study is to evaluate advanced practice physiotherapy and orthopedic surgeon care and clinical outcomes for new patients with a peripheral musculoskeletal disorders consulting at the orthopedic outpatient clinic of the Hôpital Jean-Talon. The main questions it aims to answer are: 1. To describe the models of care at the Hôpital Jean-Talon orthopedic outpatient clinic; 2. To assess change in pain, disability, quality of life and pain catastrophizing at 6, 12 and 26 weeks after the initial evaluation; 3. To assess interprofessional collaboration between the advanced practice physiotherapists and orthopedic surgeons; 4. To assess patient satisfaction with care; 5. To assess waiting time before an initial consultation. Researchers will compare patients cared in the advanced practice physiotherapy and orthopedic surgeon group and the orthopedic surgeon only group.

Official Title
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Impacts of an Advanced Practice Physiotherapy Model of Care for Adults With a Peripheral Musculoskeletal Disorders Referred to an Orthropaedic Outpatient Clinic: a Prospective Observational Study

Conditions
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Musculoskeletal Disorders

Intervention / Treatment
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* Other: Advanced practice physiotherapy and orthopedic surgeon management
* Other: Orthopedic surgeon management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults with peripheral musculoskeletal disorders New consultation at the Hôpital Jean-Talon orthopedic outpatient clinic Legally able to consent Understand and speak French or English Beneficiaries of the provincial universal health insurance coverage (RAMQ) Exclusion Criteria: Patients directly referred from the emergency department (not considered as patients referred to the outpatient clinic).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Advanced practice physiotherapy and orthopedic surgeon group<br>Patients cared by both an advanced practice physiotherapist and an orthopedic surgeon. | Other: Advanced practice physiotherapy and orthopedic surgeon management<br>* Management of their musculoskeletal condition by an advanced practice physiotherapist and an orthopedic surgeon.<br>|
| Orthopedic surgeon only group<br>Patients cared only by an orthopedic surgeon. | Other: Orthopedic surgeon management<br>* Management of their musculoskeletal condition by an orthopedic surgeon.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Brief pain inventory severity | Pain questionnaire (0-10; higher score=worse) | 6 weeks (change from baseline) | 
| Brief pain inventory severity | Pain questionnaire (0-10; higher score=worse) | 12 weeks (change from baseline) | 
| Brief pain inventory severity | Pain questionnaire (0-10; higher score=worse) | 26 weeks (change from baseline) | 
| Brief pain inventory inventory | Pain interference (disability) questionnaire (0-10; higher score=worse) | 6 weeks (change from baseline) | 
| Brief pain inventory inventory | Pain interference (disability) questionnaire (0-10; higher score=worse) | 12 weeks (change from baseline) | 
| Brief pain inventory inventory | Pain interference (disability) questionnaire (0-10; higher score=worse) | 26 weeks (change from baseline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shortened Disability of the Arm, Shoulder and Hand (QuickDASH) | Disability questionnaire for upper extremity disorders (0-100; higher=worse) | 6 weeks (change from baseline) | 
| Shortened Disability of the Arm, Shoulder and Hand (QuickDASH) | Disability questionnaire for upper extremity disorders (0-100; higher=worse) | 12 weeks (change from baseline) | 
| Shortened Disability of the Arm, Shoulder and Hand (QuickDASH) | Disability questionnaire for upper extremity disorders (0-100; higher=worse) | 26 weeks (change from baseline) | 
| Hip disability and Osteoarthritis Outcomes Score (HOOS) | Disability questionnaire for hip disorders (0-100; higher=better) | 6 weeks (change from baseline) | 
| Hip disability and Osteoarthritis Outcomes Score (HOOS) | Disability questionnaire for hip disorders (0-100; higher=better) | 12 weeks (change from baseline) | 
| Hip disability and Osteoarthritis Outcomes Score (HOOS) | Disability questionnaire for hip disorders (0-100; higher=better) | 26 weeks (change from baseline) | 
| Knee injury and Osteoarthritis Outcomes Score (KOOS) | Disability questionnaire for knee disorders (0-100; higher=better) | 6 weeks (change from baseline) | 
| Knee injury and Osteoarthritis Outcomes Score (KOOS) | Disability questionnaire for knee disorders (0-100; higher=better) | 12 weeks (change from baseline) | 
| Knee injury and Osteoarthritis Outcomes Score (KOOS) | Disability questionnaire for knee disorders (0-100; higher=better) | 26 weeks (change from baseline) | 
| Foot and Ankle Ability Measure (FAAM) | Disability questionnaire for ankle/foot disorders (0-100; higher=better) | 6 weeks (change from baseline) | 
| Foot and Ankle Ability Measure (FAAM) | Disability questionnaire for ankle/foot disorders (0-100; higher=better) | 12 weeks (change from baseline) | 
| Foot and Ankle Ability Measure (FAAM) | Disability questionnaire for ankle/foot disorders (0-100; higher=better) | 26 weeks (change from baseline) | 
| EQ-5D-5L | Health-related quality of life questionnaire (to be converted in QALYs 0-1; higher=better) | 6 weeks (change from baseline) | 
| EQ-5D-5L | Health-related quality of life questionnaire (to be converted in QALYs 0-1; higher=better) | 12 weeks (change from baseline) | 
| EQ-5D-5L | Health-related quality of life questionnaire (to be converted in QALYs 0-1; higher=better) | 26 weeks (change from baseline) | 
| EQ-5D-VAS | Health-related quality of life questionnaire (0-100; higher=better) | 6 weeks (change from baseline) | 
| EQ-5D-VAS | Health-related quality of life questionnaire (0-100; higher=better) | 12 weeks (change from baseline) | 
| EQ-5D-VAS | Health-related quality of life questionnaire (0-100; higher=better) | 26 weeks (change from baseline) | 
| Pain Catastrophizing Scale (PCS) | Health-related quality of life questionnaire (0-50; higher=worse) | 6 weeks (change from baseline) | 
| Pain Catastrophizing Scale (PCS) | Health-related quality of life questionnaire (0-50; higher=worse) | 12 weeks (change from baseline) | 
| Pain Catastrophizing Scale (PCS) | Health-related quality of life questionnaire (0-50; higher=worse) | 26 weeks (change from baseline) | 
| Patient perceptions of team effectiveness (Patient-PTE) | Perceptions of team effectiveness questionnaire (24-144; higher=better) | 0 week (post initial consultation) | 
| modified validated version of the 9-item visit-specific satisfaction questionnaire (VSQ-9) | Patient satisfaction questionnaire (0-100; higher=better) | 0 week (post initial consultation) | 
| Modified MedRisk | Patient satisfaction questionnaire (0-100; higher=better) | 12 weeks | 
| Modified MedRisk | Patient satisfaction questionnaire (0-100; higher=better) | 26 weeks | 
| Provider perceptions of team effectiveness (Prodiver-PTE) | Perceptions of team effectiveness questionnaire (26-156; higher=better) | Through study completion (once) | 
| Waiting time | Waiting time (time in days and minutes) | Pre-intervention | 
| Adverse events | Rate of adverse events | 12 weeks | 
| Adverse events | Rate of adverse events | 26 weeks | 
| Treatment and compliance | Treatment received and % of treatment compliance | 6 weeks | 
| Treatment and compliance | Treatment received and % of treatment compliance | 12 weeks | 
| Treatment and compliance | Treatment received and % of treatment compliance | 26 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Advanced practice, Physiotherapy, Musculoskeletal disorders, Orthopedic, Observation