Dr Michael Murphy1,2, Dr John Radovanovic1
1Mater Health, Brisbane, Australia, 2The University of Queensland, St Lucia, Australia
The Joint Replacement Clinic (JRC) is an expanded scope substitution model of care at Mater Hospital Brisbane where advanced practice physiotherapists (APP’s) substitute for surgeons in routine post-operative review following uncomplicated hip or knee arthroplasty. The primary aim is to reduce outpatient clinic burden and waitlists. Clinical safety and effectiveness has been established with over 1,000 occasions of service provided by APP’s, less than 5% of those requiring additional review by surgeons and no adverse events (missed complications). As the clinic consolidated it was important to evaluate the satisfaction of patients attending the JRC and compare with those attending surgeon clinics.
Using a modified 9 item Visit-Specific Satisfaction Instrument (VSQ-9), fifty JRC patients and fifty patients attending surgeon clinics were surveyed. The VSQ-9 has been standardised across different care settings to compare satisfaction with different clinicians. Demographic, procedural and satisfaction information was also collected for group comparison. The surveys were handed to patients by administrative staff. Clinicians in the JRC and surgeon clinics were aware of the audit, but blinded to results. Sample means (SD) were calculated for each domain of the VSQ-9. Non-inferiority testing was performed using 95% confidence interval of the adjusted mean difference to examine whether normalised patient satisfaction scores in the JRC group were no worse than those in the surgeon group.
Both groups were highly satisfied (overall domain; 100% of both groups rated good-excellent). Based on average item score, there was strong evidence that satisfaction of the JRC group was non-inferior to the surgeon group (adjusted mean difference (95% CI) in average score (JRC–surgeon): 5.1(-0.3-10.4). Furthermore, in our sample, the mean differences in all but one of the nine domains were in favour of the JRC.
Patients attending an expanded scope physiotherapy arthroplasty review clinic are no less satisfied than those attending traditional surgeon clinics.
Michael Murphy is an advanced practice physiotherapist in orthopaedics at Mater Hospital Brisbane involved with clinical education, research and an expanded scope arthroplasty review clinic.