Physiotherapy assistants in the musculoskeletal outpatients setting

Purpose

Physiotherapy assistants accounted for approximately 20% of the physiotherapy workforce across Stoke on Trent Community Health Services. Although their job descriptions clearly stated that the post was primarily clinical, their role depended heavily on the qualified physiotherapists and how they utilised the clinical skills of physiotherapy assistants. As a result in some clinics/clinical areas physiotherapy assistants had a predominant clinical role whereas in others they fulfilled what was primarily an administrative role. This latter trend led to physiotherapy assistants not being able to utilise their clinical skills and to job dissatisfaction as well as disparity in the clinical service provided to patients of equal clinical needs.

Approach

An audit of the physiotherapy assistants' tasks was carried out to reveal whether the physiotherapy assistants' time spent on clinical tasks complied with the Job Descriptions. This included assessing the physiotherapy assistants' job satisfaction with a self-completed questionnaire. Using the audit improvement cycle, pathway mapping of specific anatomical areas was performed with the aim of identifying which parts of treatment can be carried out by physiotherapy assistants, clarifying the physiotherapy assistants' clinical role and standardising treatments. Additionally, a competences and training needs analysis was completed and all physiotherapy assistants were trained before the developed pathways were implemented. A pilot study and a focus group were conducted to assess the impact of the early implementation of the pathways. Finally, the physiotherapy assistants' practice was re-audited and job satisfaction questionnaires were redistributed after the pathways were fully implemented.

Outcomes

The results showed that prior to the implementation of the pathways the physiotherapy assistants spent 9% of their working time treating patients. This percentage increased to 16% following the implementation of the pathways. The results from the pilot study showed that all patients who were treated with the clinical pathways and completed their course of treatment were discharged having improved clinical outcomes. The focus group analysis demonstrated that both the qualified physiotherapists and the physiotherapy assistants were satisfied with the use of the pathways. The results from the questionnaires showed that there was a significant difference in relation to the physiotherapy assistants' job satisfaction which changed from 11% prior to the implementation of the pathways to 100% post implementation.

Implications

Overall the results from this audit indicated that using defined pathways in the treatment of musculoskeletal conditions of the peripheral joints provides the framework to standardise delegation of clinical tasks from qualified physiotherapists to physiotherapy assistants.

The implementation of such pathways in Physiotherapy Services where physiotherapy assistants do not have a primarily clinical role but an administrative one may potentially facilitate the increase in face to face patient contact of physiotherapy assistants as well as in the physiotherapy assistants' job satisfaction. Nevertheless, the utilisation of such pathways needs to be further examined in order to clarify issues such as the clinical and cost effectiveness of delegating clinical work to physiotherapy assistants and the qualified physiotherapists' perceptions which were not fully explored in this audit.

Top three learning points

  • Implementation of treatment pathways may facilitate standardisation of delegation.
  • Clinical engagement is essential when designing such pathways.
  • Increase of face to face patient contact increases physiotherapy assistants’ job satisfaction.

Fund acknowledgements

This audit completed in partial fulfilment of an MBA course which was partially funded by the Chartered Society of Physiotherapy (Charitable Trust, Educational Awards Panel)

Additional notes

Sarigiovannis P, Cropper S. An audit of the utilisation of physiotherapy assistants in the musculoskeletal outpatients setting within a primary care physiotherapy service. Musculoskeletal Care. 2018;1–4.

https://doi.org/10.1002/msc.1238

This work was presented at Physiotherapy UK 2017.

For further information, please contact Panos Sarigiovannis