An expanded role for physiotherapists can mean better and faster care

In Quebec, physiotherapists are getting involved in treating patients a lot earlier in the process of their care—and that’s a good thing, experts say.

“The idea isn’t that patients shouldn’t seen by doctors but that physiotherapists can be the first point of contact and begin treatment without waiting for the doctor,” said François Desmeules, a professor at Université de Montréal’s School of Rehabilitation and head of its advanced-practice physiotherapy program.

From emergency departments to family medicine groups, advanced practice physiotherapy—where physiotherapists play a greater role in care management and decision-making—is increasingly part of front-line care, much like specialized nurse practitioners.

The benefits are particularly evident at pain clinics, where wait times can be long. One example where this can be seen is the Institut universitaire de gériatrie de Montréal’s chronic-pain management clinic.

“We have a long waiting list and limited resources, so we wanted to improve our patient care,” said François Dubé, an associate clinical professor at UdeM and physiotherapist at the clinic, where an advanced-practice physiotherapy model has been documented in a new study.

The research results were published in March in Physical & Occupational Therapy in Geriatrics.

Treatment sped up

“We already had physiotherapists at the clinic but they saw patients only after the doctor had already assessed them,” Desmeules recalled. As the waiting time to see a physiotherapist is shorter than for a doctor and almost 90 percent of patients benefit from physiotherapy, bringing the physiotherapist in at the start of care was found to speed up treatment.

In all, 65 new patients at the clinic were followed for the purposes of the study between November 2018 and 2020. Some were initially assessed by a physiotherapist and seen by a doctor only later.

The researchers evaluated the patients’ progress and satisfaction three months after the initial consultation. They had planned to follow up again at six and 12 months but the COVID-19 pandemic intervened.

Less waiting, greater satisfaction

The study found modest but encouraging benefits. Seeing a physiotherapist first resulted in patients’ wait time to see a health professional cut by two months, from an average of 230 days to 170 days.

Patients reported a modest improvement in their clinical condition, an important gain for individuals who often experience progressive decline. “These chronic patients have multiple underlying disabilities and degenerative conditions such as osteoarthritis,” said Desmeules.

Patients also reported high levels of satisfaction with their care.

The model of care was interdisciplinary and focused on education and non-pharmacological pain management strategies. “The goal was to help people regain some of the control over their lives that they had lost,” said Dubé. Before coming to a pain clinic, patients have often run a confusing gauntlet of differing kinds of health care.

In the study, the patients who were first assessed by a physiotherapist were also able to join the chronic-pain clinic’s group education program sooner. “Our group program gives more people access to an effective approach earlier in the care pathway,” Dubé explained. “It provides information on the neuroscience of pain and ways to manage it.”

The advanced practice physiotherapy model therefore appears promising and the Institut’s pain clinic continues to use it. “The ultimate goal is to reduce medical consultation time and free up doctors from cases that mainly require physiotherapy,” said Dubé. As a result, physicians would have more time to concentrate on complex, urgent or medically intensive cases, such as patients with opioid dependence, he added.