Ep 204: Expanding roles for musculoskeletal rehabilitation clinicians, with Dr Simon Lafrance
Nov 25, 2024
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Dr. Simon Lafrance, a physiotherapist and researcher at the University of Montreal, dives into the pressing challenges in our healthcare system, particularly the growing wait times for musculoskeletal care. He discusses innovative models where physiotherapists lead as the first point of contact, enhancing patient access and reducing costs. Simon also explores the evolution of physiotherapists' roles in rehabilitation, the effectiveness of treatment approaches for spine pain, and how personalized care can transform patient satisfaction and outcomes.
Advanced practice physiotherapy can alleviate healthcare system strains by empowering physiotherapists to take on diagnostic and triaging roles traditionally held by doctors.
Recent trials indicate that single-session care for spine pain provided by advanced practice physiotherapists can match the efficacy of multiple sessions, highlighting innovative approaches to treatment.
Deep dives
Challenges in Accessing Musculoskeletal Healthcare
Access to specialist musculoskeletal healthcare has significantly declined over the years due to increasing wait times for treatment. For instance, in Canada, the time from a general practitioner referral to a specialist has ballooned from approximately nine weeks in the early 1990s to around 27 weeks today. This decline is attributed to a growing number of musculoskeletal disorders and a healthcare model that struggles to meet current demands. The need for innovative solutions, such as advanced practice physiotherapy models, is essential to improve patient access and reallocate the responsibilities traditionally held by medical doctors.
Advanced Practice Physiotherapy as a Solution
Advanced practice physiotherapy offers a promising alternative to traditional healthcare models by allowing physiotherapists to take on roles typically filled by doctors, such as diagnosing and triaging patients. This shift can lead to improved access to care, particularly for non-surgical patients requiring timely evaluations. Evidence shows that implementing these advanced roles in various healthcare settings, including primary care and emergency departments, has reduced referral rates to surgeons, alleviating the burden on specialists. Consequently, enhancing the role of physiotherapists could streamline care delivery and ensure that patients receive appropriate treatment at the right time.
Evaluating the Value of Care Models
A recent trial exploring different treatment approaches for spine pain indicated that single-session care provided by advanced practice physiotherapists yielded similar outcomes to that of multiple follow-up sessions, challenging conventional healthcare practices. Patients receiving multiple sessions reported higher satisfaction, although both models effectively reduced pain and improved function. Notably, the single-session approach demonstrates the potential for cost savings within the healthcare system, as it prompts a re-evaluation of resource allocation. Ultimately, this emerging evidence suggests that a focus on high-value care should prioritize patient-centered education and exercise recommendations while still addressing concerns regarding follow-up support.
Ballooning wait times, overworked and burnt out staff. No doubt you're only too familiar with the signs of a health system that's under serious strain. And not just since the Covid-19 pandemic.
Simon Lafrance, physiotherapist and researcher from the University of Montreal, explains musculoskeletal care models that flip the traditional medical model of the doctor as the first contact point a patient has with the health system, to a musculoskeletal specialist, like a physical therapist, leading instead.
Simon's clinical work and research work merge as he works to develop and evaluate advance practice physiotherapy models.
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RESOURCES
Trial of single vs. multiple sessions of advanced practice physiotherapy: https://www.jospt.org/doi/10.2519/jospt.2024.12618
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