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Evaluation of Extended Scope Physiotherapists in an Orthopaedic Outpatient Shoulder Clinic

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ClinicalTrials.gov Identifier: NCT03343951
Recruitment Status : Completed
First Posted : November 17, 2017
Last Update Posted : August 15, 2018
Sponsor:
Information provided by (Responsible Party):
Central Jutland Regional Hospital

Brief Summary:
This study investigates the agreement between extended scope physiotherapists (ESP) and orthopaedic surgeons (OS) on diagnosis and treatment plan in an orthopaedic outpatient shoulder clinic. Furthermore a cost analysis and an evaluation of the interdisciplinary collaboration at the orthopaedic outpatient shoulder clinic (termed shoulder clinic in the following) will be performed.

Condition or disease Intervention/treatment
Shoulder Injuries and Disorders Shoulder Pain Musculoskeletal Pain Other: Examination

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Study Type : Observational
Actual Enrollment : 69 participants
Observational Model: Cohort
Time Perspective: Cross-Sectional
Official Title: Clinical Examination by Extended Scope Physiotherapists and Orthopaedic Surgeons in an Outpatient Shoulder Clinic: Agreement on Diagnosis and Treatment Plan and Evaluation of Costs and Organisation
Actual Study Start Date : November 17, 2017
Actual Primary Completion Date : April 13, 2018
Actual Study Completion Date : June 19, 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Health Checkup

Group/Cohort Intervention/treatment
Shoulder patients
Shoulder patients referred to examination at the shoulder clinic, Silkeborg Regional Hospital.
Other: Examination

Patients will be examined twice the same day by an extended scope physiotherapist (ESP) and an orthopaedic surgeon (OS) in random order. They will independently and blinded to each other's opinion register

  • diagnosis and treatment plan (including need for further diagnostic examinations - i.e. imaging)
  • if the patient needs a new appointment at the shoulder clinic
  • if they under usual conditions would discuss their results with the opposite health professional before deciding diagnosis and treatment plan.

After the individual examinations the ESP and OS discuss their results and come to an agreement (common decision) regarding the patient's diagnosis, treatment plan and need of a new appointment. Patients will be informed only of the common decision of the ESP and OS.





Primary Outcome Measures :
  1. Treatment plan - orthopaedic surgeon [ Time Frame: Baseline ]
    Treatment plan suggested by the OS will be registered in a chart developed for the occasion. The chart has 5 pre-defined categories: 1) referral to physiotherapy, 2) referral to diagnostic examination, 3) steroid injection, 4) surgery and 5) no intervention (categorical)

  2. Treatment plan - physiotherapist [ Time Frame: Baseline ]
    Treatment plan suggested by the ESP will be registered in a chart developed for the occasion. The chart has the same 5 pre-defined categories as for the OS: 1) referral to physiotherapy, 2) referral to diagnostic examination, 3) steroid injection, 4) surgery and 5) no intervention (categorical)

  3. Treatment plan - common decision [ Time Frame: Baseline ]
    The OS and ESP will discuss their results until they agree which treatment plan to offer the patient. Their decision will be registered in a chart developed for the occasion. The chart has the same 5 pre-defined categories as for the individual examinations: 1) referral to physiotherapy, 2) referral to diagnostic examination, 3) steroid injection, 4) surgery and 5) no intervention (categorical)


Secondary Outcome Measures :
  1. Diagnosis - orthopaedic surgeon [ Time Frame: Baseline ]
    One primary diagnosis (and if relevant secondary diagnoses) suggested by the OS will be registered in a chart developed for the occasion. The chart has 9 pre-defined categories of diagnoses: 1) impingement, 2) rotator cuff injury, 3) glenohumeral instability, 4) glenohumeral osteoarthritis, 5) periarthritis humeroscapularis, 6) scapular instability, 7) fracture sequelae, 8) acromioclavicular joint disorder, 9) non-related shoulder diagnoses (categorical).

  2. Diagnosis - physiotherapist [ Time Frame: Baseline ]
    One primary diagnosis (and if relevant secondary diagnoses) suggested by the ESP will be registered in a chart developed for the occasion. The chart has the same 9 pre-defined categories of diagnoses as for the OS (categorical).

  3. Diagnosis - common decision [ Time Frame: Baseline ]
    The OS and ESP will discuss their results until they agree on patient diagnosis. Their decision will be registered in a chart developed for the occasion. The chart has the same 9 pre-defined categories of diagnoses as for the individual examinations (categorical).

  4. New appointment - orthopaedic surgeon [ Time Frame: Baseline ]
    The OS registers whether he considers, that the patient should be offered a new appointment at the shoulder clinic (categorical, yes/no)

  5. New appointment - physiotherapist [ Time Frame: Baseline ]
    The ESP registers whether he/she considers, that the patient should be offered a new appointment at the shoulder clinic (categorical, yes/no)

  6. New appointment - common decision [ Time Frame: Baseline ]
    The OS and ESP will discuss their results until they agree, whether the patient should have a new appointment at the shoulder clinic or not. Their decision will be registered (categorical, yes/no)

  7. Discussion needed - orthopaedic surgeon [ Time Frame: Baseline ]
    The OS registers whether he under usual conditions would discuss his results with an ESP before making a decision on diagnosis or treatment plan (categorical, yes/no).

  8. Discussion needed - physiotherapist [ Time Frame: Baseline ]
    The ESP registers whether he/she under usual conditions would discuss his/her results with an OS before making a decision on diagnosis or treatment plan (categorical, yes/no).


Other Outcome Measures:
  1. Salary - orthopaedic surgeon, first clinical examination [ Time Frame: Baseline ]
    Mean expenditure on salary for an OS performing a clinical examination of a shoulder patient at the first visit. The estimate will be calculated based on time spent on the examination and mean salary for an OS (information on mean salary will be obtained from statistics at the finance department at the hospital)

  2. Salary - orthopaedic surgeon, planned new appointment [ Time Frame: Baseline ]
    Mean expenditure on salary for an OS performing a follow up appointment with a shoulder patient. The estimate will be calculated based on time spent on the appointment and mean salary for an OS (information on mean salary will be obtained from statistics at the finance department at the hospital)

  3. Salary - extended scope physiotherapist, first clinical examination [ Time Frame: Baseline ]
    Mean expenditure on salary for an ESP performing a clinical examination of a shoulder patient at the first visit. The estimate will be calculated based on time spent on the examination and mean salary for an ESP (information on mean salary will be obtained from statistics at the finance department at the hospital)

  4. Salary - extended scope physiotherapist, planned new appointment [ Time Frame: Baseline ]
    Mean expenditure on salary for an ESP performing a follow up appointment with a shoulder patient. The estimate will be calculated based on time spent on the appointment and mean salary for an ESP (information on mean salary will be obtained from statistics at the finance department at the hospital)

  5. Costs - computed tomography (CT) imaging [ Time Frame: Baseline ]
    Expenditure on CT imaging. Estimate obtained from the finance department at the hospital.

  6. Costs - magnetic resonance (MR) imaging [ Time Frame: Baseline ]
    Expenditure on MR imaging. Estimate obtained from the finance department at the hospital.

  7. Costs - MR arthrography [ Time Frame: Baseline ]
    Expenditure on MR arthrography. Estimate obtained from the finance department at the hospital.

  8. Costs - electroneurography (ENG) [ Time Frame: Baseline ]
    Expenditure on ENG. Estimate obtained from the finance department at the hospital.

  9. Costs - electromyography (EMG) [ Time Frame: Baseline ]
    Expenditure on EMG. Estimate obtained from the finance department at the hospital.

  10. Costs - X-ray [ Time Frame: Baseline ]
    Expenditure on X-ray. Estimate obtained from the finance department at the hospital.



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Patients with shoulder problems referred to the shoulder clinic at Silkeborg Regional Hospital.
Criteria

Inclusion Criteria:

  • Above the age of 18 years
  • Referred to The Shoulder Clinic at Silkeborg Regional Hospital
  • Considered equally appropriate to be examined by an ESP or an OS
  • Ability to read and understand Danish

Exclusion Criteria:

  • None

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03343951


Locations
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Denmark
Silkeborg Regional Hospital
Silkeborg, Denmark, 8600
Sponsors and Collaborators
Central Jutland Regional Hospital
Investigators
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Principal Investigator: Merete N Madsen, MSc Silkeborg Regional Hospital
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Central Jutland Regional Hospital
ClinicalTrials.gov Identifier: NCT03343951    
Other Study ID Numbers: 654821
First Posted: November 17, 2017    Key Record Dates
Last Update Posted: August 15, 2018
Last Verified: February 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Central Jutland Regional Hospital:
Physical Therapists
Diagnosis
Clinical Competence
Interprofessional Relations
Cost Analysis
Additional relevant MeSH terms:
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Shoulder Pain
Musculoskeletal Pain
Shoulder Injuries
Arthralgia
Joint Diseases
Musculoskeletal Diseases
Pain
Neurologic Manifestations
Muscular Diseases
Wounds and Injuries