Background
Timely access for orthopaedic spine consultation remains a challenge due to increasing demand and workforce constraints. Integrating advanced physiotherapy practice within orthopaedic services is an emerging strategy to streamline care. While this approach is well adopted in the tertiary sector, it is less explored in secondary care.
Aims
This study evaluates the feasibility of a physiotherapy-integrated joint orthopaedic spine consultation model in private secondary care by looking at the following – consultation outcomes, patient satisfaction, wait times and diagnostic concordance.
Methods
A retrospective review was conducted on patients seen between March and July 2023 using a structured five-step consultation model: (1) physiotherapist-led history, (2) physical examination, (3) imaging review and provisional diagnosis, (4) handover and surgeon validation, and (5) multidisciplinary shared decision-making. Outcomes included management decisions, patient satisfaction (5-item survey), wait times compared with a 2021 pre-model cohort, and a diagnostic concordance sub-study (n=35) which was planned but unavailable at submission.
Results
Among 233 patients (mean 46.8 years; 53.6% male), 89.3% were referred by general practitioners. The predominant presentation was “lower back and associated leg pain” (73.4%).
Non-operative management was referred for in 74.7% of cases, including physiotherapy (51.1%) and musculoskeletal medicine (44.8%). One quarter of patients (25.3%) underwent further surgical workup, with 10.7% proceeding to surgery.
Patient satisfaction was high (overall mean score: 91.3%), with highest ratings for “quality of care” (92.3%) followed by “explanation of treatment/outcomes” (91.7%). Mean wait times were longer than the 2021 cohort (63 vs 43 days), reflecting service growth during the study period.
Conclusions
A physiotherapy-integrated model in private orthopaedic spine care is feasible and highly rated by patients. As most patients are managed non-operatively, appropriately-trained physiotherapists can play an adjunctive role in improving care pathways and enhancing service delivery.