Elsevier

Physiotherapy

Volume 88, Issue 3, March 2002, Pages 153-157
Physiotherapy

Audit
Accuracy of Clinical Diagnosis of Internal Derangement of the Knee by Extended Scope Physiotherapists and Orthopaedic Doctors: Retrospective audit

https://doi.org/10.1016/S0031-9406(05)60549-4Get rights and content

Summary

Extended scope physiotherapists (ESPs) were introduced into orthopaedic outpatient clinics in Stockport in 1995 in an attempt to reduce junior doctors' hours. The role of an ESP is diverse and can vary greatly depending on the specialty of the consultant with whom the ESP works. This retrospective audit acknowledges the use of ESPs in orthopaedic outpatient clinics and compares the accuracy of clinical diagnosis of internal derangement of the knee (IDK) by the ESPs with their medical counterparts, including consultant and sub-consultant doctors and surgeons.

All subjects who underwent knee arthroscopy under one consultant over a five-month period in 1998 were included. The clinical diagnosis was noted and compared to the arthroscopic diagnosis. The results of those seen by the ESPs and the orthopaedic surgeons or doctors were compared; 52% of listings by the ESPs were in agreement with arthroscopic findings compared with 37% from the doctors. Arthroscopies were deemed of therapeutic value in 79% of those recorded by doctors and 100% of those listed by ESPs.

The overall accuracy of the orthopaedic team was also analysed against pre-set standards set by the consultant. In all 83% were found to have gained therapeutic benefit from the arthroscopic procedure. In this audit sample the ESP showed a greater agreement between clinical diagnosis and arthroscopic diagnosis than her medical counterparts. The overall standards fell below those pre-set but were notably higher than in other similar studies.

Section snippets

Background

Extended scope physiotherapists (ESPs) were introduced in the late 1980s (Byles and Ling, 1989). Although the exact nature of their role varied between org-anisations, there was increasing recog-nition that senior musculoskeletal phys-iotherapists had the knowledge and experience to carry out some of the clinical assessment duties traditionally performed by doctors in the same field (Hockin and Bannister, 1994). By includ-ing ESPs within clinical teams in outpatient departments, their presence

Purpose

The main aim behind this audit was to establish whether an ESP in one of the orthopaedic outpatient clinics was making reasonable clinical decisions when compared with those of her medical counterparts.

The secondary aim was to establish the overall accuracy of the orthopaedic team and to review standards for diagnostic accuracy in internal derangement of the knee.

Methods

The audit was carried out retrospectively on patients listed for arthroscopy by one orthopaedic consultant's team, comprising one consultant, various specialist registrars, staff grade doctors, senior house officers and an ESP, during a five-month period in 1998. Patients were excluded from the audit if they were specifically listed for arthroscopic ass-essment only. All data were taken from medical notes and information was collected and analysed by one person (JG). The trust's confidentiality

Results

A total of 128 sets of patients' medical notes were examined. Table 1 illustrates the proportion of patients seen by each member of the orthopaedic team. The ESP saw only 23 (18%) of the 128 patients who underwent arthroscopy within the clinic during the five-month period of the audit. The remaining 105 (82%) patients were listed for arthroscopy by the doctors in the orthopaedic team. A breakdown is given in table 1.

The outcomes of each patient were categorised by diagnostic accuracy, and it

Discussion

The main aim of this audit was to establish whether the ESP was making reasonable clinical decisions compared with her medical counterparts. The results suggest that the ESP was actually more accurate than the doctors in listing patients correctly for arthroscopy. The second aim was to establish the overall accuracy of the orthopaedic team and review the standards for diagnostic accuracy. The audit showed that the team's results fell below the standards set.

With regard to the proportion of

Recommendations and Actions

A standard has now been implemented for layout and dictation of clinical notes in order that the clinical diagnosis and action are clear, facilitating both patient care and audit. New avenues for use of ESPs have been initiated in the form of independent triage clinics.

Guidelines have been written on the criteria for listing for an examination under anaesthetic and arthroscopy or conversely an MRI scan under this consultant.

Thirty of the 128 patients who underwent arthroscopy had MRI

Acknowledgement

We are grateful to Dr Joanne Thomas PhD BSc.

References (9)

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Cited by (0)

This paper is based on a presentation at the CSP Annual Congress in October 2001.

1

Mrs Joanna Gardiner MCSP is an extended scope physiotherapist at Stepping Hill Hospital, Stockport.

2

Mr Philip Turner FRCS is a consultant orthopaedic surgeon at Stepping Hill Hospital, Stockport.

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