An Advanced Practice Physiotherapy Spine Triage Service for Adults with Neck and Back Pain: A Feasibility Study

Abstract

Background Adults with degenerative spine disease constitute a significant proportion of referrals to Ontario neurosurgeons. By 2024, the demand is projected to increase by 67%. Wait times for patients to be seen by a spine surgeon in southeastern Ontario are the longest in the province. Purpose of Study A three-phase intervention study was designed to determine whether an Advanced Practice Physiotherapist (APP) Spine Triage model was feasible within the context of the Neurosurgical Referral Clinic. Methods Sample. In Phase I and III, three categories of participants were sampled using a consecutive sampling technique: patients scheduled for a spine assessment; healthcare providers who referred patients to the Neurosurgical Referral/APP Spine Triage Clinic; and, Neurosurgical Referral/APP Spine Triage Clinic and hospital stakeholders. In Phase II, key stakeholders were recruited to participate in the planning and development of the new APP role using a purposive sampling technique. Procedure. Phase I assessed the current Neurosurgical Referral practice using a descriptive observational cross-sectional design. Phase II used a modified case study design to determine the satisfaction with the APP role development process amongst stakeholders while Phase III utilized a cross-sectional multiple methods study design to determine the acceptability and feasibility of this new role. Instruments. Various quantitative and qualitative tools were used to collect data related to demographic and symptom characteristics, self-perceived pain, function, quality of life, wait times, and stakeholder satisfaction. Results The APP Spine Triage Service for adults with neck and back pain was feasible within the context of the Neurosurgical practice with higher rates of stakeholder satisfaction and very strong support for the new model of care. The findings in the current study are in line with existing literature that the APP model provides access to patient-centred care that is timely, informative, coordinated and integrated to better meet the health needs of patients with neck and back pain. Implications The APP model of care will provide early identification of patients for whom non-surgical management has been deemed the most appropriate approach along with education, reassurance, and evidence-based self-management strategies that will be linked to local programs and resources.