Physiatry-physiotherapy interdisciplinary project (PHY2): service evaluation of a new caregiving model for musculoskeletal pain by advanced practice physiotherapists in the physiatry department

Objective To describe a collaborative care model combining advanced practice physiotherapists (APPs) and physiatrists while addressing a gap in the existing literature. Design Single-center prospective descriptive cohort study. Setting Outpatient clinic of the physiatry department of a tertiary academic medical center. Participants 300 patients referred by specialists within the same academic center. All participants were on the physiatry referral waiting list and presented with musculoskeletal pathologies deemed likely to benefit from physiotherapy treatment. Interventions New comprehensive care model including a one-hour initial assessment by an APP to optimize patient sorting into appropriate care trajectories. Main Outcome Measures Proportion of patients assigned to each care trajectory. Results The proportion of participants discharged by the APP without the need for a physiatry consultation was 41% (n=124/300), with a 24% direct discharge rate after the first evaluation. In the study's duration, the APP team evaluated approximately 12% of new referrals to the physiatry department coming from specialists, including 27% referred by emergency physicians. Wait times for APP evaluation were shorter than for physiatry consultation, and patient satisfaction was high. Patients discharged by the APP had significantly higher SF-36 scores than those referred to physiatry (53 [IQR 38-66] vs. 36 [IQR 24-49]; median difference -16, 95% CI -18 to -13), as well as better condition-specific patient-reported outcome measure (PROM) scores. Conclusion Implementing a multidisciplinary collaborative model with an APP enabled a high proportion of patient to be managed independently by the APP while improving patient selection for physiatry consultation. Contribution of the paper Addresses a critical gap in the literature describing an APP-integrated care model within an outpatient physiatry setting, highlighting potential implications for healthcare delivery and patient outcomes in rehabilitation medicine.