Orthopaedic consultant’s experiences and perceptions regarding advanced practice physiotherapists in orthopaedic clinics: a qualitative study

BACKGROUND: Perceptions of key stakeholders may be barriers or facilitators to advanced practice physiotherapy services. However, the experience and perception of orthopedic consultants regarding advanced practice physiotherapy roles is poorly understood. OBJECTIVE: Explore orthopedic consultants' experiences and perceptions regarding advanced practice physiotherapists in adult orthopedic clinics. METHODS: Qualitative study: Reflexive thematic analysis of data from semi-structured interviews with twelve orthopedic consultants practising at Royal Perth Hospital. Interviews were driven by indicative questions based upon contemporary literature regarding advanced practice physiotherapy and conducted using a constructivist lens to capture diverse perspectives. Themes/subthemes were reviewed by the entire research team. RESULTS: Four themes, capturing conflicting views, were derived: 1) APP role clarity. 2) Enhancement of orthopedic services. 3) Health system challenges. 4) Expectations of orthopedic services. Theme one reflected a lack of clarity, amongst orthopedic consultants interviewed, regarding the advanced practice physiotherapist's role, scope of practice and level of education, while complimenting their diagnostic skills. Theme two highlighted enhancement of orthopedic services through thorough biopsychosocial assessments, contrasting perceptions regarding advanced practice physiotherapist efficiency, and considered whether advanced practice physiotherapists are a burden on orthopedic clinics. Theme three considered shifting clinical responsibilities and the perceived need for clinical pathways. Theme four highlighted negative perceptions of patient and referrer feedback.