title: A comparison of different sources of information about pregnancy and childbirth. Knee injury and Osteoarthritis Outcome Score (KOOS) – validation and comparison to the WOMAC in total knee replacement A single group follow-up study of non-surgical patients seen by physiotherapists working in expanded roles in orthopaedic departments: recall of recommendations, change in exercise and self-efficacy A physiotherapy triage service for orthopaedic surgery: an effective strategy for reducing wait times. Increasing Capacity for the Treatment of Common Musculoskeletal Problems: A Non-Inferiority RCT and Economic Analysis of Corticosteroid Injection for Shoulder Pain Comparing a Physiotherapist and Orthopaedic Surgeon Clinimetric properties of the EuroQol-5D in patients with chronic low back pain. The clinical importance of changes in outcome scores after treatment for chronic low back pain A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments. A systematic review of outcome tools used to measure lower leg conditions. Physiotherapy screening of patients referred for orthopaedic consultation in primary healthcare - a randomised controlled trial. Physiotherapy triage assessment of patients referred for orthopaedic consultation - Long-term follow-up of health-related quality of life, pain-related disability and sick leave. Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care. Randomised controlled trial and cost consequences study comparing initial physiotherapy assessment and management with routine practice for selected patients in an accident and emergency department of an acute hospital Clinical outcomes from a physiotherapist-led intra-articular hyaluronic acid injection clinic. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of Health-Related Quality of Life Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care. Patient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparison Evaluation of a primary care musculoskeletal clinical assessment service: a preliminary study. Evaluation of an advanced-practice physical therapist in a specialty shoulder clinic: diagnostic agreement and effect on wait times. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. Development of a shoulder pain and disability index. A randomised trial comparing the clinical effectiveness of different emergency department healthcare professionals in soft tissue injury management
abstract: Different methods of obtaining information in medical and social research present problems of interpretation for the research er . However , there are few systematic studies on the extent of the lack of concordance yielded by different methods . This paper uses data from a r and omized controlled trial of social support in pregnancy to examine this issue in relation to three methods of data collection --medical records , home interviews and a postal question naire -- on the following topics : obstetric history ; smoking , alcohol use , number of antenatal hospital visits , bleeding and depression in pregnancy ; length of labour ; baby 's sex , birthweight and neonatal health problems ; and ethnicity . Considerable discrepancies are found comparing the different data sources . These suggest that mothers may be more reliable sources of information than medical records , and that the anonymity of a postal question naire may provide higher estimates than home interviews on some sensitive topics , such as smoking in pregnancy Background The Knee injury and Osteoarthritis Outcome Score ( KOOS ) is an extension of the Western Ontario and McMaster Universities Osteoarthrtis Index ( WOMAC ) , the most commonly used outcome instrument for assessment of patient-relevant treatment effects in osteoarthritis . KOOS was developed for younger and /or more active patients with knee injury and knee osteoarthritis and has in previous studies on these groups been the more responsive instrument compared to the WOMAC . Some patients eligible for total knee replacement have expectations of more dem and ing physical functions than required for daily living . This encouraged us to study the use of the Knee injury and Osteoarthritis Outcome Score ( KOOS ) to assess the outcome of total knee replacement . Methods We studied the test-retest reliability , validity and responsiveness of the Swedish version LK 1.0 of the KOOS when used to prospect ively evaluate the outcome of 105 patients ( mean age 71.3 , 66 women ) after total knee replacement .  The follow-up rates at 6 and 12 months were 92 % and 86 % , respectively . Results The intraclass correlation coefficients were over 0.75 for all subscales indicating sufficient test-retest reliability . Bl and -Altman plots confirmed this finding . Over 90 % of the patients regarded improvement in the subscales Pain , Symptoms , Activities of Daily Living , and knee-related Quality of Life to be extremely or very important when deciding to have their knee operated on indicating good content validity . The correlations found in comparison to the SF-36 indicated the KOOS measured expected constructs . The most responsive subscale was knee-related Quality of Life . The effect sizes of the five KOOS subscales at 12 months ranged from 1.08 to 3.54 and for the WOMAC from 1.65 to 2.56 . Conclusion The Knee injury and Osteoarthritis Outcome Score ( KOOS ) is a valid , reliable , and responsive outcome measure in total joint replacement . In comparison to the WOMAC , the KOOS improved validity and may be at least as responsive as the WOMAC Background Specially trained physiotherapists ( advanced practice physiotherapists ( APP ) ) are working in orthopaedic clinics to improve access to orthopaedic services and support chronic disease management . Little attention has been paid to the impact APPs may have on non-surgical patients . In non-surgical patients with hip or knee arthritis consulting an APP in an orthopaedic clinic , the objectives were to : 1 ) describe patients ’ recall of APP recommendations , use of self-management strategies , and barriers to management six weeks following consultation ; and , 2 ) compare exercise behaviour and self-efficacy at baseline and six weeks . Findings This was a single group pre- and post-intervention study of patients who saw an APP when consulting the orthopaedic departments of two hospitals . At baseline and six weeks participants completed the adapted Stanford Exercise Behaviour Scale ( response options : none , < 60 minutes/week , 1–3 hours/week or > 3 hours/week ) , and the Chronic Disease Self-efficacy Scale ( range 1–10 ; higher scores indicate higher self-efficacy ) . At follow-up participants completed questions on recall of APP recommendations , use of self-management strategies and barriers to management . Seventy three non-surgical patients with hip or knee arthritis participated , a response rate of 89 % at follow-up . Seventy one percent of patients reported that the APP recommended exercise , of whom 83 % reported exercising to manage their arthritis since the visit . Almost 50 % reported an increase in time spent stretching ; over 40 % reported an increase in time spent walking or doing strengthening exercises at follow-up . Common barriers to arthritis management were time , cost and other health problems . Mean chronic disease self-efficacy scores significantly improved from 6.3 to 7.2 ( p < 0.001 ) . The mean difference was 0.95 ( 95 % CI 0.43 , 1.62 ) ; the effect size was 0.51 . Conclusions This pilot study of an APP intervention for non-surgical patients referred for orthopaedic consultation showed promising results , particularly for enhancing use of conservative management strategies such as exercise PURPOSE To investigate the effectiveness of a physiotherapy triage service for orthopaedic surgery referrals from primary -care physicians . METHODS A prospect i ve , observational design was used with patients referred to an orthopaedic surgeon based out of two small urban centres in British Columbia . The level of agreement between the physiotherapist and surgeon was determined using a weighted kappa statistic ( κw ) with 95 % CI . A patient satisfaction question naire was administered , and the surgical conversion rate ( SCR ) was calculated to assess the level of appropriate referrals . RESULTS The analysis found substantial agreement ( κw=0.77 ; 95 % CI , 0.60 - 0.94 ) between surgeon and physiotherapist for surgical management decisions . All patients reported being " satisfied " or " very satisfied " with the overall care they received from the physiotherapist . The SCR of patients referred by the physiotherapist to the surgeon was 91 % , versus 22 % among patients referred by a general practitioner or emergency physician . CONCLUSION More than three-fourths of patients referred by primary -care physicians did not need to see a surgeon and were able to be managed by an experienced orthopaedic physiotherapist . This triage model could have considerable impact on orthopaedic wait times in Canada by minimizing unnecessary referrals ; the model could also promote timely and conservative management of non-surgical conditions by physiotherapists Background Role substitution is a strategy employed to assist health services manage the growing dem and for musculoskeletal care . Corticosteroid injection is a common treatment in this population but the efficacy of its prescription and delivery by physiotherapists has not been established against orthopaedic st and ards . This paper investigates whether corticosteroid injection given by a physiotherapist for shoulder pain is as clinical ly and cost effective as that from an orthopaedic surgeon . Methods A double blind non-inferiority r and omized controlled trial was conducted in an Australian public hospital orthopaedic outpatient service , from January 2013 to June 2014 . Adults with a General Practitioner referral to Orthopaedics for shoulder pain received subacromial corticosteroid and local anaesthetic injection prescribed and delivered independently by a physiotherapist or a consultant orthopaedic surgeon . The main outcome measure was total Shoulder Pain and Disability Index ( SPADI ) score at baseline , six and 12 weeks , applying a non-inferiority margin of 15 points . Secondary outcomes tested for superiority included pain , shoulder movement , perceived improvement , adverse events , satisfaction , quality of life and costs . Results 278 participants were independently assessed by the physiotherapist and the orthopaedic surgeon , with 64 r and omised ( physiotherapist 33 , orthopaedic surgeon 31 ) . There were no significant differences in baseline characteristics between groups . Non-inferiority of injection by the physiotherapist was declared from total SPADI scores at 6 and 12 weeks ( upper limit of the 95 % one-sided confidence interval 13.34 and 7.17 at 6 and 12 weeks , respectively ) . There were no statistically significant differences between groups on any outcome measures at 6 or 12 weeks . From the perspective of the health funder , the physiotherapist was less expensive . Conclusions Corticosteroid injection for shoulder pain , provided by a suitably qualified physiotherapist is at least as clinical ly effective , and less expensive , compared with similar care delivered by an orthopaedic surgeon . Policy makers and service providers should consider implementing this model of care . Trial Registration Australia and New Zeal and Clinical Trials Registry BACKGROUND CONTEXT Clinimetric properties of the EuroQol-5D ( EQ-5D ) in patients with nonspecific chronic low back pain ( CLBP ) are largely unknown . PURPOSE To study the criterion validity , responsiveness , and minimal clinical ly important change ( MCIC ) of EQ-5D in patients with CLBP . STUDY DESIGN Prospect i ve study design carried out in a multispecialist Spine Center in The Netherl and s. PATIENT SAMPLE One hundred fifty-one patients with CLBP . OUTCOME MEASURES Quality of life ( QOL ) was measured with EQ-5D , consisting of two scales : one scale measuring QOL with five categorical questions and the other measuring health state on a visual analog scale ( 0 - 100 ) . Criterion measures were disability , measured with the Pain Disability Index ( PDI ) and the Rol and Morris Disability Question naire ( RMDQ ) , and pain intensity , measured with a numeric rating scale ( NRS ) . METHODS Pearson correlation coefficients between the EQ-5D and RMDQ , PDI , and NRS were calculated to test the criterion validity . Correlations were interpreted based on predefined criteria . Responsiveness of the EQ-5D was calculated with area under the receiver operating characteristics ( ROC ) curve . Minimal clinical ly important change was calculated with the optimal cutoff point under the ROC curve , and sensitivity and specificity were also calculated . RESULTS Correlations between EQ-5D and criterion measures ranged between 0.39 and 0.59 and were considered moderate to good . Areas under the ROC curve ranged from 0.59 to 0.72 depending on the external criterion and EQ-5D subscale . The MCIC was 0.03 points for the categorical scales of the EQ-5D and 10.5 points for the EQ-5D visual analog scale . CONCLUSIONS The EQ-5D is a valid and responsive QOL scale in patients with CLBP Abstract . When measuring treatment effect in chronic low back pain with multi-item outcome instruments , it is necessary , both for clinical decision-making and research purpose s , to underst and the clinical importance of the outcome scores . The aims of the present study were three-fold . Firstly , it aim ed to estimate the minimal clinical ly important difference of three multi-item outcome instruments ( the Oswestry Disability Index , the General Function Score and the Zung Depression Scale )  and of the  visual analogue scale ( VAS ) of back pain .  Secondly , it aim ed to estimate the error of measurement of these instruments ; and its third aim was to describe the clinical meaning of score change . The study population consisted of 289 patients treated surgically or non-surgically in a r and omised controlled trial . The minimal clinical ly important difference was estimated with patient global assessment as the external criterion . It was compared with the st and ard error of measurement of the instruments . The individual items of the instruments were compared for score changes related to improvement and deterioration . The st and ard error of measurement of the Oswestry Disability Index , the General Function Score and the Zung Depression Scale was 4 , 6 and 3 units , respectively . The 95 % tolerance interval was 10 , 16 and 8 units , respectively . The minimal clinical ly important difference was 10 , 12 and 8–9 units , respectively , thus not significantly exceeding the tolerance interval . The minimal clinical ly important difference of VAS back pain was 18–19 units , well exceeding the 95 % tolerance interval , which was 15 units . Improvement after treatment for chronic low back pain tends to occur to a greater extent in sleep disturbance , ability to do usual things and psychological irritability , but to a lesser extent in the ability to sit , st and and lift . We conclude that the VAS of back pain is responsive enough to detect the minimal clinical ly important difference , whereas the smallest acceptable score changes of the Oswestry Disability Index , the General Function Score and the Zung Depression Scale may require an increase to exceed the 95 % tolerance interval when used for clinical decision making and for power calculation . Despite improvement after treatment , the ability to sit , st and and lift , remain notable problems OBJECTIVE : To evaluate the effectiveness and cost effectiveness of specially trained physiotherapists in the assessment and management of defined referrals to hospital orthopaedic departments . DESIGN : R and omised controlled trial . SETTING : Orthopaedic outpatient departments in two hospitals . SUBJECTS : 481 patients with musculoskeletal problems referred for specialist orthopaedic opinion . INTERVENTIONS : Initial assessment and management undertaken by post-Fellowship junior orthopaedic surgeons , or by specially trained physiotherapists working in an extended role ( orthopaedic physiotherapy specialists ) . MAIN OUTCOME MEASURES : Patient centred measures of pain , functional disability and perceived h and icap . RESULTS : A total of 654 patients were eligible to join the trial , 481 ( 73.6 % ) gave their consent to be r and omised . The two arms ( doctor n = 244 , physiotherapist n = 237 ) were similar at baseline . Baseline and follow up question naires were completed by 383 patients ( 79.6 % ) . The mean time to follow up was 5.6 months after r and omisation , with similar distributions of intervals to follow up in both arms . The only outcome for which there was a statistically or clinical ly important difference between arms was in a measure of patient satisfaction , which favoured the physiotherapist arm . A cost minimisation analysis showed no significant differences in direct costs to the patient or NHS primary care costs . Direct hospital costs were lower ( p < 0.00001 ) in the physiotherapist arm ( mean cost per patient = 256 Pounds , n = 232 ) , as they were less likely to order radiographs and to refer patients for orthopaedic surgery than were the junior doctors ( mean cost per patient in arm = 498 Pounds , n = 238 ) . CONCLUSIONS : On the basis of the patient centred outcomes measured in this r and omised trial , orthopaedic physiotherapy specialists are as effective as post-Fellowship junior staff and clinical assistant orthopaedic surgeons in the initial assessment and management of new referrals to outpatient orthopaedic departments , and generate lower initial direct hospital costs BACKGROUND CONTEXT A variety of self-report and physical performance-based outcome measures are commonly used to assess progress and recovery in the lower leg , ankle , and foot . A requisite attribute of any outcome measure is its ability to detect change in a condition , a construct known as " responsiveness " . There is a lack of consistency in how responsiveness is defined in all outcome measures . PURPOSE The purpose of this study was to review the currently used recovery outcome measures for lower leg , ankle and foot conditions in order to determine and report recommended responsiveness values . METHODS A systematic literature search that included electronic search es of PubMed , CINAHL and SportD iscus as well extensive cross-referencing was performed in January , 2013 . Studies were included if each involved : 1 ) a prospect i ve , longitudinal study of any design ; 2 ) any condition associated with the lower leg , ankle or foot ; 3 ) a measure of responsiveness ; and 4 ) was an acceptable type of outcome measure ( eg . self-report , physical performance , or clinician report ) . The quality of the included articles was assessed by two independent authors using the responsiveness sub-component of the Consensus-based St and ards for the selection of health Measurement Instruments ( COSMIN ) . RESULTS Sixteen different studies met the inclusion criteria for this systematic review . The most commonly used outcome measures were the Foot and Ankle Ability Measure and the Lower Extremity Functional Scale . Responsiveness was calculated in a variety of methods including effect size , st and ardized response mean , minimal clinical ly important difference/ importance , minimal detectable change , and minimal important change . CONCLUSION Based on the findings of this systematic review there is a lack of consistency for reporting responsiveness among recovery measures used in the lower leg , ankle or foot studies . It is possible that the variability of conditions that involve the lower leg , ankle and foot contribute to the discrepancies found in reporting responsiveness values . Further research must be conducted in order to st and ardize reporting measures for responsiveness . LEVEL OF EVIDENCE 2a A large proportion of patients who consult primary healthcare for musculoskeletal pain are referred for orthopaedic consultation , but only a small number of these patients are appropriate for orthopaedic intervention . Experienced physiotherapists have the appropriate knowledge to manage musculoskeletal disorders . The primary aim of this r and omised study was therefore to evaluate a screening by a physiotherapist of patients referred for orthopaedic consultation compared to st and ard practice in primary care . Patients referred for orthopaedic consultation ( n=203 ) were r and omised to physiotherapy screening or st and ard practice .  Selection accuracy for orthopaedic intervention and other referrals were analysed with proportion analysis . Patient views of the quality of care were analysed with Mann-Whitney U-test , waiting time with Independent t-test . There was higher selection accuracy for orthopaedic intervention in the physiotherapy screening group ( p=0.002 ) . A smaller proportion of patients in the screening group were referred back to their general practitioner ( GP ) ( p<0.001 ) and a larger proportion to the physiotherapy clinic ( p<0.001 ) compared to st and ard practice . The proportion of patients referred for further investigations was significantly lower in the physiotherapy screening group ( p<0.039 ) . Waiting time was shorter in the screening group ( p<0.001 ) . A large proportion of the patients reported no hesitation to attend the clinic for future care , no difference between the groups ( p<0.95 ) . The findings in this study suggest that an experienced physiotherapist effectively can screen patients referred for orthopaedic consultation in primary healthcare INTRODUCTION The literature indicates that physiotherapy triage assessment can be efficient for patients referred for orthopaedic consultation , however long-term follow up of patient reported outcome measures are not available . AIM To report a long-term evaluation of patient-reported health-related quality of life , pain-related disability , and sick leave after a physiotherapy triage assessment of patients referred for orthopaedic consultation compared with st and ard practice . METHODS Patients referred for orthopaedic consultation ( n = 208 ) were r and omised to physiotherapy triage assessment or st and ard practice .  The r and omised cohort was analysed on an intention-to-treat ( ITT ) basis . The patient reported outcome measures EuroQol VAS ( self-reported health-state ) , EuroQol 5D-3L ( EQ-5D ) and Pain Disability Index ( PDI ) were assessed at baseline and after 3 , 6 and 12 months . EQ VAS was analysed using a repeated measure ANOVA . PDI and EQ-5D were analysed using a marginal logistic regression model . Sick leave was analysed for the 12 months following consultation using a Mann-Whitney U-test . RESULTS The patients rated a significantly better health-state at 3 after physiotherapy triage assessment [ mean difference -5.7 ( 95 % CI -11.1 ; -0.2 ) ; p = 0.04 ] . There were no other statistically significant differences in perceived health-related quality of life or pain related disability between the groups at any of the follow-ups , or sick leave . CONCLUSION This study reports that the long-term follow up of the patient related outcome measures health-related quality of life , pain-related disability and sick leave after physiotherapy triage assessment did not differ from st and ard practice , indicating the possible benefits of implementation of this model of care OBJECTIVES To evaluate primary physiotherapist assessment and management of patients with musculoskeletal disorders in primary care , and to compare patient satisfaction with primary assessment by a physiotherapist or a general practitioner ( GP ) . DESIGN An observational , retrospective cohort study review ing medical records , and a separate consecutive non-r and omised study of patient satisfaction . SETTING Primary healthcare centre . PARTICIPANTS Four hundred and thirty-two patients with musculoskeletal disorders , primarily assessed by a physiotherapist . Fifty-one of these patients primarily assessed by a physiotherapist and 42 patients assessed by a GP answered a patient satisfaction question naire . INTERVENTIONS Primary assessment and management of patients with musculoskeletal disorders . MAIN OUTCOME MEASURES Data from medical records within 3-month after the visit , and patient satisfaction question naire . RESULTS Eighty-five percent ( 367/432 ) of patients did not need to see a GP . Serious pathologies were found among the 6 % ( 26/432 ) of patients who were referred to a GP by a physiotherapist , but no serious pathologies were found among the 9 % ( 39/432 ) of patients who subsequently returned for a GP appointment for the same disorder . Patients assessed by a physiotherapist were more satisfied with the information received about their disorder and self-care than patients assessed by a GP . Patients also had higher confidence in the ability of physiotherapists to assess their disorder ( P<0.002 ) . CONCLUSION Physiotherapists can be considered primary assessors of patients with musculoskeletal disorders in primary care as few patients needed additional assessment by a GP , patients with confirmed serious pathologies were identified by the physiotherapists , and patients were satisfied with assessment by a physiotherapist Objective : The Department of Health is review ing the effectiveness of accident and emergency ( A&E ) departments . This study aim ed to compare health and economic effects of physiotherapy initial assessment and management with routine practice in an A&E department . Methods : R and omised controlled trial and cost and consequences study . Patients presenting at A&E were eligible if suspected at triage to have soft tissue injury without fracture . The efficacy end point was “ days to return to usual activities ” . Secondary end points included patient satisfaction with their care and further health outcomes and cost data . Results : 766 of 844 ( 915 ) patients were r and omised . The median days before return to usual activities ( available for 73 % of those r and omised ) was greater in the physiotherapist group ( 41 days compared with 28.5 days ; hazard ratio 0.85 p = 0.071 ) . The physiotherapy group expressed greater satisfaction with their A&E care ( on a scale of 1 to 5 , median was 4.2 compared with 4.0 , p<0.001 ) , were more likely to be given advice and reassurance , and more likely to be provided with aids and appliances . Costs were the same between the two arms . Conclusion : There is evidence that physiotherapy leads to a prolonged time before patients return to usual activities . This study shows no clear danger from physiotherapy intervention and long term outcomes may be different but given these findings , a best estimate is that introducing physiotherapist assessment will increase costs to the health service and society . Routine care should continue be provided unless there is some reason why it is not feasible to do so and an alternative must be found OBJECTIVES To describe the clinical course of knee osteoarthritis following a single course of intra-articular hyaluronic acid ( HA ) injection clinic , and specifically to explore treatment withdrawal . DESIGN Prospect i ve consecutive case series with follow-up , set in an innovative physiotherapist-led clinic , based in a hospital orthopaedic surgery department . PARTICIPANTS A total of 100 patients with knee osteoarthritis referred to the clinic received a single course of five injections of Hyalgan . Patients were followed up in clinic at five , 13 , 26 and 52 weeks . The primary outcome measures were Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) Likert 3.0 pain ( 0 - 20 ) and physical function ( 0 - 68 ) scores . In addition , at 13 and 26 weeks , patients were review ed independently by an orthopaedic surgeon , with the option of withdrawing for alternative management those patients who had not responded . RESULTS Ninety ( 90 % ) patients were successfully followed to study endpoint . Improvements were seen at five weeks and , to a lesser extent , at 13 weeks ( mean reduction in WOMAC pain at 13 weeks = 1.3 ; 95 % confidence interval [ CI ] 0.5 , 2.0 ; mean reduction in WOMAC Physical Function at 13 weeks = 5.6 ; 95 % CI 3.0 , 8.1 ) . Of 34 treatment withdrawals , most had returned to baseline levels by 13 weeks . The remaining 56 patients maintained improvements up to 52 weeks , although the pattern of outcome was highly variable between individuals . Withdrawals and non-responders had higher initial pain severity . CONCLUSIONS Physiotherapist-led intra-articular HA clinics are feasible . Clinical outcomes for individual patients are highly heterogeneous up to one year after injections . Patients with initially high levels of pain may be less likely to benefit BACKGROUND AND PURPOSE The purpose of this study was to assess the reliability , construct validity , and sensitivity to change of the Lower Extremity Functional Scale ( LEFS ) . SUBJECTS AND METHODS The LEFS was administered to 107 patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics . METHODS The LEFS was administered during the initial assessment , 24 to 48 hours following the initial assessment , and then at weekly intervals for 4 weeks . The SF-36 ( acute version ) was administered during the initial assessment and at weekly intervals . A type 2,1 intraclass correlation coefficient was used to estimate test-retest reliability . Pearson correlations and one-way analyses of variance were used to examine construct validity . Spearman rank-order correlation coefficients were used to examine the relationship between an independent prognostic rating of change for each patient and change in the LEFS and SF-36 scores . RESULTS Test-retest reliability of the LEFS scores was excellent ( R = .94 [ 95 % lower limit confidence interval ( CI ) = .89 ] ) . Correlations between the LEFS and the SF-36 physical function subscale and physical component score were r=.80 ( 95 % lower limit CI = .73 ) and r = .64 ( 95 % lower limit CI = .54 ) , respectively . There was a higher correlation between the prognostic rating of change and the LEFS than between the prognostic rating of change and the SF-36 physical function score . The potential error associated with a score on the LEFS at a given point in time is + /-5.3 scale points ( 90 % CI ) , the minimal detectable change is 9 scale points ( 90 % CI ) , and the minimal clinical ly important difference is 9 scale points ( 90 % CI ) . CONCLUSION AND DISCUSSION The LEFS is reliable , and construct validity was supported by comparison with the SF-36 . The sensitivity to change of the LEFS was superior to that of the SF-36 in this population . The LEFS is efficient to administer and score and is applicable for research purpose s and clinical decision making for individual patients Abstract This study examined the relations between disability , as measured by the Pain Disability Index ( PDI ) and self‐efficacy , fear avoidance variables ( kinesiophobia and catastrophizing ) , and pain intensity , using a prospect i ve design . Two primary health care sample s ( n1=210 ; n2=161 ) of patients with subacute , chronic or recurring musculoskeletal pain completed sets of question naires at the beginning of a physiotherapy treatment period .  Multiple hierarchial regression analyses showed that self‐efficacy explained a considerably larger proportion of the variance in disability scores than the fear avoidance variables in the first sample . This finding was replicated in the second sample . Pain intensity explained a small , but significant proportion of the variance in disability scores in one sample only . Gender , age , and pain duration were not related to disability . These findings suggest that self‐efficacy beliefs are more important determinants of disability than fear avoidance beliefs in primary health care patients with musculoskeletal pain . The findings also suggest that pain‐related beliefs , such as self‐efficacy and fear avoidance , in turn , are more important determinants of disability than pain intensity and pain duration in these patients This paper describes constructing the Assessment of Quality of Life ( AQoL ) instrument ; design ed to measure health-related quality of life ( HRQoL )  , and to be the descriptive system for a multi-attribute utility instrument . Unlike previous utility instruments ' descriptive systems , the AQoL 's has been developed using state-of-the-art psychometric procedures . The result is a descriptive system which emphasizes five different facets of HRQoL and which can cl aim to have construct validity . Based on the WHO 's definition of health a model of HRQoL was developed . Items were written by focus groups of doctors and the research ers . These were administered to a construction sample , comprising hospital patients , and community members chosen at r and om . Final construction was through an iterative process of factor and reliability analyses . The AQoL measures 5 dimensions : illness , independent living , social relationships , physical senses and psychological wellbeing . Each has three items . Exploratory factor analysis showed the dimensions were orthogonal , and each was unidimensional . Internal consistency was α = 0.81 . Structural equation modeling explored its internal structure ; the comparative fit index was 0.90 . These preliminary results indicate the AQoL has the prerequisite qualities for a psychometric HRQoL instrument for evaluation ; replication with a larger sample is needed to verify these findings . Scaling it for economic evaluation using utilities is being undertaken . Respondents have indicated the AQoL is easy to underst and and is quickly completed . Its initial properties suggest it may be widely applicable OBJECTIVE To investigate the impact , quality and acceptability of a musculoskeletal screening clinic provided by physiotherapists for patients referred to the outpatient orthopaedic department at a major metropolitan hospital . DESIGN , SETTING AND PARTICIPANTS Prospect i ve observational trial undertaken between 29 November 2005 and 6 June 2006 at the Northern Hospital ( a tertiary teaching hospital in outer Melbourne ) of 52 patients with non-urgent musculoskeletal conditions who were assessed by one of two physiotherapists with postgraduate qualifications and subsequently by an orthopaedic surgeon . MAIN OUTCOME MEASURES Proportion of new patients referred who could have been managed without needing to see a surgeon ; level of agreement between physiotherapists and orthopaedic surgeon on diagnoses and management decisions ; and levels of satisfaction of patients , referring general practitioners and the orthopaedic surgeon with the physiotherapist-led screening initiative . RESULTS 45 of 52 selected patients ( 31 women and 21 men ; mean age , 53.3 years ) attended their appointment with the physiotherapist ; of these , 38 also attended a later appointment with the orthopaedic surgeon . Seven of the 38 patients were listed for surgery , and seven others needed management by the surgeon ( injection for three , imaging for four ) . Almost two-thirds ( 63 % ) were appropriate for non-surgical management . The physiotherapists identified the same patient management plans as the surgeon for 74 % of the group . Patients and doctors reported high levels of satisfaction with the physiotherapist-led service . CONCLUSIONS Nearly two-thirds of patients with non-urgent musculoskeletal conditions referred by their GPs to one public outpatient orthopaedic department did not need to see a surgeon at the time of referral , and were appropriately assessed and managed by experienced , qualified physiotherapists Abstract Objectives : ( 1 ) To attain a quantitative estimate of patient satisfaction with physiotherapy care for musculoskeletal conditions in Australia ; ( 2 ) to compare the observed level of patient satisfaction with care in Australia with those from other countries ; and ( 3 ) to compare factors contributing to patient satisfaction between Australia and the United States ( US ) . Methods : We conducted a prospect i ve study of 274 patients presenting for physiotherapy treatment of a musculoskeletal disorder in Australian clinics .  Patient satisfaction was measured using the 20-item MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care ( MRPS ) and satisfaction scores were compared with those from Northern Europe , North America , the United Kingdom , and Irel and . To investigate factors contributing to patient satisfaction between Australia and the US , we compared 20-item MRPS data from Australian and Spanish-speaking US cohorts . Results : Mean Australian MRPS satisfaction score was 4·55 ( 95 % confidence interval : 4·51–4·59 ) on a scale of 1 to 5 , where 1 indicates high dissatisfaction and 5 indicates high satisfaction . This high level of patient satisfaction is consistent with international data . Australian respondents specifically valued interpersonal aspects of care , including advice and information about their condition and an explanation about self-management . The correlation between treatment outcomes and global patient satisfaction was low ( r = −0·22 ) . A comparison of data collected from Australia and the US showed that MRPS items regarding interpersonal aspects of care , such as the therapists ’ communication skills , correlated strongly with global satisfaction in both countries . However , there were other question naire items for which the correlation with global satisfaction was significantly different between Australia and the US . Conclusions : Patient satisfaction with musculoskeletal physiotherapy care in Australia is high and comparable with Northern Europe , North America , the United Kingdom and Irel and . Comparison of data between Australia and the US indicates that while some determinants of patient satisfaction are common , country-specific differences also exist OBJECTIVES To evaluate the clinical effectiveness of a primary care musculoskeletal clinical assessment service ( MCAS ) . The MCAS is a triage and treatment service for the management of patients with musculoskeletal conditions . DESIGN Prospect i ve observational cohort study . PARTICIPANTS Consecutive patients with musculoskeletal disorders referred to the MCAS from primary care over a 6-month period . INTERVENTIONS Patients were managed within the service in accordance with usual MCAS management/treatment pathways . MAIN OUTCOME MEASURES Previously vali date d self-administered question naires were selected as outcome measures in order to facilitate the use of postal responses . These comprised two generic health status question naires ( Short Form 36 , EuroQol EQ-5D ) , a pain assessment using a visual analogue scale and two measures of patient satisfaction ( Perceived Improvement Evaluation , Deyo and Diehl satisfaction question naire ) . Outcome measures were taken at baseline , and 3 and 12 months after recruitment . RESULTS In total , 217 patients were recruited into the study . Significant improvement was demonstrated with EuroQol at 3 and 12 months ( P=0.043 and 0.035 , respectively ) and the pain visual analogue scale at 3 and 12 months ( P=0.001 and 0.002 , respectively ) . No significant differences were demonstrated with Short Form 36 ( P=0.73 and 0.87 ) . The mean patient-perceived improvement was 33 % at 3 months and 46 % at 12 months . Results showed high levels of patient satisfaction , with 72 % of patients indicating total satisfaction with all aspects of the MCAS . CONCLUSIONS Nationally , models similar to the MCAS have been developed to help improve care for patients and achieve the 18-week access target . This preliminary study shows the possible benefits of adopting this model of care , and identifies the need for further research PURPOSE To examine the role of an advanced- practice physiotherapist ( APP ) with respect to ( 1 ) agreement with an orthopaedic surgeon on diagnosis and management of patients with shoulder problems ; ( 2 ) wait times ; and ( 3 ) satisfaction with care . METHODS This prospect i ve study involved patients with shoulder complaints who were referred to a shoulder specialist in a tertiary care centre . Agreement was examined on seven major diagnostic categories , need for further examination and surgery , and type of surgical procedure . Wait times were compared between the APP- and surgeon-led clinics from referral date to date of initial consultation , date of final diagnostic test , and date of confirmed diagnosis and planned treatment . A modified and vali date d version of the Visit-Specific Satisfaction Instrument assessed satisfaction in seven domains . Kappa ( κ ) coefficients and bias- and prevalence-adjusted kappa ( PABAK ) values were calculated , and strength of agreement was categorized . Wait time and satisfaction data were examined using non-parametric statistics . RESULTS Agreement on major diagnostic categories varied from 0.68 ( good ) to 0.96 ( excellent ) . Agreement with respect to indication for surgery was κ=0.75 , p<0.001 ; 95 % CI , 0.62 - 0.88 ( good ) . Wait time for APP assessment was significantly shorter than wait time for surgeon consultation at all time points ( p<0.001 ) ; the surgeon 's wait time was significantly reduced over 3 years . High satisfaction was reported in all components of care received from both health care providers . CONCLUSIONS Using experienced physiotherapists in an extended role reduces wait times without compromising patient clinical management and overall satisfaction The assessment of a measure of chronic pain , should be reliable , valid and sensitive to change . Our study evaluated the reliability of 3 pain scales , visual analogue scale ( VAS ) , numerical rating scale ( NRS ) and verbal rating scale ( VRS )  in literate and illiterate patients with rheumatoid arthritis ( RA ) . Patients with RA attending an outpatient rheumatology clinic were interviewed and asked to score their pain levels on the 3 pain scales . The scales were presented in r and om order , twice , before and just after a regular medical consultation . Ninety-one patients were studied ( 25 illiterate and 66 literate ) . The Pearson product moment correlation between first and second assessment was 0.937 for VAS , 0.963 for NRS and 0.901 for VRS in the literate patient group and 0.712 for VAS , 0.947 for NRS and 0.820 for VRS in the illiterate patient group . These results indicate that the NRS has the higher reliability in both groups of patients A  shoulder pain and disability index ( SPADI ) was developed to measure the pain and disability associated with shoulder pathology . The SPADI is a self-administered index consisting of 13 items divided into two subscales : pain and disability . Thirty-seven male patients with shoulder pain were used in a study to examine the measurement characteristics of the SPADI . Test-retest reliability of the SPADI total and subscale scores ranged from 0.6377 to 0.6552 . Internal consistency ranged from 0.8604 to 0.9507 . SPADI total and subscale scores were highly negatively correlated with shoulder range of motion ( ROM ) supporting the criterion validity of the index . Principal components factor analysis with and without varimax rotation supported the construct validity of the total SPADI and its subscales . High negative correlations between changes in SPADI scores and changes in shoulder ROM indicated the SPADI detected changes in clinical status over short time intervals . The SPADI should prove useful for both clinical and research purpose Objectives To evaluate the clinical effectiveness of soft tissue injury management by emergency nurse practitioners ( ENPs ) and extended scope physiotherapists ( ESPs ) compared to the routine care provided by doctors in a UK emergency department ( ED ) . Design R and omised , pragmatic trial of equivalence . Setting One adult ED in Engl and . Participants 372 patients were r and omised ; 126 to the ESP group , 123 to the ENP group and 123 to the doctor group . Participants were adults ( older than 16 years ) presenting to the ED with a peripheral soft tissue injury eligible for management by any of the three professional groups . Patients were excluded if they had any of the following : injury greater than 72 hours old ; systemic disease ; dislocated joints ; recent surgery ; unable to give informed consent ( eg , dementia ) , open wounds ; major deformities ; opiate analgesia required ; concurrent chest/rib injury ; neurovascular deficits and associated fracture . Interventions Patients were r and omised to treatment by ESPs , ENPs or routine care provided by doctors ( of all grade s ) . Main outcome measures Upper-limb and lower-limb functional scores , quality of life , physical well-being , preference-based health measures and the number of days off work . Results The clinical outcomes of soft tissue injury treated by ESPs and ENPs in the ED were equivalent to routine care provided by doctors . Conclusions As all groups were clinical ly equivalent it is other factors such as cost , workforce sustainability , service provision and skill mix that become important . This result vali date s the role of the ENP , which is becoming established as an integral part of minor injuries care , and demonstrates that the ESP should be considered as part of the clinical skill mix without detriment to outcomes . IS RCT N-IS RCT N trials register number 70891354
target: The quality of the PROMs varied greatly , with Satisfaction most commonly measured utilizing non-st and ardized locally-devised tools ; the EuroQol five-dimensions question naire ( EuroQoL-5D ) and 36-Item Short-Form ( SF-36 ) cited most frequently to capture QoL ; and the Visual Analogue Scale ( VAS ) to capture Pain .
  APPs utilized a multiplicity of PROMs across a range of MSK disorders .
background: OBJECTIVE Advanced practice physiotherapists ( APPs ) , also known as extended scope physiotherapists , provide a new model of service delivery for musculoskeletal ( MSK ) disorders .
  Research to date has largely focused on health service efficiencies , with less emphasis on patient outcomes .
  The present systematic review aim ed to identify the  patient-reported outcome measures ( PROMs ) being utilized by APPs .