The role of the physiotherapists in a specialized back clinic in Denmark: a qualitative study.

Background: Neck and low back pain (LBP) are amongst the leading causes of years lived with disability, and their prevalence is increasing. Surgery is a possible treatment option when a specific diagnosis can be established. However, in unspecific back problems, a thorough examination, conservative management, and patient education can be enough in most cases. Physiotherapists with special training, also called Extended Scope Physiotherapists (ESPs), have gained popularity in many countries, and interdisciplinary models of care with ESPs have been shown to positively influence healthcare quality including that in spinal care. ESPs’ role in interdisciplinary units has previously been investigated, but there is wide variability in their functioning which can affect the team members’ and patients’ experiences.
Purpose: To elucidate experiences of interdisciplinary collaboration between the doctors and the ESPs at the Spine Clinic - Koege Hospital, Denmark, which was established in 2012. The study also aimed to investigate the experiences of patients attending the spine clinic, describe how the ESPs work, and evaluate the ESPs' role in the diagnosis and treatment of patients with long- term neck and back pain.
Methods: Informal observations and chat interviews with the physiotherapists were used to understand the clinic's workflow. Semi-structured observations of the initial examinations of two patients were conducted. Two researchers took notes and interviewed the patients immediately after their visit. In addition, six semi-structured interviews were conducted with the interdisciplinary team members – a rheumatologist, a spine surgeon, a radiologist, two physiotherapists, leaders of the physiotherapists. The phenomenological approach was used to conduct and analyze all the interviews.
Results: Two main themes emerged in the analyses: trust in the physiotherapists from doctors and the leader and patients' satisfaction with the physiotherapists’ competencies. The interdisciplinary collaboration was unproblematic and based on mutual trust. Specialist doctors and physiotherapists appreciated working together, drawing on each other's competencies. The radiologist assessed the referrals as relevant and together with the physiotherapist's thorough examination, led to a comprehensive patient evaluation in a shorter time span. The physiotherapists appreciated their contribution to the team, as extended scope practice demands their advanced professional and personal competencies. The ESPs used the biopsychosocial and patient-centered approaches with considerable focus on communication with the patient.
Conclusion: The interdisciplinary collaboration was based on mutual trust between the doctors and ESP’s. The ESP’s were equal partners in the team’s clinical decision-making, and their referrals to radiology were relevant. Patients valued the physiotherapists’ efforts and biopsychosocial approach leading to relatively faster evaluations, which in turn may boost cost-effectiveness.
Implications: With good professional collaboration and competencies, ESPs can play a crucial role in delivering patient-centered spine care. Interdisciplinary spine clinics utilizing ESPs, such as the one described in this study, are examples of innovative models of spine care and should be considered in the changing face of healthcare, where cost-effectiveness and quality are becoming increasingly important.