FEASIBILITY AND OUTCOMES OF A JOINT PHYSIOTHERAPY-ORTHOPAEDIC CONSULTATION MODEL: A SINGLE-CENTRE SECONDARY CARE EXPERIENCE

Introduction: Timely access to orthopaedic spine consultation remains a challenge due to increasing demand and workforce constraints. Integrating advanced physiotherapy practice models within orthopaedic services is an emerging strategy to streamline care. While adopted across New Zealand's tertiary sector, its role in private secondary care is largely underexplored. This study aimed to evaluate the feasibility, patient satisfaction, diagnostic concordance and clinical outcomes of a physiotherapy- integrated orthopaedic spine consultation model in private secondary care. Methods: A retrospective review was conducted on all consenting patients seen between March and July 2023 in structured five-step physiotherapy–orthopaedic consultation model: (1) physiotherapist-led subjective history, (2) physical examination, (3) imaging review and provisional diagnosis, (4) handover and surgeon validation and (5) multidisciplinary shared decision-making. Outcomes included management decisions, wait times and patient satisfaction (5-item survey). Wait times were compared with a 2021 pre- model cohort. A diagnostic concordance sub-study (n=35) was planned but unavailable at submission. Results: Among 233 patients (mean age: 46.8 years; 53.6% male), 89.3% were referred by their general practitioners. The predominant presentation was “lower back pain with referred leg symptoms” (73.4%). Non-operative care was indicated in 74.7% of cases, including referral for physiotherapy (51.1%), musculoskeletal medicine consultation (44.8%), or further imaging (24.1%). Surgical workup was indicated for 25.3% (n=59), with 10.7% (n=25) proceeding to surgery. Patient satisfaction was high (mean: 91.3%), with highest ratings for “quality of care” (92.3%), followed by “explanation of treatment/outcomes” (91.7%) and “feeling heard with concerns addressed” (91.3%). As anticipated, mean wait times were longer compared to the 2021 cohort (63 vs 43 days), due to service growth during the study period. Conclusion: A physiotherapy-integrated model is both feasible and well-received in private orthopaedic spine care. Given most patients are managed non-operatively, appropriately-trained physiotherapists can play a valuable adjunctive role in streamlining care pathways and optimising service delivery.