Abstract
Abstract
Background: Globally, advanced physiotherapy practice, titles, definition, scope, level
of practice, and competencies vary. In New Zealand, the physiotherapy profession is
regulated by the Physiotherapy Board, which sets the standards and prescribes scopes
of practice. Development of a proposed new Advanced Practice Physiotherapist (APP)
scope started in 2016 and was approved in March 2021 with agreement to protect the
title ‘Advanced Practice Physiotherapist’.
Aims and Objectives: This study aimed to provide knowledge of physiotherapists’ and
other health professionals’ understandings and views of advanced physiotherapy
practice within the context of musculoskeletal management in NZ primary healthcare.
The objectives were to: develop a definition of APP; explore physiotherapists’ and
other health professionals’ perceptions and attitudes regarding the introduction of the
new APP scope of practice; and explore physiotherapists’ and other health
professionals’ views of the potential barriers and enablers to the implementation of the
APP scope.
Methods: A qualitative study was conducted using the methodology of Interpretive
Description. Fifteen participants from a variety of professional and stakeholder groups,
including physiotherapists (n=6), general practitioners (n=4), medical specialists (n=3)
and Accident Compensation Corporation case managers (n=2) were interviewed face to
face. Interviews were audio-recorded, transcribed verbatim and analysed.
Results: Five themes, each with subthemes, were identified in the interview data.
Theme one: ‘Perceptions of current musculoskeletal management in primary
healthcare’, had three subthemes, ‘Variability in diagnostic accuracy and inappropriate
use of investigations’, ‘Lack of clear clinical pathways and access to secondary care’,
and ‘Fragmentation, poor communication and lack of collaboration’. Theme two:
‘Current challenges to physiotherapy practice in primary care’, had three subthemes,
‘Lack of career pathway’, ‘Professional culture is a problem’ and ‘Lack of support and
mentoring’. Theme three: ‘How APPs might facilitate change and what their role would
be’, had two subthemes, ‘Improved patient journeys’ and ‘Peer support and mentoring’.
Theme four: ‘Characteristics of an APP’, had two subthemes, ‘Qualifications,
competencies and skills required to be an APP’ and ‘How APPs will be assessed and
recognised’. Theme five: ‘Implementation of the APP role into practice’, had two
subthemes, ‘Opportunities and risks for acceptance of the APP role’ and ‘Barriers to
acceptance of the APP role’.
Conclusion: The APP scope of practice will enable health professionals, funders, the
public and physiotherapists to recognise physiotherapists with specific levels of
expertise and skills. Implementation of the APP scope of practice would provide a
recognised career pathway for physiotherapists. A clear definition of the APP role will
improve understanding of the new scope. Standardised criteria and robust processes for
assessment of clinical skills and competencies are critical to ensure external credibility
and acceptance of the APP scope. To improve recognition and acceptance of the role,
APPs must demonstrate their value to healthcare delivery by improving patient
pathways and outcomes. Valuable insights emerged regarding the culture of private
practice, with a lack of collegiality and collaboration between physiotherapists and
variability in acceptance of supervision and peer support. Recommendations are made to the
Physiotherapy Board, Physiotherapy New Zealand, stakeholders, funders and policy makers
and the universities to support change.