What is the prevalence of burnout amongst first contact physiotherapists working within primary care?

BACKGROUND: It has long been known general practitioners suffer with burnout. First contact physiotherapists (FCP's) are a new role to primary care. However, concerns have been raised around the longevity and sustainability of the role and the risk of clinician burnout. AIMS: To assess the prevalence of burnout amongst the FCP workforce. METHOD: A self-reporting online questionnaire was developed and captured key demographical data and burnout scores amongst FCP's between February 2022 and March 2022. The burnout assessment tool (BAT12) was used to assess clinician burnout. RESULTS: A total of 332 responses were collected. Overall, 13% of clinicians were burnt out, and 16% at risk. The BAT12 also found 43% of the clinicians are exhausted and a further 35% are at risk of exhaustion. Non-clinical hours were significantly associated with burnout score. Clinicians who had more non-clinical time per month were the least burnt out. Increased non-clinical hours was significant in reducing burnout score. CONCLUSIONS: This study found 13% of clinicians are suffering from burnout with a further 16% at risk. Worryingly 78% of clinicians are either exhausted or at risk of exhaustion. Non-clinical hours have a direct impact on burnout and every effort is needed by employers to increase non-clinical time. This study supports the release by the Chartered Society of Physiotherapy whereby they recommend sufficient time be allocated within job plans for appropriate supervision, training and continued professional development. Further research is needed to explore the association of non-clinical time and clinician burnout.

Steroid injections in musculoskeletal conditions and COVID infection rates: What is the impact on positive rates following the injection?

BACKGROUND AND AIM: Therapeutic glucocorticosteroid injections are commonly utilised to manage musculoskeletal (MSK) complaints. Following the SARS-CoV-2 pandemic, national guidelines advised against their use due to potential immunosuppressant effects. The aim of the study was to determine whether steroid injections for MSK conditions impacts on positive COVID 19 infection rates. PATIENTS AND METHODS: This retrospective evaluation involved primary care participants who received a steroid injection for a MSK condition. 291 participants receiving a total of 299 steroid injections entered the study between the 25 September 2020 and the 29 April 2021. RESULTS: Six participants had positive polymerase chain reaction (PCR) tests, averaging 22.83 days (SD 10.48) after the injection. An infection rate of 2.06% was demonstrated in the injection group with the control group demonstrating 6.97% (p = 0.000752) with statistical significance set at p = 0.05. The odds ratio was identified as 0.27 indicating a lower odds of a positive PCR test compared with the control group. CONCLUSIONS: This retrospective evaluation found a low risk of positive PCR tests for low and moderate COVID-19 risk patients injected during the COVID-19 pandemic. Glucocorticosteroid injections within the COVID-19 pandemic were not associated with higher COVID-19 rates compared to the local population, in fact, they were related to lower rates. For future studies, large scale studies and meta analyses are needed to provide greater generalisation to the population.

A multi-site prospective, observational study of physiotherapist independent prescribing activity across musculoskeletal clinics in the United Kingdom.

OBJECTIVE: To establish how advanced practice physiotherapists in the UK working in the musculoskeletal specialty are utilising their independent non-medical prescribing skills. DESIGN: Multi-site, prospective, descriptive observational study. Ethics reference No: ERN_19-0994). METHOD: The study was conducted by seven advanced practitioners, across seven clinical sites representative of advanced musculoskeletal practice in the UK, between 1st October 2019-March 31, 2020. Advanced physiotherapy practitioner independent prescribers working in a variety of musculoskeletal specialty areas collected data across 5 contexts of musculoskeletal clinical service: first contact practice, primary care, community triage, secondary care orthopaedics, secondary care rheumatology and private practice. Quantitative data were analysed descriptively with qualitative data analysed/synthesised via thematic analysis. RESULTS: Prescribing activity data for n = 2470 patients were collected. Prescribing activity was highest for the treatment of nociceptive pain (51.3%) and inflammation (39.6%). Most prescribing activity occurred in the first 2-6 weeks (34.1%) following onset of condition. Medicines optimisation accounted for most of prescribing activity (18.1%), followed by over-the-counter medication recommendation (15.5%). De-prescribing accounted for 10.8% of all prescribing activity recorded. Qualitative data were synthesised into 4 themes: multimodal physiotherapeutic approach, joint decision making and patient choice, working with complexity, and legal and regulatory restriction. CONCLUSIONS: Physiotherapist independent prescribing was used within all health sectors in conjunction with advanced skills in musculoskeletal physiotherapy as part of a multimodal physiotherapeutic approach. Prescribing activity was dictated by the clinicians' clinical reasoning and use of joint decision-making. Prescribing activity for acute back and neuropathic radicular pain was limited secondary to recent reclassification of gabapentin and pregabalin.

Independent prescribing by advanced physiotherapists for patients with low back pain in primary care: A feasibility trial with an embedded qualitative component.

BACKGROUND: Low back pain (LBP) is the most prevalent musculoskeletal condition. Guidelines advocate a multimodal approach, including prescription of medications. Advanced Physiotherapy Practitioners (APPs) are well placed to manage LBP. To date no trial has evaluated the efficacy of physiotherapist-prescribing for LBP. OBJECTIVES: To evaluate the feasibility, suitability and acceptability of assessing the effectiveness of physiotherapist-prescribing for LBP in primary care; informing the design of a future definitive stepped-wedged cluster trial (SWcRCT). METHODS: Mixed-methods, single-arm feasibility design with two components. 1) Trial component: participants with medium-risk LBP +/-leg pain were recruited across 3 sites. Outcome measures (primary outcome measures-Pain/RMDQ) were completed at baseline, 6 and 12 weeks Physical activity/sedentary behaviour were assessed over 7 days using accelerometery. A CONSORT diagram analysed recruitment/follow-up rates. Descriptive analysis evaluated procedure/floor-effects. 2) Embedded qualitative component: focus groups (n = 6) and semi-structured interviews (n = 3) evaluated the views/experiences of patients and APPs about feasibility/suitability/acceptability of the proposed trial. Thematic analysis synthesised the qualitative data. Findings were evaluated against a priori success criteria. RESULTS: n = 29 participants were recruited. 90% of success criteria were met. Loss to follow-up at 12 weeks (65.5%) did not satisfy success criteria. Primary and secondary outcome measures were suitable and acceptable with no floor effects. The addition of a sleep assessment tool was advised. Accelerometer use was acceptable with 100% adherence. APPs felt all patients presenting with non-specific LBP +/- leg pain and capture data representative of the full scope of physiotherapist independent prescribing should be included. Data collection methods were acceptable to APPs and patients. APPs advocated necessity for using research assistants owing to time limitations. CONCLUSIONS: Methods evaluated are feasible, suitable and acceptable for a definitive SWcRCT, with modification of eligibility criteria, and use of research assistants to overcome limited clinician capacity. A definitive SWcRCT is feasible with minor modifications. REGISTRATION: ISRCTN15516596.

Limb girdle muscular dystrophy: a case report initially presenting to an outpatient musculoskeletal physiotherapy clinic with spinal pain and functional weakness.

BACKGROUND: The term limb girdle muscular dystrophy (LGMD) describes a group of genetic muscular disorders that require specialist input from neurologically trained clinicians. The plethora of potential symptoms of this heterogenous group can result in patients presenting initially to musculoskeletal (MSK) physiotherapists. CASE PRESENTATION: The following case report highlights the presentation of a 21 year old female attending with 2 years of spinal pain and an unusual pattern of weakness, namely when rising from a sitting position the hips were abducted and then internally rotated. Formal testing in clinic revealed no isolated weakness initially despite the odd functional movements. There were no neural limb pains and no upper or lower motor neuron concerns on testing. There were no other health concerns. Some gains were reported with recent physiotherapy strengthening exercises and these were persisted with but proved ineffective overall. The Biopsychosocial model was used judiciously to explore alternative pathologies and led to appropriate investigations, onward referral, diagnosis and appropriate management of LGMD. Extensive atrophy of the spinal muscles was evident on imaging which was not particularly identified within the physiotherapy testing process in the earlier stages. Creatine kinase levels were also significantly raised. CONCLUSIONS: Being mindful of this novel presentation in musculoskeletal clinics may well aid future, similar cases to be identified. The case highlights the importance of looking at the functional impact as opposed to traditional testing methods especially in the early stages of such conditions.

The intra and inter-rater reliability of a modified weight-bearing lunge measure of ankle dorsiflexion.

This study assessed the intra and inter-rater reliability of a modified weight-bearing lunge measure of ankle dorsiflexion range of movement. Thirteen healthy subjects were recruited. Each subject performed 3 repetitions of the lunging method with one rater and 3 more repetitions with a second rater within 30 min. The process was repeated within 3 h. Intra-rater reliability results indicated excellent correlation of measurements (intraclass correlation coefficients (ICCs) of 0.98-0.99). Standard error of measurement (SEM), 95% limits of agreement (LOA) and coefficient of repeatability (CR) calculations indicated suitably low ranges of measurement variance (SEM = 0.4 cm, LOA = ± 1.28 to ± 1.47 cm and CR = 1.21-1.35 cm). Inter-rater reliability was also deemed excellent (ICC = 0.99, SEM = 0.3 cm, LOA = ± 0.83 to ± 1.47 cm, CR = 1.44 cm). The modified lunge technique therefore demonstrates excellent intra and inter-rater reliability.