University Of Tasmania

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Diagnosis and management of chronic hip and knee pain in a Tasmanian orthopaedic clinic: a study assessing the diagnostic and treatment planning decisions of an advanced scope physiotherapist

journal contribution
posted on 2023-05-20, 22:36 authored by Jovic, D, Mulford, J, Kathryn OgdenKathryn Ogden, Zalucki, N
The aim of this study is to investigate the clinical effectiveness of an advanced practice physiotherapist triaging patients referred from primary care to the orthopaedic clinic with chronic hip and knee pain. An exploratory study design was used to assess 87 consecutive patients referred from general practice in Northern Tasmania. Patients were assessed by both an advanced practice physiotherapist and a consultant orthopaedic surgeon. Diagnostic and treatment decisions were compared, with the orthopaedic consultant decision defined as the gold standard. By using these decisions, over and under referral rates to orthopaedics could be calculated, as well as the surgical conversion rate. Conservative care of patients referred to the orthopaedic clinic with hip and knee pain was limited. The diagnostic agreement between the advanced scope physiotherapist and the orthopaedic surgeon was almost perfect (weighted kappa 0.93 (95% CI 0.87-1.00)), with treatment agreement substantial (weighted kappa 0.75 (95% CI 0.62-0.89)). Under a physiotherapist-led triage service, the surgical conversion rate doubled from 38% to 78%. An advanced physiotherapist assessing and treating patients with chronic hip and knee pain made decisions that match substantially with decisions made by an orthopaedic consultant. A model of care utilising an advanced physiotherapist in this way has the potential to support high-quality orthopaedic care in regional centres.


Publication title

Australian Journal of Primary Health








Tasmanian School of Medicine


Australian Journal of Public Health, Australian Institute for Primary Care, La Trobe University

Place of publication


Rights statement

Copyright 2019 La Trobe University

Repository Status

  • Restricted

Socio-economic Objectives

Treatment of human diseases and conditions; Health system performance (incl. effectiveness of programs); Allied health therapies (excl. mental health services)