An observational study in Shoulder Injuries and Disorders, Shoulder Pain and Musculoskeletal Pain, sponsored by Central Jutland Regional Hospital. Completed at 1 site in Denmark. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2018-08-15.
Sponsored by Central Jutland Regional Hospital · Observational
This study investigates the agreement between extended scope physiotherapists (ESP) and orthopaedic surgeons (OS) on diagnosis and treatment plan in an orthopaedic outpatient shoulder clinic. Furthermore a cost analysis and an evaluation of the interdisciplinary collaboration at the orthopaedic outpatient shoulder clinic (termed shoulder clinic in the following) will be performed.
According to current practice, patients referred from a general practitioner (GP) to the Orthopaedic Outpatient Shoulder Clinic, Silkeborg Regional Hospital (SRH), Denmark, will be examined by either an orthopaedic surgeon (OS) or an extended scope physiotherapist (ESP), as these two groups of health professionals share this assignment. The decision on, which health professional is considered most appropriate to examine the patient, is done by a senior orthopaedic surgeon based on the available information in the referral letter from the GP. Three categories of appropriateness are used: most appropriate to be examined by an OS, most appropriate to be examined by an ESP and equally appropriate to be examined by an ESP or an OS.
The overall purpose of this study is to evaluate the quality of the shared assignment investigated through both professional and organisational outcomes. The following three subsidiary objectives are used:
Methods are described underneath related to each subsidiary objective.
The study is conducted at the shoulder clinic, SRH. Eligibility criteria, intervention and outcomes are described elsewhere.
Primary analysis:
Agreement between ESP and OS in choice of treatment plan (three categories: 1) referral to physiotherapy, 2) need of further diagnostic examination, steroid injection or surgery and 3) no intervention) will be evaluated by estimating the proportion of agreement between
Secondary analyses:
Agreement between ESP and OS in choice of treatment plan (five categories: as described in the outcome section) will be evaluated the same way as described above.
Agreement between ESP and OS in diagnosis of the patient will be evaluated by estimating both the proportion of total agreement and partial agreement between the two health professionals. Total agreement is defined as ESP and OS having registered the same primary diagnosis. Partial agreement is defined as ESP and OS having registered the same diagnosis but one of them considers it the primary diagnosis while the other considers it a secondary diagnosis.
The Association of Danish Physiotherapists is partly funding the salary for the principal investigator.
118 studies on the registry are indexed under Shoulder Injuries; 32 are open to participants now.
This study's enrollment of 69 is above the median of 60 across 45 observational studies indexed under Shoulder Injuries.
Browse Shoulder Injuries studies →Central Jutland Regional Hospital is the lead sponsor of 32 studies on the registry; 5 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Patients with shoulder problems referred to the shoulder clinic at Silkeborg Regional Hospital.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Shoulder patients referred to examination at the shoulder clinic, Silkeborg Regional Hospital.
Other: Examination
Patients will be examined twice the same day by an extended scope physiotherapist (ESP) and an orthopaedic surgeon (OS) in random order. They will independently and blinded to each other's opinion register * diagnosis and treatment plan (including need for further diagnostic examinations - i.e. imaging) * if the patient needs a new appointment at the shoulder clinic * if they under usual conditions would discuss their results with the opposite health professional before deciding diagnosis and treatment plan. After the individual examinations the ESP and OS discuss their results and come to an agreement (common decision) regarding the patient's diagnosis, treatment plan and need of a new appointment. Patients will be informed only of the common decision of the ESP and OS.
Treatment plan - orthopaedic surgeon
Treatment plan suggested by the OS will be registered in a chart developed for the occasion. The chart has 5 pre-defined categories: 1) referral to physiotherapy, 2) referral to diagnostic examination, 3) steroid injection, 4) surgery and 5) no intervention (categorical)
Time frame: Baseline
Treatment plan - physiotherapist
Treatment plan suggested by the ESP will be registered in a chart developed for the occasion. The chart has the same 5 pre-defined categories as for the OS: 1) referral to physiotherapy, 2) referral to diagnostic examination, 3) steroid injection, 4) surgery and 5) no intervention (categorical)
Time frame: Baseline
Treatment plan - common decision
The OS and ESP will discuss their results until they agree which treatment plan to offer the patient. Their decision will be registered in a chart developed for the occasion. The chart has the same 5 pre-defined categories as for the individual examinations: 1) referral to physiotherapy, 2) referral to diagnostic examination, 3) steroid injection, 4) surgery and 5) no intervention (categorical)
Time frame: Baseline
Diagnosis - orthopaedic surgeon
One primary diagnosis (and if relevant secondary diagnoses) suggested by the OS will be registered in a chart developed for the occasion. The chart has 9 pre-defined categories of diagnoses: 1) impingement, 2) rotator cuff injury, 3) glenohumeral instability, 4) glenohumeral osteoarthritis, 5) periarthritis humeroscapularis, 6) scapular instability, 7) fracture sequelae, 8) acromioclavicular joint disorder, 9) non-related shoulder diagnoses (categorical).
Time frame: Baseline
Diagnosis - physiotherapist
One primary diagnosis (and if relevant secondary diagnoses) suggested by the ESP will be registered in a chart developed for the occasion. The chart has the same 9 pre-defined categories of diagnoses as for the OS (categorical).
Time frame: Baseline
Diagnosis - common decision
The OS and ESP will discuss their results until they agree on patient diagnosis. Their decision will be registered in a chart developed for the occasion. The chart has the same 9 pre-defined categories of diagnoses as for the individual examinations (categorical).
Time frame: Baseline
New appointment - orthopaedic surgeon
The OS registers whether he considers, that the patient should be offered a new appointment at the shoulder clinic (categorical, yes/no)
Time frame: Baseline
New appointment - physiotherapist
The ESP registers whether he/she considers, that the patient should be offered a new appointment at the shoulder clinic (categorical, yes/no)
Time frame: Baseline
New appointment - common decision
The OS and ESP will discuss their results until they agree, whether the patient should have a new appointment at the shoulder clinic or not. Their decision will be registered (categorical, yes/no)
Time frame: Baseline
Discussion needed - orthopaedic surgeon
The OS registers whether he under usual conditions would discuss his results with an ESP before making a decision on diagnosis or treatment plan (categorical, yes/no).
Time frame: Baseline
Discussion needed - physiotherapist
The ESP registers whether he/she under usual conditions would discuss his/her results with an OS before making a decision on diagnosis or treatment plan (categorical, yes/no).
Time frame: Baseline
Salary - orthopaedic surgeon, first clinical examination
Mean expenditure on salary for an OS performing a clinical examination of a shoulder patient at the first visit. The estimate will be calculated based on time spent on the examination and mean salary for an OS (information on mean salary will be obtained from statistics at the finance department at the hospital)
Time frame: Baseline
Salary - orthopaedic surgeon, planned new appointment
Mean expenditure on salary for an OS performing a follow up appointment with a shoulder patient. The estimate will be calculated based on time spent on the appointment and mean salary for an OS (information on mean salary will be obtained from statistics at the finance department at the hospital)
Time frame: Baseline
Salary - extended scope physiotherapist, first clinical examination
Mean expenditure on salary for an ESP performing a clinical examination of a shoulder patient at the first visit. The estimate will be calculated based on time spent on the examination and mean salary for an ESP (information on mean salary will be obtained from statistics at the finance department at the hospital)
Time frame: Baseline
Salary - extended scope physiotherapist, planned new appointment
Mean expenditure on salary for an ESP performing a follow up appointment with a shoulder patient. The estimate will be calculated based on time spent on the appointment and mean salary for an ESP (information on mean salary will be obtained from statistics at the finance department at the hospital)
Time frame: Baseline
Costs - computed tomography (CT) imaging
Expenditure on CT imaging. Estimate obtained from the finance department at the hospital.
Time frame: Baseline
Costs - magnetic resonance (MR) imaging
Expenditure on MR imaging. Estimate obtained from the finance department at the hospital.
Time frame: Baseline
Costs - MR arthrography
Expenditure on MR arthrography. Estimate obtained from the finance department at the hospital.
Time frame: Baseline
Costs - electroneurography (ENG)
Expenditure on ENG. Estimate obtained from the finance department at the hospital.
Time frame: Baseline
Costs - electromyography (EMG)
Expenditure on EMG. Estimate obtained from the finance department at the hospital.
Time frame: Baseline
Costs - X-ray
Expenditure on X-ray. Estimate obtained from the finance department at the hospital.
Time frame: Baseline
Plan to share: No
Ran from Nov 2017 to primary completion in Apr 2018, 4 months.
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Central Jutland Regional Hospital