Nottingham

Understanding the diagnostic referral activity and consequences in advanced practice physiotherapists working in community interface clinics

This internship is embedded within a mixed-methods research project entitled “Understanding the diagnostic referral activity and consequences in advanced practice physiotherapists working in community interface clinics.” The project seeks to examine how physiotherapists working in advanced practice roles use diagnostic investigations—particularly MRI imaging—and to explore the clinical, professional, and patient-level consequences of these referral decisions.

Physiotherapists working in community interface and primary care settings increasingly have access to advanced diagnostic privileges. While these extended roles may improve access to care, they may also introduce additional professional pressures and uncertainty, with potential implications for referral behaviour, shared decision-making, and patient experience. The project aims to understand whether diagnostic referrals made by advanced practice physiotherapists working in community interface clinics are appropriate and clinically meaningful. The project will also explore how decisions are made and experienced by patients, and whether there are unintended consequences for both patients and clinicians, including potential iatrogenic harm.

The study uses a mixed-methods design. Quantitative components include analysis of routinely collected data on shared decision-making (using the CollaboRATE questionnaire), diagnostic referral rates, referral appropriateness, and therapeutic yield. Qualitative components involve in-depth interviews with patients and physiotherapists to explore beliefs, experiences, motivations, and perceptions related to diagnostic referral and imaging decisions.

The intern will support data analysis and synthesis across both quantitative and qualitative work packages. Activities will include data cleaning and descriptive analysis, contributing to the assessment of referral appropriateness and outcomes, assisting with qualitative analysis of interview data, and supporting the integration and write-up of findings. The project and any work will be under-pinned by realist methodology (For details see; https://www.ramesesproject.org/ ). The intern will receive regular supervision and mentorship from the project lead, providing a supportive environment to develop skills in mixed-methods research, applied health services research, and academic writing.

Using realist research approaches to understand the retention and support needs of first contact practitioner physiotherapists in primary care

This internship is embedded within an ongoing research project entitled "Using realist research approaches to understand the retention and support needs of first contact practitioner physiotherapists in primary care." The project examines how the evolving First Contact Practitioner Physiotherapist (FCPP) role is experienced in UK general practice, with a particular focus on the contextual factors and underlying mechanisms that influence practitioner wellbeing, retention, and workforce sustainability.  

The project is currently at the stage of data synthesis and, from a realist perspective, programme theory refinement. Multiple data sources have been collected, including qualitative and quantitative data, and the next phase of work focuses on integrating these findings to refine and test explanatory programme theories. These theories will be used to identify how, why, for whom, and in what circumstances different aspects of the FCPP role influence retention and support needs in primary care settings.

The internship will support this phase of the project by contributing to qualitative data analysis, realist synthesis, and triangulation of qualitative and quantitative findings. The intern will work closely with the project lead to assist in refining context–mechanism–outcome (CMO) configurations and in developing theory-informed, practical recommendations aimed at improving support structures for FCPPs in primary care.

The internship will also involve contributing to the write-up of study findings and recommendations for academic and applied outputs.  The project and any work will be under-pinned by realist methodology (For details see; https://www.ramesesproject.org/). The student will receive regular supervision and support from the project lead, providing structured opportunities to develop skills in realist methodology, qualitative analysis, research synthesis, and academic writing within a supportive research environment.