Understanding the diagnostic referral activity and consequences in advanced practice physiotherapists working in primary care settings, a mixed methods realist evaluation

PI Title: Dr Rob Goodwin

Lead Member: University of Nottingham

Background
Physiotherapists are often working in places like GP practices. It is common for them to use new and advanced skills. For physiotherapists this can include sending patients for investigations, like x-rays and MRI scans. Working in these advanced
roles seems to cause the physiotherapists extra pressure and some physiotherapists find this stressful. We think that this stress may mean that physiotherapists send more people than is needed for these investigations.

We also know that most people don’t need an x-ray or scan. In fact, sometimes having a scan can do more harm than good. For example, if a patient is told they have a ‘damaged disc’ in their back they may worry about it and may decide to stop
exercising. The worry might make the patient feel unwell (maybe anxious or depressed).

Aim
We will explore the experiences and opinions of patients and physiotherapists to understand why referrals for investigations are made and if patients feel involved in the decision. We will also explore the outcomes of the investigations to see if they
were helpful or not.

Methods
This study will be split into two parts.
Part 1
In part 1 we will look at patients’ records to see what the result of the investigation was and if it helped inform their treatment. We will also use a questionnaire that asks if the patient felt involved in the decision. This questionnaire is called the CollaboRATE questionnaire.

Part 2
In part 2 we will do separate interviews with patients and physiotherapists. The interviews will take place after the result of the investigation has come back. We will ask patients and physiotherapists about the whole process- from meeting each
other, deciding to make the referral for the investigation, to getting the result and what that meant.

What will this tell us?
This will help us understand why physiotherapists make these referrals.
It will help us understand if patients feel involved in these types of decisions
It will help us understand if the referrals that are made are helpful or not.

Results
We will produce guidelines to support physiotherapists in making decisions around referrals for investigations
We will produce information to help patients understand the role that investigations play in supporting their health.

Patient and public involvement
Patients with lived experience of injury or illness, and expertise in healthcare have been involved in the development of this application. They will be involved throughout the study and involved in reviewing documents, attending meetings and
writing publications.