The role of the advanced practice physiotherapist (APP) in outpatient orthopedic clinics has been present in Ontario for over five years. These professionals have additional duties beyond those of a regular physiotherapist in order to screen patients pre- and post-operatively, triage patients for surgery, prescribe conservative management and monitor patients on an ongoing basis. The purpose of this role is to improve patient access to timely surgical care by reducing wait times for hip and knee replacement surgeries. Several positive outcomes have been reported in the literature. It has been established that an APP can effectively manage over 30% of the patients referred to a surgeon for hip or knee replacement surgery because these patients do not require surgery; rather, they require conservative management (Aiken et al. 2008). The APP and the orthopedic surgeon prioritize those who do require surgery in a similar manner, with the APP offering more conservative management strategies to the patients while they await surgery (Aiken et al. 2008). For those patients followed post-operatively, it was found that the APP and the orthopedic surgeon make similar assessments of the patients' functional status, the APP offers enhanced options for conservative management and these patients can be effectively managed by an APP (Aiken et al. 2007). In all instances, patient satisfaction is very high with the care they receive from both the APP and the orthopedic surgeon (Aiken et al. 2007, 2008).
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