Simon Lafrance, Jean-Gabriel Lapalme, Marianne Méquignon, Carlo Santaguida, Julio Fernandes, François Desmeules

April 2021, Volume 30, Issue 4, pp 990 - 1003 Review Article Read Full Article 10.1007/s00586-020-06648-5

First Online: 29 October 2020


To appraise the available evidence on advanced practice physiotherapy (APP) models of care (MoC) in specialized secondary care such as orthopaedic, rheumatology or neurosurgery outpatients’ clinics for adults with spinal pain.


Systematic review with meta-analysis. Electronic searches were conducted up to July 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL. Studies on APP MoC in specialized secondary care for adults with spinal pain were included.


Eighteen studies (n = 9405), including two randomized controlled trials and sixteen observational studies were included. One study was considered at high quality, fourteen studies were considered of moderate quality and three were considered of low quality. Pooled results for change in disability for patients with spinal pain reported no significant difference between APP and usual medical care (UMC). Mean wait time for initial consultation was lower with APP (1–9.4 weeks) than with UMC MoC (23–65 weeks). Following the implementation of APP MoC, wait time for a consultation with a medical specialist was reduced (6–16 weeks). Physiotherapists in APP MoC managed independently 89.2% of the patients referred (n = 8393). Stakeholders and patients reported high satisfaction with APP care.


APP MoC and UMC likely result in comparable pain, disability and quality of life improvement for adults with spinal pain. However, APP MoC have the potential to improve health care access by reducing wait time for consultation in specialized care and maintaining a high level of satisfaction among stakeholders and patients.

Read Full Article