Fennelly O, Desmeules F, O’Sullivan C, Heneghan NR, and Cunningham C. Advanced musculoskeletal physiotherapy practice: Informing education curricula. Musculoskelet Sci Pract. 2020;48:102174.

Abstracted by Vicente Mauri PT, ScD, COMT Anchorage, Alaska – Fellowship Candidate, IAOM-US Fellowship Program & Jean-Michel Brismée, PT, ScD, Fellowship Director, IAOM-US Fellowship program

Context: Physiotherapists operate at an advanced level of practice, usually on ad hoc basis with inhouse training, in response to the increasing burden of musculoskeletal (MSK) disorders. Discrepancies in role-specific education of advanced practice physiotherapists (APPs) create challenges in ensuring a quality service, workforce mobility and formal recognition.

Objective: This study reviewed existing MSK APP competency frameworks and education offerings, and explored physiotherapist learning needs with a view to informing international standardization of MSK APP education curricula.

Type of Review: Scoping review.

Settings: A scoping review of the literature and relevant university and regulatory websites identified APP competency frameworks and education curricula, which were verified by international experts.

Details of the Paper:  Content analysis, performed on the identified competencies and modules, produced a list of themes existing in MSK advanced practice internationally. A survey based on those themes identified the learning priorities of physiotherapists (n = 25) participating in an APP symposium in Ireland. Six APP competency frameworks and eleven curricula from the UK, Canada and Australia were identified. The identified topics deemed high priority for Advanced Practice Physiotherapy Education/Continuous Professional Development are: radiology, assessment and diagnosis, clinical reasoning and decision-making, research and evidence-based practice, education and clinical mentoring, leadership and service management, injection therapy, communication and interpersonal skills, pharmacology, professional-related matters, and critical MSK physiotherapy.

Applications: As the IFOMPT standards already provide an internationally-recognized governance framework for MSK physiotherapy education, adaption of this framework to encompass the additional identified competencies would perhaps facilitate the expansion of MSK post-graduate offerings. Other aspects of education provision include experiential learning, which has long been deemed an important component of APP training and interprofessional learning which was common place across the identified education curricula.

Conclusions: This paper provides an overview of international MSK APP competency frameworks and education curricula, which acts as a foundation to enhance and standardize MSK APP education. This should ultimately enhance APP practice, bring greater recognition for advanced practice and helping establish clearer physiotherapy career progression pathways while enabling workforce mobility. Despite variances in APPs profiles both between and within countries, common themes emerged regarding their expected competencies and skills.

 IAOM-US Commentary

As highlighted by the authors, the IAOM-US agrees with the principle that consistency in advanced practice competencies facilitates workforce mobility and skills transferability.  Fennelly O et al carried out an excellent work gathering the common understanding of those competencies recognized as needed for a successful MSK professional education.

Through the last 30 years, the IAOM-US has adapted its curricula based on the evolution of the physical therapy profession. From pure orthopedic manual therapy courses and certifications in the first 20 years, to more specific and detailed instruction towards advanced musculoskeletal management training with fellowship and residency programs.

The present commentary aims to show how current IAOM-US courses and other educational offerings cover the reported topics (Table 1).

Table 1 – IAOM-US educational offerings and their associated topics/competences and total continued educational hours.

IAOM-US educational offering Primary Topic and Competence Secondary Topic and Competence Total Continued Educational Hours (format)
NEXT Series 2-4, 7, 9, 10 1, 6, 8 24 (8 online + 16 ILO)
Differential Diagnosis and MSK Management / Clinical Examination and MSK Management 2-4, 7, 9, 10 1, 8 14.5 (hands-on)
Diagnosis and Management 2-4, 7, 9, 10 1, 8 8 (online)
Advanced Manual Techniques 2-5, 7, 10 1, 8 8 (hands-on)
Clinical Reasoning for spinal management 2-4, 6, 10 1, 8, 9  
Rapid ID Series 1-4, 10   45 min to 1 hours (online)
Residency 2-5, 7, 9,10 1, 6, 8 1 year (Hands-on and ILO)
Fellowship 2-5, 7, 9, 10 1, 6, 8 2-3 years (Hands-on and ILO)

1- radiology, 2-assessment and diagnosis, 3-clinical reasoning and decision-making, 4- Research and Evidence-based Practice, 5- Education and Clinical Mentoring, 6- Injection Therapy, 7- Communication and Interpersonal Skills, 8- Pharmacology, 9- Professional-related matters, 10- Clinical MSK Physiotherapy, ILO- Instructed led online course.

Besides the Residency and Fellowship programs which include more comprehensive educational curricula, the IAOM-US Next series becomes the best educational offering aiming to develop not only high skilled clinical MSK physiotherapy but also education and clinical mentoring through approximately 16 hours of synchronous teaching (and 8-hr online content) where instructors teach through their own professional experience while contrasting it with the most recent and available research and evidence-based practice. As mentioned by Carr et al., clinical expertise is facilitated using a valued practice-based collaborative learning cycle and subsequent reflection and analysis that support clinical expertise development.1

Other online content such as webinars and short online lectures aim to more specific topics/competences. “A physical therapist’s guide to Cervical and Lumbar MRIs” short lectures emphasize topics associated with radiology and clinical reasoning; “Leadership and clinical reasoning” webinar guides participants to gain skills related to education and clinical mentoring, professional-related matters and clinical reasoning; and “Shoulder arthroplasty,” “Temporomandibular joint disorders,” and “Disc hydration principles for treating the intervertebral disc” webinars are perfect examples of strong clinical MSK physiotherapy and evidence-supported practice.

Topics and competences more associated with pharmacology and assessment/diagnosis are fairly represented by “Understanding Opioids: pain management and addiction” and “Surface anatomy” short courses, respectively. More content should be produced to cover those specific topics and competences offered by the current IAOM-US curricula.

Based on this short and introductory analysis of current offerings, the IAOM-US shows strong musculoskeletal approaches from assessment to treatment. New content and future certification path must show combined structure courses with complementary webinars and short lectures in an intent to encompass most (at least 8 out of 10) of reported topics and competences expected to be included in an advanced MSK continuing education program that brings substantial professional, clinical and financial benefits to the participant.2

This information will serve to enhance post-professional continuing education for physical therapists and other health-related careers while enabling workforce to aim specific content towards educational improvements.

References

  1. Carr M, Morris J, and Kersten P. Developing clinical expertise in musculoskeletal physiotherapy; Using observed practice to create a valued practice-based collaborative learning cycle. Musculoskeletal Science and Practice. 2020;50:102278
  2. Whitman JM et al. An orthopedic manual physical therapy fellowship training’s impact on professional development, involvement, personal lives, and income – A survey study. Journal of Manual & Manipulative Therapy. 2020;28:5,287-297.
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