This website presents independent research funded by Health Education England and supported by the National Institute for Health Research (NIHR), Midlands Partnership NHS Foundation Trust and Keele University under a Clinical Doctoral Research Fellowship (NIHR301550). The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.
MOPeD STUDY BACKGROUND
WHY IS THIS STUDY IMPORTANT?
There are approximately 9000 physiotherapy assistants/support workers in the UK. Many of them work in NHS physiotherapy outpatient services treating patients with musculoskeletal or painful muscle and joint conditions. However, their role is not well defined and their duties and tasks vary from one service to another. This may lead to unjustified variation in care and services delivered to patients.
WHAT IS THE AIM?
This study aims to develop a ‘best practice’ framework of delegation to physiotherapy assistants in NHS musculoskeletal outpatient physiotherapy services.
HOW WILL WE DO IT?
We have worked with a group of patients to develop this study. They all have experience of treatment from a physiotherapist and/or physiotherapy assistant for musculoskeletal conditions. This group will continue to have an active role in contributing to the study which will use different research designs across three stages.
PLAIN ENGLISH SUMMARY
Musculoskeletal Outpatient Physiotherapy Delegation (MOPeD): A mixed methods study
Background of this research
There are approximately 9,000 physiotherapy assistants in the UK. Many of them work in physiotherapy outpatient services treating patients with musculoskeletal or painful muscle and joint conditions that are more common as people age. This is the largest group of patients that NHS physiotherapy services care for. The role of physiotherapy assistants is not well defined and their duties and tasks vary from one service to another. National guidance from the Chartered Society of Physiotherapy (CSP) is not very helpful, as it leaves decision-making about the delegation of tasks to the individual physiotherapist supervising the work of the physiotherapy assistant. As a result, in some services physiotherapy assistants take responsibility, under the professional supervision of a physiotherapist, for clinical work that traditionally physiotherapists would have undertaken, such as leading patient exercise classes and treating individual patients. In other services their role is mainly administrative. We do not know what best practice is in terms of delegation of work to physiotherapy assistants. As the NHS responds to a growing and ageing patient population and higher healthcare costs, physiotherapy assistants are likely to become increasingly important members of physiotherapy teams and clarity is needed about their role.
Aim
The overall aim of this research is to develop a ‘best practice’ framework of delegation to physiotherapy assistants in NHS musculoskeletal outpatient physiotherapy services.
Design and methods used
The study will use different research designs across three stages.
Stage 1: I will explore how the culture in physiotherapy services may influence how tasks are delegated to physiotherapy assistants by doing detailed observations in two NHS musculoskeletal outpatient physiotherapy services. I will also conduct interviews with physiotherapists, physiotherapy assistants, managers and patients to find out about their experiences of and attitudes about delegation. The findings will inform the design of the next stages of the study.
Stage 2a: I will work with three separate groups of physiotherapists, physiotherapy assistants and physiotherapy service managers. I will use a discussion method called Nominal Group Technique to reach agreement about what a ‘best practice’ delegation framework should include.
Stage 2b: I will also use findings from the patient interviews in stage one to design a survey to better understand patients’ preferences for receiving physiotherapy treatment from physiotherapy assistants. Specifically, I will use a technique called Discrete Choice Experiment to describe, explain and predict patients’ preferences between care fromphysiotherapists and physiotherapy assistants.
Stage 3: I will bring together all findings to develop a “best practice” framework to guide physiotherapists in delegating clinical work to physiotherapy assistants.
Patient and public involvement
I have worked with a group of seven patients to develop this study. They all have experience of treatment from a physiotherapist and/or physiotherapy assistant for musculoskeletal conditions. This group will continue to have an active role in contributing to all stages of the research, including giving input into:
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- The design of materials to inform participants and the public about the study
- The design of the patient interviews and survey
- The interpretation of the results
- The design of the best practice model of delegation
- Producing the materials for sharing the results publicly and deciding where to share the results
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Sharing the results
The findings will be shared with the appropriate professional groups and networks within the CSP. A summary of the results will be disseminated widely on social media. I will prepare a webinar for physiotherapists and physiotherapy assistants and share it via the CSP website. I intend to present findings at local, national and/or international physiotherapy and healthcare conferences. I will submit publications in selected magazines/newspapers and articles in professional and academic journals.
MOPeD STUDY STAGES
STAGE 1
A focused ethnographic study where we will explore how the culture in physiotherapy services influences how tasks are delegated to physiotherapy assistants by observing two NHS physiotherapy services, and interviewing clinicians and patients about their experiences and attitudes regarding delegation.
Data collection for stage 1 started in March 2022. The data analysis will be completed by June 2023.
STAGE 2a
We will work with 3 separate groups of physiotherapists, physiotherapy assistants and managers, using a discussion method called Nominal Group Technique to reach agreement about what a ‘best practice’ delegation framework should include
Stage 2 was conducted in July 2023
STAGE 2b
A survey using a technique called Discrete Choice Experiment to understand patients’ preferences for receiving physiotherapy treatment from physiotherapy assistants.
Recruitment for Stage 2b started on 15th May 2023
STAGE 3
We will bring together all findings to develop a “best practice” framework to guide physiotherapists in delegating clinical work to physiotherapy assistants.
It is anticipated that stage 3 will be completed by June 2024
MOPeD STUDY TEAM MEMBERS
Panos Sarigiovannis
Dr Benjamin Saunders
Professor Nadine E Foster
Professor Sue Jowett
NEWS & EVENTS
Milestones in the MOPeD Study
Great to hear the plans to enhance optimal delegation in clinical practice #physio24 @ClaireFordham5
“How are we serving the rough sleepers within our services?” important question for all clinicians from @awgilbert11 #Physio2024
Power outrage at Stockport, trains from Stoke to Manchester cancelled. En route to Manchester for #csp24 on a campervan instead with @DennisonCorinna 😂
Φυσική θέση των χεριών του Ρέτσου κατά τον κο Βαρούχα. Θα μας κάνετε να σκίσουμε και τα πτυχία μας στο τέλος εκεί στην @ERTflixOfficial #paool @paofc_
PLESAE DISSEMINATE. Excellent opportunity to work with my brilliant team. Great for professional and personal development if you are interested in implementation research and prognosis research in psychosis.
Post Doc Research Associat Keele University
Ready to share @MOPeD_study findings and first draft of delegation principles with our clinical advisory group. Exciting times #delegation #supportworkers
MOPeD STUDY PUBLICATIONS
P Sarigiovannis, NE Foster, S Jowett, B Saunders (2022) Delegation of workload from musculoskeletal physiotherapists to physiotherapy assistants/support workers: A UK online survey. Musculoskeletal Science and Practice, Volume 62, [102631] https://doi.org/10.1016/j.msksp.2022.102631
Sarigiovannis P, Foster NE, Jowett S, Saunders B (2023) Developing a best-practice framework for Musculoskeletal Outpatient Physiotherapy Delegation: the MOPeD mixed methods research study protocol. BMJ Open, 13(3), [e072989]. https://doi.org/10.1136/bmjopen-2023-072989
Sarigiovannis P; Cropper S (2018) An audit of the utilization of physiotherapy assistants in the musculoskeletal outpatients setting within a primary care physiotherapy service. Musculoskeletal Care, 16(3):405–408 https://doi.org/10.1002/msc.1238
Sarigiovannis P, Jowett S, Saunders B, Corp N, Bishop A (2020) Delegation by Allied Health Professionals to Allied Health Assistants: a mixed methods systematic review. Physiotherapy, 112:16-30. https://doi.org/10.1016/j.physio.2020.10.002
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MOPeD Background
There are approximately 9000 physiotherapy assistants/support workers in the UK. Many of them work in NHS physiotherapy outpatient services treating patients with musculoskeletal or painful muscle and joint conditions.
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Study Stages
The MOPeD study is a mixed methods study which will take place over three stages…
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Team Members
The MOPeD study is comprised of an international team of highly qualified musculoskeletal academics …