Advancing Musculoskeletal Physiotherapy Practice – Informing Advanced Practice Curricula

Almost a year ago, results of a IFOMPT survey investigating advanced physiotherapy practice (APP) were published. Results showed that the term APP causes confusion and frustration due to a lack of clarity and defintion of what qualifications and governance is required to be an APP and this is because of the ad-hoc development of the roles to this point.  There was also a clear difference in stadnard and understanding of practice between countries. In the UK the conversation has progressed considerably with the publication of the multi-professional clinical framework for advanced clinical practice which aims to unify all clinical practice cross-profession and cross-speciality to a standard of practice. This is achieved through the 4 pillars; clinical practiceleadership and managementeducation and research. Level 7 (equivalent to MSc level) practice must be evidence for each of the four pillars to demonstrate competence at this level. This can be done through protofolio or academic routes.

A huge amount of work has been put into develping the educational component of the framework and this should definitely be applauded and signals how the UK has come a long way in a short amout of time. There are clearly lessons to be learned for other organisations worldwide. There are also lessons to be learned for how to meet specific professional needs when training physiotherapists for enhanced roles in which clinicians move away from specific roles to working at an advanced level of practice. This often requires traditionally medically or nurse-controlled tasks and there is still an ad-hoc nature to the education and development of clinicians to enable them to safely meet the requirments of the jobs. To overcome this often competency based framework/education is used and Parson et al (2018) advocate using the following steps:

  1. Identification of the required APP competencies
  2. Organisation of competencies into themes
  3. Organisation of themes into courses
  4. Organisation of courses into curricula

Due to advanced practice existing for decades now it is likely that many different competency frameworks and educational curricula/courses have been adopted and therefore a scoping review was performed to identify commonality  and create the foundation of an internationally-recognised MSK APP competency and educational standard. As a result of the scoping review siz APP competency frameworks were identified from the literature – 4 from the UK and 2 from Australia and eleven advanced practice curricula relevant to MSK practice were identified (9-UK based, 1 – Australia and 1 – Canadian). When comparing and contrastic priorities for education, development and competency frameworks for MSK APPs the following themes (in bold) and topics (underneath themes) were deemed high priority:

  • Radiology
    • requesting and interpreting ionising radiation
  • Assessment & Diagnosis
    • MSK pathology
    • MSK assessment and diagnosis
    • Rheumatology
    • Haematology
  • Clinical Reasoning & Decision-Making
    • Critical thinking in MSK practice
    • Clinical decision making
    • Shared decision making
  • Research & EBP
    • Evidence based practice
    • Developing clinical practice guidelines
    • Action research
  • Education & Clinical Mentoring
    • Practice based learning
    • How to become an effective clinical educator/mentor
    • Presentation and knowledge sharing skills
  • Leadership & Service Management
    • Service development and evaluation
    • Leadership
    • Clinical audit
    • Outcome measurement
    • Integrated MSK care models
    • Data management
  • Injection Therapy
    • Performance of and higher reasoning
  • Communication & Interpersonal Skills
    • Communication skills
    • Behaviour change approachs
    • Brief intervention training
  • Pharmacology
    • Non-medical prescribing
  • Professional-Related Matters
    • Promoting the profession
    • Professional advocacy
  • Clinical MSK Physiotherapy
    • Enhancing practice through technology
    • Manual therapy