There is an understandable ‘conservatism’ in health and the unwieldy structure of the Medicare system, along with frustrating health bureaucracies and shared responsibilities between state and federal governments, also makes innovation difficult to achieve.

When advocating for a shift from reactive to proactive healthcare and the implementation of evidence-based first-line strategies, which the physiotherapy workforce is ideally equipped to deliver, we commonly use clichés such as ‘we’re not reinventing the wheel’—meaning that we’re not asking governments to take risks but we are asking them to adopt models of care that have been proven to work in other (similar) countries.

For example, for the past three years Te Whatu Ora (Health New Zealand) has been operating a trial program (across Bay of Plenty, Taranaki, Waikato, Wellington and Northland) to reduce orthopaedic waiting lists by offering physiotherapy treatments instead. 

This innovative program aims to reduce surgery waiting times by 75 per cent.

According to Radio New Zealand, ‘Te Whatu Ora says patients who are waiting for pre-surgery assessments for a range of conditions involving hips, knees and spines are now being offered preliminary physio appointments in their communities. In some cases, patients are being told physiotherapy is enough—and they’re removed from the “suitable for surgery” waiting list.’

What I like about this model is that a physiotherapist can make assessments and recommendations directly to an orthopaedic surgeon. 

Physiotherapy treatments are likely to offer patients some symptomatic improvement, education and a higher quality of life, which can delay the need for surgery, provide relief while awaiting surgery or help avoid unnecessary surgery altogether.

It would be a welcome innovation if Australian patients on public orthopaedic surgical waiting lists could access
physiotherapy screening, rehabilitation and/or prehabilitation through expanded chronic disease management items.

New funding models in preventive care and screening through private health insurance would also reduce the musculoskeletal load on the healthcare system.

The New Zealand model is very similar to Australia’s public Orthopaedic Physiotherapy Screening Clinics. 

Screening of patients with non-urgent musculoskeletal conditions by advanced practice physiotherapists can contribute to priority- based waiting list management while also delivering early alternative care when surgery is not indicated.

Looking at just one of these clinics, I note that they offer assessments by an experienced musculoskeletal/sports physiotherapist and that patients are provided with clinical advice on the nature of their condition and their non-surgical management options. 

The clinic comprises physiotherapists, occupational therapists, a psychologist and a dietitian. 

If a patient experiences particular problems or further clinical investigations are required (such as an X-ray, CT scan or MRI), then the musculoskeletal physiotherapist and the orthopaedic consultant will review the patient’s needs while they remain on the waiting list to see an orthopaedic surgeon.

The evidence indicates that Orthopaedic Physiotherapy Screening Clinics, like the Te Whatu Ora program, improve patient outcomes, drastically reduce waiting times and improve efficiency, saving time and money. 

The New Zealand model is publicly funded. 

It includes screening and assessment of suitability for orthopaedic surgery and there is also a prehabilitation component.

Speaking of which, the APA was contacted recently about pursuing a ‘prehab’ model for patients scheduled for major abdominal surgery. 

While these discussions are very much in a preliminary stage, the prehab model is an innovative approach that is already used for cancer patients and others. If something works, there’s no need to reinvent it. 

Just replicate and expand it so that more patients can benefit.

Contact Simon via email. 

>>Simon Tatz General Manager, Policy and Government Relations