As a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2013) working in the jaw assessment clinic (JAC) at the Princess Alexandra Hospital, Rod McLean is providing innovative solutions for people experiencing pain from temporomandibular dysfunction (TMD). Rod says ‘physiotherapists are integral team members in the management of TMD. We have a unique ability to proactively and extensively question our patients, explore their beliefs and perceptions, adequately assess and appreciate the interplay of a multitude of factors on their presenting symptoms.’

Developed as a new service only two years ago, the JAC is the first of its kind. Despite other multidisciplinary TMD clinics existing across the globe, none use the extensive musculoskeletal expertise of specialist physiotherapists to lead the triage, assessment and management of TMD in a multidisciplinary team.

Following the blueprint from other successful orthopaedic physiotherapy screening clinics, the JAC sought to replicate this model of care to reduce waitlist times and improve patient access to treatment. Having worked for several years as a clinical lead in an orthopaedic physiotherapy screening clinic for spinal pain as well as working in private practice, Rod saw this as a unique opportunity to apply his expertise in a novel setting.

TMD is one of the most common causes of facial or mouth pain, with multifactorial and biopsychosocial processes that can contribute to the predisposition, initiation and perpetuation of the pain experience. TMD is associated with significant negative impact on function and quality of life.

Traditionally, many of these patients have been referred to maxillofacial surgeons for medical management; however, this advanced practice role in JAC facilitates patients accessing the right healthcare options more quickly than before and improve their outcomes.

‘This is where the service has had the greatest impact. The patients are seen sooner, instead of remaining on a waiting list for an extended period of time and potentially worsening,’ Rod explains. ‘They can then access appropriate multidisciplinary management.’

Given the complex interacting biopsychosocial factors that contribute to TMD, the JAC multidisciplinary team works together to provide a holistic service. Rod says by working as part of a multidisciplinary team, ‘the patients gain so much from an integrated approach being taken to their condition as TMD often has impacts on patients in psychological domains.’ He adds ‘by not recognising stressors, lack of relaxation skills, poor coping mechanisms or external drivers for these conditions means that people don’t improve and the problem recurs.’

Rod works collaboratively with maxillofacial surgeons, treating physiotherapists and psychologists to develop solutions for each individual patient. An advanced scope role in a setting such as JAC can be complex. In some cases, jaw pain may not be necessarily related to musculoskeletal causes, requiring the screening physiotherapist to think outside the box when assessing and triaging.

‘Knowledge is a major component. I became much more aware of the diagnostic categories, masqueraders and literature around patients with jaw pain through the specialisation process,’ Rod says. ‘I had come back to Australia to complete my master’s of musculoskeletal physiotherapy in 2008 and started working with specialist musculoskeletal physiotherapists—they all knew so much more than me.’

The Australian College of Physiotherapists specialisation program is one that is growing in popularity, as more clinicians are seeing the benefit of undertaking a career pathway. While originally developed in the musculoskeletal setting, the APA has expanded career pathways for those working in sports and exercise, pain, neurology, gerontology, leadership and management, and cancer,palliative care and lymphoedema.

For Rod, this journey began with a desire to continue to develop as a clinician.‘I wanted to become a better physiotherapist who was able to effectively manage the greater proportion of more challenging clients I was starting to see,’ he says.

Then there was the inspiration that came from working alongside specialist physiotherapists. Rod was fortunate to be mentored by physiotherapists such as APA Honoured Member Gwen Jull, Shaun O’Leary, FACP, Erica Williams, FACP, and Sue Kelley, FACP, who, Rod says, ‘motivated me to take the plunge and commit to pursuing the specialisation pathway.

'They were role models and hugely supportive throughout the whole process. I was fortunate to have the help and support of everyone else on the training program, my facilitator Cameron Lawson [FACP] and all the other specialists who were so kind with their time, expertise and feedback,’ Rod says.

While undertaking a career pathway has been a positive experience for Rod, it doesn’t come without its challenges. The specialisation process takes time commitment, requiring the balancing of work and life pressures, and taking a significant step outside of your comfort zone. Despite these challenges, Rod wouldn’t change a thing. For those contemplating undertaking a physiotherapy pathway or specialisation, he says ‘do it!

The process is the hardest process I have ever undertaken but there are so many personal and professional rewards that result from this. I’ve worked with Gwen Jull on a curriculum re-design/evaluation project, been involved in a statewide training program for musculoskeletal physiotherapists in Queensland Health, have worked as a lecturer and clinical educator of postgraduate students, and been involved in setting up, implementing and evaluating the jaw assessment clinic.’

And for those who are looking to set up new clinics or models of care, Rod believes success is brought about by a combination of people, opportunity and skillset. Rod’s managers at the Princess Alexandra Hospital, Louise Matthews and Peter Tonks, had been in discussion with the oro-maxillofacial surgical team for some time about a collaborative approach to managing these patients.

‘The combination of support from the physiotherapy department, support from the surgeons, waitlist pressures, the political environment and the right skillsets achieved a successful grant to pilot the JAC,’ Rod says. ‘Another grant was obtained to ensure the running of this clinic over the next year. We continue to apply for further funding and are looking at consolidating research opportunities in this area.’