Early identification of nerve lesions and associated neuropathic pain in spine-related pain disorders is important for tailored treatment. Correlating compressive neurological pathologies (e.g. myelopathy, radiculopathy) may benefit from early surgical intervention.

 

With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment (Category 1 – assessment within 1 months, Category 2 within 3 months, category 3 within 12 months), a call to support new models of care has been made (1), including the evaluation and expansion of workforce models supporting advanced skills in allied health (1).

 

An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2FTE )assess patients from the neurosurgery triage waitlist for their potential suitability for spinal surgery. Recommendation of either further investigation and possible assessment by a neurosurgeon or appropriate non-surgical management of the patients’ pain condition is suggested. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. Patient cases are discussed with a neurosurgery consultant on a weekly basis. Patients with correlating compressive neurological pathologies are fast tracked for neurosurgeon consultation for surgical opinion and early surgical intervention. The aim of this project is to evaluate the ASP service in the year 2022.

A retrospective descriptive analysis of patient data captured in 2022 was performed. 

 

In 2022, 1337 new patient referrals were managed plus 267 follow-ups from the previous year. Category 1 patients (n=81) waited on average 31 days for their first appointment, Category 2 patients (n=394) waited 76 days and Category 3 patients (n=854) waited 376 days.

 

 

287 (18%) referrals were discharged without physical assessment of the patient (DNA, cancellations, declined). Of the 1317 patients physically assessed by the ASPs (57%) were discharged directly after assessment, for 290 patients (22%) their outcome was still pending at time of analysis (March 2023).   281 (22%) patients were referred for review with a neurosurgeon. Of the 229 patients already assessed by a neurosurgeon (including patients from 2022), 103 patients (45%) were offered surgery, 52 (23%) were not offered surgery, 46 (20%) patients had to be further  reviewed, and for the remaining (n=18) their outcome was unknown. 

Of the 1604 patients referred the Neurosurgery Spinal Clinic, only 17% needed to see a neurosurgeon. The conversion rate to surgery of 45% is higher compared to an estimated 5%-10% in a non-ASP triaged clinic. 

The ASP model of care has proved invaluable to (i) provide access of patient care within the recommended wait times (ii) optimize neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management.