ADVANCED MUSCULOSKELETAL PHYSIOTHERAPY ... · Web viewThe scope of practice for advanced musculoskeletal physiotherapists in the pain clinic includes waitlist triage, multi- and single-discipline

Advanced musculoskeletal physiotherapy

pain clinic

Workbook

Prepared by Alfred Health on behalf of the Department of Health, Victoria. © 2014

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Contents

Background........................................................................................................................................ 3

Scope of practice statement – pain clinic...........................................................................................4

Competency standard – delivering advanced musculoskeletal physiotherapy in the pain clinic........5

Learning needs analysis Part A and B: pain clinic............................................................................37

Competency standard self-assessment tool – Part A of the learning needs analysis: pain clinic.....37

Knowledge and skills self-assessment – Part B of the learning needs analysis: pain clinics...........46

Learning and assessment plan: pain clinic (example only)..............................................................79

Workplace learning program............................................................................................................87

Competency-based assessment and related tools...........................................................................90

Curriculum overview....................................................................................................................... 133

Glossary......................................................................................................................................... 136

References..................................................................................................................................... 136

Bibliography................................................................................................................................... 137

Appendix........................................................................................................................................ 139

Learning and assessment plan template....................................................................................139

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BackgroundThis workbook contains the resources for the competency-based learning and assessment program for advanced musculoskeletal physiotherapists commencing work in the pain clinic. It should be read in conjunction with each individual organisation’s policy and procedures for delivering advanced musculoskeletal physiotherapy services and, in particular, with the operational guidelines and clinical governance policy for the relevant advanced musculoskeletal physiotherapy service. The competency-based learning and assessment program is designed to be flexible and tailored to suit the needs of individual physiotherapists and the needs of the organisation. Therefore decisions regarding the detail of the program need to be made for each organisation by the clinical lead physiotherapist in collaboration with the pain management team. This workbook provides the framework to be used along with examples of the learning and assessment program. Organisations may choose to include additional learning and assessment tasks or do away with some of the proposed tasks depending on the experience and skills of the individual, the resources available, the requirements of the medical and physiotherapy departments, and the needs of the organisation as a whole.

A summary of the key components of the competency-based learning and assessment program contained in this workbook specifically written for the pain clinic are as follows:

the scope of practice definition the competency standard Competency standard self-assessment tool (Part A of the Learning needs analysis) Learning needs analysis (Part A and B) Learning and assessment plan assessment and related tools.

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Scope of practice statement – pain clinic

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The scope of practice for advanced musculoskeletal physiotherapists in the pain clinic includes waitlist triage, multi- and single-discipline management of patients presenting with pain conditions including acute, subacute, recurrent, persistent, nociceptive, neuropathic and mixed pain. The physiotherapist is responsible for assessing, diagnosing, formulating and undertaking a comprehensive management plan alone or in conjunction with expert colleagues. Advanced musculoskeletal physiotherapy interventions will include both individual and group interventions. The physiotherapist is also responsible for presenting a comprehensive, but succinct, synopsis at case conference, and for recognising signs and symptoms that require urgent medical or psychological attention.

The physiotherapist will commence working under the supervision of the pain consultant until work-based competency standards have been met. Once competency has been achieved, the physiotherapist will be deemed to work autonomously with simple or complex patients who, on assessment:

present with no red flags do not need imaging or pathology do not need to be admitted do not present with unmanaged psychological comorbidities.

Any patients who do not meet the above criteria will need to be discussed with the pain consultant and/or psychologist. Regardless of being deemed competent, a collaborative, team-based approach to patient care is strongly encouraged at all times while working in the pain clinic, and the physiotherapist should remain in close consultation with expert colleagues regarding any patient concerns.

Competency standard – delivering advanced musculoskeletal physiotherapy in the pain clinic

Refer to the Advanced musculoskeletal physiotherapy clinical education framework manual for details regarding the background and development of the competency standard for advanced musculoskeletal physiotherapists delivering services in these clinics. In addition, the steps involved in achieving competence are detailed in the manual. Refer to the flowchart on the next page for an overview of the competency standard for the pain clinic.

There are variations across Victoria in the model of care for advanced musculoskeletal physiotherapy clinics therefore it may be that some of the domains and performance criteria described in the competency standard may not apply to every organisation. For example, paediatrics may not be seen at some sites. Also the prevalence of diabetes varies across different demographics. If the prevalence of diabetes is high in the patient population the organisation services, it is recommended that the diabetes section of the competency-based learning and assessment program be included, otherwise it may not be a high priority for learning and assessment, and there may be other chronic illnesses more prevalent that warrant further knowledge.

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Element

Elements describe the essential outcome of the competency standard

Performance criteria

The performance criteria specify the level of the performance required to demonstrate achievement of the element

Performance cues

Performance cues provide practical examples of what an independent performer may look like in action

Professional behaviours

1. Operate within scope of practice

1.1 Identify and act within own knowledge base and scope of practice

Confer with expert colleagues for a second opinion when unsure or exposed to uncommon presentations

Refrain from procedures outside scope Annually review potential scope of practice in accordance with

organisational needs and current legislation

1.2 Work towards the full extent of the role Demonstrate a desire to acquire further knowledge and extend practice to achieve full potential within scope of practice

Extend the range of patient conditions/profile over time

2. Display accountability 2.1 Demonstrate responsibility for own actions, as it apply to the practice context

Identify the additional responsibilities resulting from working in advanced practice roles

Identify the impact own decision making has on patient outcomes and act to minimise risks

Lifelong learning

3. Demonstrate a commitment to lifelong learning

3.1 Engage in lifelong learning practices to maintain and extend professional competence

Use methods to self-assess own knowledge and clinical skills; for example, engage in learning needs analyses and/or performance appraisals

Design a plan to appropriately address identified learning needs

Maintain a comprehensive professional portfolio, including evidence supporting achievement of identified needs

Actively participate in ongoing continued education programs, both in-house and external, intra- and interdisciplinary

3.2 Identify own professional development needs and implement strategies for achieving them

3.3 Engage in both self-directed and practice-based

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Performance cues


learning Prepare in advance for work-based assessment and/or continuing education sessions

Initiate and create own learning opportunities, for example:o follow up on uncommon or complex caseso obtain and act on advice from other professionals to

improve own practice Share clinical experiences that provide learning opportunities

for others Observe, co-assess and co-treat with other experienced

clinicians

3.4 Reflect on clinical practice to identify strengths and areas requiring further development

Communication

4. Communicate with colleagues

4.1 Use concise, systematic communication at the appropriate level when conversing with a range of colleagues in the practice context

Verbally present patients to consultant with appropriate brevity and pre-considered purpose using a systematic approach – for example, ISBAR

When presenting cases, consistently include essential information while excluding what is extraneous

Write referral letters that are concise, accurate and contain all required information to accepted practice standards and are appropriate to the audience

With the patient’s consent, consistently provide concise and accurate reports back to referrer and community services that contain assessment findings, working diagnosis and plan

4.2 When acting to obtain their involvement, present all relevant information to expert colleagues

Provision and coordination of care

5. Evaluate referrals 5.1 Discern patients appropriate for advanced physiotherapy management in accordance with individual strengths or limitations, any legal or organisational restrictions on practice, the environment, the patient

Consistently discern patients appropriate for advanced musculoskeletal physiotherapy management

Consistently discern patients not appropriate for advanced

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Performance cues


profile/needs and within defined work roles musculoskeletal physiotherapy management and act to redirect the patient down the appropriate referral pathway

Engage in timely discussion and referral to expert colleagues for appropriate cases

Appropriately and immediately identify red flags from initial referrals

Appropriately acknowledge yellow flags identified from initial referral and consider the relevance and potential influence of these

Complete all necessary arrangements to facilitate triaged management plans

Ensure triage decisions are documented according to organisational procedure

When prioritising work, consistently apply local organisational requirements regarding patient flow

5.2 Discern patients appropriate for management in a shared-care arrangement in accordance with individual strengths or limitations, any legal or organisational restrictions on practice, the environment, the patient profile/needs and within defined work roles

5.3 Defer patient referrals to relevant health professionals, including other physiotherapists, when limitations of skill or job role prevent the patient’s needs from being adequately addressed or when indicated by local triage procedure

Act to ensure relevant health professionals receive an accurate and timely handover when transferring patient care and that urgency of care is understood

Document referral/handover clearly with all necessary information

5.4 Prioritise referrals based on patient profile/need, organisational procedure or targets, and any local factors

5.5 Communicate action taken on referrals using established organisational processes

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Performance cues


6. Perform health assessment/examination

6.1 Design and perform an individualised, culturally appropriate and effective patient interview for common and/or complex conditions/presentations

Use the role of each team member in a multidisciplinary assessment

Implement an interdisciplinary biopsychosocial assessment that seeks to complement the assessment of other team members, but also seeks to minimise the burden to patients through duplicating information collection

Use a suite of outcome measures that evaluate the multidimensional nature of the pain experience

Apply an understanding of the limitations of outcome measurement collection in individuals with communication difficulties and cognitive impairments

The following has been adapted from the work of Suckley (2012):

History-taking skills include: history of presenting conditions

o chronological relevant sequence of events and symptoms

o stability of the presenting condition over the past weeks and months

o mechanism of injury and associated questions relating to this

o severity, irritability and nature of problem o specific red flag and yellow flag questioning

consideration of the impact of the presenting complaint on the patient, including:

o functional activities, mental status, work and social roles

o compensable injuries, litigation factors, medical or otherwise, that could influence treatment

6.2 Formulate a preliminary hypothesis and differential diagnoses for a patient with common and/or complex conditions, as relevant to the practice context

6.3 Perform complex modifications to routine musculoskeletal assessment in recognition of factors that may impact on the process, such as the patient profile/needs and the practice context

6.4 Design and conduct an individualised, culturally appropriate and effective clinical assessment that:

o is systems-based o includes relevant clinical tests o selects and measures relevant health indicatorso substantiates the provisional diagnosis

6.5 Identify when input is required from expert colleagues and act to obtain their involvement

6.6 Act to ensure all red flags are identified in the assessment process, link red flags to diagnoses not to be missed and take appropriate action in a timely manner

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Performance cues


outcomes or prognosis – for example, time since onset, initial/previous management, patient compliance

history of medications and other pain-related interventions, including

o current medications o previous response to medicationso over-the-counter medicationso past interventions that have been beneficialo past interventions that have not been beneficial

medical and surgical history, including smoking, alcohol and recreational drug use

neurological history social and family history, including

o hand dominance, sport, work, hobbieso social supports, dependants, physical access to home

and worko depression, anxiety and other key psychological factors

population-specific questions including pregnancy, breastfeeding, family history, infectious diseases

ability to make a working diagnosis after taking a history

History-taking skills are used to identify the following conditions or presentations: red flags or possible serious underlying pathology, notably

cancer, infection and major structural abnormality secondary to trauma

use questions relating to the risk factors for serious pathology including general health, history of trauma, fevers, sweats, prolonged steroid use, unexplained weight loss, severe or progressive sensory alteration or weakness, bladder or bowel dysfunction, recent infection, IV drug use, immunosuppression,

6.7 Act to ensure yellow flags are identified in the assessment process and take appropriate action in a timely manner

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Performance cues


history of cancer, night pain

yellow flags or psychosocial indicators suggesting increased risk of progression to long-term distress, disability and pain, including patients’ emotions, behaviours, family and workplace issues, as well as the patients’ and their support groups’ attitudes, beliefs and behaviours, such as

o the belief that pain is harmful or severely disabling

o fear-avoidance behaviour (avoiding activity because of fear of pain)

o low mood and social withdrawal

o expectation that passive treatment rather than active participation will help

o unhelpful solicitous behaviour

common musculoskeletal conditionso clinical patterns of pain and symptoms, 24-hour

symptom behaviour, aggravating and easing factorso inflammatory versus non-inflammatory conditionso symptoms emanating from damage to or disease of the

nervous systemo more complex musculoskeletal presentations that

require a medical opiniono when features do not fit a musculoskeletal diagnosis (a

possible non-musculoskeletal cause of a musculoskeletal presentation)

use history-taking skills to direct an appropriate physical examination, use of investigations and outcome measures

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Performance cues


consistent with evidence-based practice

Physical examination skills An initial assessment inclusive of musculoskeletal and

neurological status and skin condition, as indicated

Advanced skills in physical examination of the musculoskeletal system as it applies to the practice context and as directed by information obtained in history taking, including

o routine musculoskeletal clinical examinationo region-specific special testso neurological examination – for example, upper motor

neurone and lower motor neurone testingo testing for sensory indicators of potential neuropathic

pain – for example, hypoaesthesia and hyperalgesia, including to mechanical and/or thermal stimuli, allodynia, hyperpathia and autonomic dysfunction

Physical examination skills are used to identify the following conditions or presentations: common musculoskeletal presentations

red flags or features suggesting serious underlying pathology

yellow flags or features suggestive of psychosocial factors that may suggest an increased risk of progression to long-term distress, disability and pain

more complex musculoskeletal presentations that require a medical opinion

possible non-musculoskeletal cause of a musculoskeletal presentation

regional pain (using relevant special tests for each joint or

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Performance cues


region)

signs of neurological disease localised to the correct neuraxis level

neuropathic pain including complex regional pain syndrome

7. Apply the use of radiological investigations in advanced musculoskeletal physiotherapy services

7.1 Anticipate and minimise risks associated with radiological investigations

Apply the principles of assessing the risk:benefit ratio of ionising radiations to decision making

Consistently question appropriate female patients regarding current pregnancy/breastfeeding status

Determine if any previous imaging exists before requesting investigation

Apply the indications, advantages and disadvantages, precautions and contraindications of different imaging modalities to decision making, for a variety of presentations

Follow the clinical decision-making rules to determine imaging applicable to the pain clinic setting

Follow the local organisation’s policies and procedures regarding the referral and requesting of imaging by physiotherapists

Describe the recommended imaging pathways for a variety of common presentations – for example, upper limb, lower limb, spinal

Determine when imaging is not indicated and effectively communicate this to the patient

Determine when imaging other than plain film may be indicated and liaise effectively with consultant/medical

7.2 Determine the indication for imaging based on assessment findings and clinical decision-making rules

7.3 Select the appropriate modality consistently and act to gain authorisation as required

7.4 Convey all required information on the imaging request consistently

7.5 Interpret plain-film images accurately using a systematic approach for patients with common and/or complex conditions, as relevant to the practice context


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Performance cues


specialist regarding this, ensuring all precautions and contraindications have been identified prior to discussion

Consistently include all essential information on the imaging referral:

o authorising consultant, own name, designated role and contact details as agreed via local policy

o correct patient information and sideo clinical findings, such as site of injury and mechanismo preliminary diagnosiso other relevant information, such as previous

fracture/injury to region Consistently use a systematic approach to x-ray interpretation:

o routine check of name, date, side and site of injuryo correct patient positioning, view and exposureo ABCS (alignment, bone, cartilage, soft tissue)o common sites of injury or pathologyo common sites for missed injuries

Interpret plain x-rays accurately and consistently and seek expert opinion when uncertain or in cases where results may be inconclusive

Seek input when interpreting imaging such as CT and MRI

7.7 Meet threshold credentials and/or external learning and assessment processes set by the organisation, governing body or state/territory legislation

8. Apply the use of pathology tests in advanced musculoskeletal physiotherapy services (under the direction and supervision of a consultant)

8.1 Anticipate and minimise risks associated with pathology tests

● Consistently identify patients infected with HIV or other blood-transmissible virus and notify staff involved in the procedure about handling of specimens according to local procedure

● Identify the common indications for pathology testing inclusive of:

o venous blood collectiono capillary blood collection (blood glucose)o urine collection

Follow the local organisation’s policies and procedures

8.2 Determine the indication for pathology testing based on assessment findings and clinical decision-making rules

8.3 Identify the appropriate test(s) consistently and act to gain authorisation as required

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Performance cues


regarding the referral and requesting of pathology (consult with medical team or nurse practitioner)

Convey accurate and relevant patient assessment findings to the consultant to ensure the pathology request form conveys full and accurate information, including:

o the right test is conducted for the right indication for the right patient

o clinical details are accurateo details of drug therapy that may affect test or

interpretation● Describe procedures and tests to the patient accurately and in a

manner they can understand and consented to● Ensure suitable location and positions for procedural access ● Interpret a range of pathology tests relevant to the practice

context in consultation with pain consultant such as blood glucose testing and full blood count

8.4 Convey all required information to appropriate personnel when initiating pathology tests

8.5 Interpret routine pathology test results for patients with common and/or complex conditions, as relevant to the practice context and in consultation with expert colleagues

8.6 Meet threshold credentials and/or external learning and assessment processes set by the organisation, governing body, or state/territory legislation

9. Apply the use of therapeutic medicines in advanced musculoskeletal physiotherapy services (under the direction and supervision of a consultant)

9.1 Determine the indication and appropriate medication requirements from information obtained from the history taking and clinical examination, and liaise with relevant health professional regarding this

Use objective measures to assess and reassess analgesic efficacy

Understand the indications, contraindications, common side effects and dosage for analgesic, anti-inflammatory and neuropathic pain medications

Understand the differences between time-contingent and pain-contingent medication use and the indications for each

Recognise the differences between tolerance, dependence and addiction

Acknowledge and understand the challenges of achieving

9.2 Demonstrate knowledge of pharmacokinetics, indications, contraindications and precautions, adverse effects, interactions, dosage and administration of medications commonly used to treat musculoskeletal conditions, applicable to the practice context

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Performance cues


analgesia in patients with opioid tolerance and substance abuse disorders

Acknowledge and follow the legislative barriers to physiotherapists prescribing therapeutic medicine, as well as local policy and procedures for providing medicines

Accurately record the patient’s current medication regimen for their condition and other pre-existing medical conditions, as well as current patient compliance with prescribed medication

Consistently record allergies and adverse drug reactions in medical history. Effectively convey essential information obtained from the patient history and physical examination to the medical team to facilitate timely, safe and efficacious prescribing

Apply the requirements of being a competent prescriber to decision making within the practice context (refer to NPS competency framework http://www.nps.org.au/health-professionals/professional-development/prescribing-competencies-framework

Monitor and reassess a patient’s response to any medication and act appropriately in the event of an adverse reaction, side effects and/or inadequate response

Provide the patient with appropriate information to ensure safe medicine use (within the physiotherapist’s scope of practice and legislative requirements) and ascertain the level of patient understanding relevant to the practice context

Provide written information for other health professionals involved in patient care regarding any changes to patient’s medication regimen initiated while being managed in the pain clinic, which is relevant to the practice context

9.3 Apply knowledge of the legal and professional responsibilities relevant to recommending, administering, using, supplying and/or prescribing medicines under the current legislation, as relevant to the practice context

9.4 Comply with national, state/territory drugs and poisons legislation


9.6 Apply relevant knowledge of the medicine involved when recommending and informing patients of the risks and benefits of use

9.7 Exercise due care including assessing properly the implications for individual patients receiving therapeutic medicine, as relevant to the practice context

9.8 Maintain proper clinical records as they relate to therapeutic medicine

9.9 Meet threshold credentials and/or external learning and assessment processes set by the organisation, governing body and national and state/territory legislation

10. Apply advanced 10.1 Synthesise and interpret findings from clinical Identify relevant evidence from subjective or objective

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http://www.nps.org.au/health-professionals/professional-development/prescribing-competencies-framework



Element




Performance cues


clinical decision making assessment and diagnostic tests to confirm the diagnosis examination to support or refute differential diagnoses, with a particular focus on those that indicate non-musculoskeletal pathology

Display an awareness of the diagnostic accuracy of physical tests performed and discuss the effect of a positive or negative test finding on pre/post-test probabilities

Demonstrate flexible thinking and revisit other subjective or objective examination findings when presented with new information, either from the patient or as a result of diagnostic investigations

Link radiological findings to the presenting complaint, demonstrating awareness of aberrant pathology, incidental findings, anatomical variants and normal images

Consider other physiological measures and their impact on differential diagnosis

Interpret the relevance of findings of pathology results and decide on further assessment or management in conjunction with appropriate medical staff

Involve other staff to determine appropriate management when necessary – for example, doctor, psychologist, occupational therapist

Incorporate the patient/caregiver in formulating a management plan

Identify the appropriate management plan for soft tissue injuries and acute and persistent spinal and peripheral conditions, including neuropathic conditions, and discuss with medical colleagues as necessary

Determine appropriate additional diagnostic imaging in line with local policies/procedures/practice context, in conjunction with medical colleagues as required

10.2 Demonstrate well-developed judgement in implementing and coordinating a patient management plan that synthesises all relevant factors

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Performance cues


Refer patients on to specialist clinics in line with local policies/procedures/practice context, in conjunction with medical colleagues as required

10.3 Use finite healthcare resources wisely to achieve best outcomes

Modify practise to accommodate changing demands in the availability of local resources

Educate patients regarding expectations of services that may not be available or may not represent ‘best practice’ – for example, a patient requesting MRI scan for low back pain

11. Formulate and implement a management/intervention plan

11.1 Formulate complex, evidence-based management plans/interventions as determined by patient diagnosis that are relevant to the practice context and in collaboration with the patient

Formulate management plans using best available evidence Identify which patients require multidisciplinary input In the presence of yellow flags, identify the need to address

specific psychosocial factors as part of a multimodal management approach

Consider the evidence base, the potential benefits and the limitations of manual therapies, electrotherapies, transcutaneous electrical nerve stimulation, dry needling, specific and general exercise prescription and cognitive behavioural therapy, in both group and individual therapy settings

Engage the patient in formulating collaborative, mutually acceptable, meaningful and agreed management plans that incorporate SMART (specific, measured, attainable, realistic and timed) goals

Seek a medical opinion when serious underlying pathology or non-musculoskeletal pathology is suspected

Engage other health professionals to complement and integrate care as required – for example, occupational therapy,

11.2 Identify when guidance is required from expert colleagues and act to obtain their involvement

11.3 Facilitate all prerequisite investigations/procedures prior to consultation, referral or follow-up, as relevant to the practice context

11.4 Assess the need for referral or follow-up and arrange if necessary

11.5 Identify when input to complementary care is required from other health professionals and act to obtain their involvement

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Performance cues


psychology, social work Communicate with patient’s GP/community services as required Educate and advise patients regarding diagnosis, treatment

plan, self-management strategies (where indicated), advice when to seek further help, medication usage, vocational advice, timelines and likelihood regarding recovery, referrals for ongoing management and information on local community resources and health promotion

Demonstrate appropriate use of therapeutic motivational techniques when interacting with patients regarding self-management

Supplement verbal information to patients with appropriate written material and web-based material where available

Confirm patient’s understanding of information provided Communicate effectively using written and verbal methods

when handing over patient care Hand over care to an appropriate professional Inform patients of the handover

11.6 Provide appropriate education and advice to patients with common and/or complex conditions, as relevant to the practice context

11.7 Conduct a thorough handover to ensure patient care is maintained

12. Monitor and escalate care

12.1 Monitor the patient’s response and progress throughout the intervention using appropriate visual, verbal and physiological observations

Ensure all appropriate baseline measures are recorded initially and at appropriate intervals throughout the patient’s management

Perform baseline neurological assessment when indicated, reassessing and acting on the findings when clinically indicated

Identify and act on verbal and non-verbal cues that indicate worsening pain and/or distress levels or symptoms

Recognise difficult and challenging behaviours such as aggression, intoxication and expressed desire to self-harm. Use appropriate de-escalation strategies and seek involvement of other team members where required – for example, code grey, security, psychology, acute psychiatry

Monitor for side effects of any medications prescribed and

12.2 Identify and respond to atypical situations that arise when implementing the management plan/intervention

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inform relevant staff Identify changes to likely differential diagnoses throughout the

assessment and management of patients Identify which patients may now require multidisciplinary input

or no longer require physiotherapy input Identify injuries that may indicate deliberate harm to a child, an

elderly person or cognitively impaired person, and escalate appropriately

Identify signs of worsening systemic features and escalate appropriately

Identify issues around continuing consent to treatment with involvement of other colleagues as necessary

13. Obtain patient consent 13.1 Explain own activity to the patient as it specifically relates to the practice context and check that the patient agrees before proceeding

Clearly inform the patient that their care is being managed by a physiotherapist and address any issues relating to patient expectation of being managed by medical staff

Educate the patient and confirm their understanding of relevant risks and benefits of investigations and procedures while under the care of the physiotherapist (but not limited to those performed by the physiotherapist)

Consistently identify factors compromising the patient’s capacity to consent such as intoxication, patient duress/stress, substance abuse, literacy, culturally and linguistically diverse groups, cognitive impairments, mental health conditions, children (without next of kin)

Liaise with expert colleagues – for example, pain consultant and psychologist – when presented with barriers to gaining fully informed consent

Recognise the benefits, limitations and hazards of using interpreters, especially those who are not professional medical interpreters such as family members or friends

13.2 Evaluate the patient’s capacity for decision making and consent

13.3 Inform the patient of any additional risks specific to advanced practice, proposed treatments and ongoing service delivery, and confirm their understanding

13.4 Employ strategies for overcoming barriers to informed consent, as relevant to the practice context

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14. Document patient information

14.1 Document in the patient health record, fully capturing the entire intervention and consultation process, addressing areas of risk and consent, and including any referral or follow-up plans

Consistently include all aspects of the patient’s assessment and management by the physiotherapist in documentation

Consistently meet standards defined by the local healthcare network

Demonstrate a working knowledge of local processes for documentation

Consistently complete all documentation related to patient attendance – for example, referrals, handovers, team communications, discharge letters

Consistently meet the standards outlined by AHPRA’s code of conduct for maintaining a health record

Specific to practice context (pain clinic) The following has been adapted from the Core curriculum for professional education in pain (Charlton et al. 2005)

15. Implement care of acute and persistent pain conditions

15.1 Identify the complexity and multidimensional and individual nature of the pain experience

Demonstrate that function, activity level and disability are associated with, but are not the same as, pain

Identify the substantial variability in response to actual tissue damage or potential tissue damage, as reflected in the modest correlations among physical damage and pain and disability for acute, progressive and persistent pain

Apply an understanding of the basic neurochemical and neurological mechanisms through which emotion, cognition and behaviour influence each other and are influenced by physiology

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Detect the various emotional reactions to actual or potential tissue damage, including anxiety, fear, depression and anger

Apply the knowledge that anticipatory anxiety, distress and fear may exacerbate pain or predict pain severity

Apply an understanding of the major interactions between cognitive appraisal and affective reactions – for example, the role of catastrophising, helplessness and other maladaptive patterns of thinking, or the consequence of self-efficacy and personal control

Demonstrate empathic and compassionate communication Apply the knowledge of how cultural, institutional, societal and

regulatory influences affect the assessment and management of pain

15.2 Identify the impact of pain on society

15.3 Formulate a preliminary hypothesis, differential diagnoses and patient-centred management plan

Apply the knowledge of cultural, environmental and racial variations in pain experience and expression, and in healthcare seeking and treatment

Apply the knowledge that pain behaviours and complaints are best understood in the context of social transactions among the individual, spouse, employers and health professionals, and in the context of community governmental or legal procedures

Identify the potential role of the family in promoting illness or well behaviour

Determine the significance of stress and trauma – for example, family violence, sexual abuse and interpersonal relationship discord as predisposing, exacerbating or maintaining factors in pain complaints and disability

Be aware that persistent pain patients can present with signs and symptoms that are incongruent with clinical expectations

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based on anatomical and physiological knowledge Identify that malingering and deception are possible, and identify

factors that increase the likelihood, as well as limitations in our capacities to accurately assess malingering

Develop a treatment plan based on the benefits and risks of available treatments

15.4 Act to ensure management plans are designed to optimise patient compliance/treatment adherence

Apply an understanding of the role of the clinician that includes acting as an advocate to assist the patient to meet treatment goals

Demonstrate familiarity with how individual differences in both patients and health professionals affect adherence to treatment recommendations

Apply an understanding of how expectations, coping, cultural factors and environmental factors influence disability, treatment outcome and maintenance of treatment effects

Demonstrate an understanding of the principles of operant theory as they relate to the acquisition and maintenance of pain behaviour and their role in devising intervention strategies – that is, primary and secondary reinforcement, punishment, extinction, schedules of reinforcement, shaping, avoidance learning, modelling and observational learning

Apply the knowledge of the distinction between operant and respondent conditioning

15.5 Design and deliver an individualised, culturally appropriate and effective education program

Monitor the effects of a management plan and adjust the plan as needed

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Demonstrate knowledge of current pain research and the ability to relate that to an individual or group. This includes current neurobiology, exercise principles, medical management (including medications and procedures) and psychology, as well as healthy lifestyle recommendations

Apply knowledge of psychological modalities such as cognitive behavioural therapy, relaxation strategies, operant therapy and graded exposure in vivo to individual and group-based physical interventions

Apply adult learning theory because adults:

o are internally motivated and self-directed o bring life experiences and knowledge to learning

experiences o are goal-oriented, relevancy-oriented and practical o like to be respected

Demonstrate awareness of differing learning styles (auditory, visual, and kinaesthetic), their impact on the individual, and the need to provide intervention and education to suit a range of learning styles. This means providing a combination of interactive, auditory and visual information

Facilitate the setting of SMART goals by the individual, with awareness of contributing factors such as motivators and expectations of the health profession, the system and themselves

Use appropriate outcome measurement in the facilitation and monitoring of goals

Organise group programs with due consideration of appropriate

15.6 Design and conduct an individualised, culturally appropriate and effective intervention

15.7 Design and deliver a group-based, culturally appropriate and effective education program

15.8 Design and conduct a group-based, culturally appropriate and effective intervention

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Performance cues


timing, duration, room set up and access

Set expectations and ground rules of behaviour in group settings

Manage contributions, allowing individuals to share appropriately without dominating

Manage difficult or inappropriate behaviour or contributions

Apply knowledge of the attributes of an effective facilitator of a group education program or intervention (ability to effectively communicate, warmth, flexibility, empathy, humour)

Demonstrate awareness of cultural and religious influences on the individual and how this impacts on their values, health expectations, expectations of the health profession, their role within the health system and on their role in their own health

16. Develop and implement a management plan for patients presenting with spinal pain

16.1 Perform a complex assessment for patients presenting for musculoskeletal assessment of spinal pain, including the evaluation of surgical versus non-surgical management

Demonstrate an advanced understanding of the natural history of acute and persistent spinal pain presentations and the likely prognosis

Demonstrate an advanced understanding of when surgery is indicated in managing musculoskeletal spinal pain

Demonstrate an advanced understanding of the evidence base for physiotherapy and exercise in managing acute and persistent spinal pain

Demonstrate an advanced understanding of the evidence base

16.2 Perform a sufficient neurological examination that incorporates upper motor neurone, lower motor neurone and peripheral nerve examinations, with consistency in documentation

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for other conservative therapies such as medications and spinal injections

Clearly identify and prioritise patients presenting with urgent surgical requirements and/or pain management requirements

Perform a musculoskeletal examination with appropriate testing of active and passive range of movement, ligamentous structures, muscle strength, special tests and functional abilities as appropriate, to determine a problem list relevant to the individual

Perform a neurological examination with appropriate testing of reflexes, sensation, power, tone and neurodynamics

Identify patients presenting with non-mechanical symptoms requiring the review of another medical specialty, such as neurology or rheumatology

Demonstrate advanced clinical reasoning in analysing findings Combine the findings of all aspects of the subjective and

physical examinations to formulate a problem list relevant to the individual

Use the problem list to construct a goal-oriented management plan that the patient understands and consents to

Consistently document that all areas are tested, including both positive and negative findings

16.3 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with spinal pain and act to obtain their involvement

16.4 Apply evidence-based practice to managing acute and persistent spinal pain

17. Develop and implement a management plan for patients presenting with limb pain

17.1 Perform complex assessment for patients presenting for musculoskeletal assessment of limb pain including the evaluation of surgical versus non-surgical management

Demonstrate an advanced understanding of the natural history of acute and persistent limb pain presentations and the likely prognosis

Demonstrate an advanced understanding of when surgery is indicated in managing limb pain

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Element




Performance cues


Demonstrate an advanced understanding of the evidence base for physiotherapy and exercise in managing acute and persistent limb pain

Demonstrate an advanced understanding of the evidence base for other conservative therapies such as local anaesthetic blocks and corticosteroid injections

Clearly identify and prioritise patients presenting with urgent surgical and/or pain-management requirements

To determine a problem list relevant to the individual, perform a musculoskeletal examination with appropriate testing of active and passive range of movement, ligamentous structures, muscle strength, special tests and functional abilities as appropriate

Identify patients presenting with non-mechanical symptoms requiring the review of another medical specialty such as neurology or rheumatology

17.2 Perform a sufficient neurological examination that incorporates upper motor neurone, lower motor neurone and peripheral nerve examinations, with consistency in documentation

Perform a neurological examination with appropriate testing of reflexes, sensation, power and tone to discern between a spinal and peripheral neuropathy

Perform an examination to address the diagnostic criteria for complex regional pain syndrome (CRPS) when appropriate, including:

o sensory signs and symptoms – burning pain, disproportionate pain, allodynia, hyperalgesia and hyperpathia

o autonomic abnormalities – swelling, hyper- or hypohydrosis, vasodilatation or vasoconstriction, changes in skin temperature

o trophic abnormalities – abnormal nail growth, increased or

17.3 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with limb pain and act to obtain their involvement

17.4 Apply evidence-based practice to managing acute and persistent limb pain

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Element




Performance cues


decreased hair growth, fibrosis, thin glossy skin, osteoporosis

o motor abnormalities – weakness, coordination deficits, tremor, dystonia, symptoms of disturbed body perception

Combine the findings of all aspects of the subjective and physical examination to formulate a problem list relevant to the individual

Demonstrate advanced clinical reasoning in analysing findings Use the problem list to construct a goal-oriented management

plan that the patient understands and consents to Consistently document that all areas are tested with both

positive and negative findings

18. Implement appropriate care of acute and persistent pain conditions in patients who have psychological and psychiatric comorbidities

18.1 Exercise due care in managing patients with acute and persistent pain or with psychological and psychiatric comorbidities, including on referral of patients with poorly managed psychological symptoms or who are considered at risk of self-harm

Demonstrate awareness that pain and depression, as well as anxiety, are associated with each other

Apply the knowledge that persistent pain is not masked depression, nor is there evidence for the pain-prone personality disorder

Be aware that depression in persistent pain patients is more likely to be a consequence than a cause of persistent pain but that psychosocial factors may increase the risk for developing persistent pain, particularly anxiety, catastrophising, alcohol or other substance disorders and occupational impairment

Apply an understanding that depression may be a predictor of pain severity, pain behaviour, disability or adherence to pain treatment, and that the presence of pain may be a predictor of depression severity. However, be aware that these are associations, not causal statements

18.2 Demonstrate knowledge of the common psychological and psychiatric comorbidities associated with acute and persistent pain

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Element




Performance cues


Identify that early intervention is increasingly seen as central to the prevention of long-term disability

Evaluate psychosocial risk factors that influence the onset and maintenance of disability and understand the interventions for their management

Act to involve expert colleagues in the evaluation and co-management of patients as appropriate

Demonstrate common syndrome recognition, such as for anxiety disorders (including panic), depression, sleep disorders, substance abuse, obsessive compulsive disorder and post-traumatic stress disorder. Act to collaborate with expert colleagues as appropriate

Identify an increase in distress or psychological or psychiatric symptoms following a stable period and understand that this may necessitate new evaluation by expert colleagues

Identify common emergencies in patients with psychological and psychiatric comorbidities, such as a risk of self-harm, and act to seek prompt evaluation and treatment – for example: contact with a GP, psychologist or psychiatrist; referral to the ED; and involvement of acute psychiatry, ‘LifeLine’ or a CAT team

19. Implement care of acute and persistent pain conditions in individuals with limited ability to communicate due to cognitive impairment

19.1 Perform complex modifications to routine musculoskeletal assessment in recognition of the patient’s cognitive abilities, as relevant to the practice context

Apply an understanding of the full range of conditions (such as dementia, developmental disabilities, severe head injury, stroke and autism) that can lead to limitations in ability to communicate due to cognitive impairment

Identify that individuals may have multiple impairments that can affect motor, cognitive, language and social/emotional capabilities to communicate pain and distress

19.2 Determine and minimise risks and limitations associated with investigations performed on patients with cognitive impairments

30

Element




Performance cues


Involve medical specialists, psychologists, neuropsychologists, occupational therapists and social workers as required

Use communication techniques and strategies that are appropriate

Modify the collection of baseline and follow-up measures, including the measurement of pain, using the most validated tools for the patient – for example, direct observation, proxy reporting, pain faces scale

Apply the knowledge that the expression of pain may vary from normal when the central nervous system is damaged

Demonstrate understanding that the process of a patient giving a numerical pain score requires memory for comparison and an ability to assign numbers to a dynamic, complex experience

Communicate with caregivers and guardians as required

19.3 Formulate an appropriate management plan in collaboration with the parent/caregiver that meets the needs of the patient and family

19.4 Identify when input is required from expert colleagues in the care of cognitively impaired patients and act to obtain their involvement

19.5 Apply evidence-based practice to managing acute and persistent pain conditions in the cognitively impaired population

19.6 Communicate at an appropriate level with patient and caregiver, ensuring all relevant information regarding diagnosis, management and follow-up is provided and understood

19.7 Function in accordance with legislation, common law, health standards and policies pertinent to providing healthcare to patients with cognitive impairment

20. Implement care of acute and persistent pain conditions in paediatric populations

20.1 Perform complex modifications to routine musculoskeletal assessment in recognition of the patient’s age, as relevant to the practice context

Demonstrate understanding that the acute and long-term healthcare needs of a child are distinct from adults and adapt accordingly

Conduct an age-appropriate musculoskeletal and neurological assessment based on knowledge of age, growth and developmental variables

Identify how indication, clinical decision-making rules and 20.2 Determine and minimise risks associated with investigations unique to paediatrics

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Element




Performance cues


interpretation of investigations of a child presenting with acute and persistent pain conditions differs from adults

Conduct a thorough assessment if a child is limping; recognise and organise a medical review when indicated

Prepare a management plan that incorporates the child’s need for play and provide age-specific activities and advice

Adapt the management and follow-up plan to meet diversity in family structures and child-rearing practices

Provide a caring environment for the child and caregiver, recognising a child’s need for security objects and comfort

Use communication techniques and strategies that are age and developmentally appropriate

Modify the collection of baseline and follow-up measures, including the measurement of pain, using the most validated tools for the patient – for example, direct observation, proxy reporting, pain faces scale

Apply an understanding that the expression of pain may vary from that of an adult and differs across developmental stages

Evaluate pain behaviour knowing that it can be a function of many influences in addition to pain

Demonstrate understanding that the process of a patient giving a numerical pain score requires memory for comparison and an ability to assign numbers to a dynamic, complex experience

Demonstrate relevant knowledge of safe pharmacological preparations used in paediatric and child healthcare

Minimise distress of procedures Identify the potential for rapid change in a child’s condition and

act accordingly to involve medical team Assist the child and family to recognise and understand current

health status and changes in health status Confirm that the parent/caregiver understands the diagnosis,

20.3 Maintain close lines of consultation with expert colleagues when interpreting investigations when managing paediatric patients, where applicable

20.4 Act to ensure the medication requirements of paediatric patients are met and applied safely and effectively, as relevant to the practice context

20.5 Formulate an appropriate management plan in collaboration with the parent/caregiver that meets the needs of the child and family

20.6 Identify when input is required from expert colleagues in the care of paediatric patients and act to obtain their involvement

20.7 Apply evidence-based practice to managing acute and persistent pain conditions in the paediatric population

20.8. Communicate at an appropriate level with children and their parent/caregiver, ensuring all relevant information regarding diagnosis, management and follow-up is provided and understood

20.9 Function in accordance with legislation, common law, health standards and policies pertinent to paediatric and child health

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Element




Performance cues


treatment plan, self-management strategies (where indicated), advice when to seek further help, medication usage, vocational and educational advice, timelines regarding recovery, referrals for ongoing management, and information on local community resources and health promotion

Act within appropriate national and state legislation and policies – for example, Children and Young Persons Act, Guidelines for hospital-based child and adolescent care, and the Australian Council on Healthcare Standards

Comply with the notification of child abuse and neglect legislation and policies

Demonstrate an awareness of, and respect for, the legal rights of young people in relation to consent and confidentiality

Conform to the specific issues of informed consent of a child, child protection issues and consider the impact of child’s condition on their family

21. Implement care of acute and persistent pain conditions in patients with diabetes

21.1 Modify routine musculoskeletal assessment in recognition of a patient’s diabetic condition, as relevant to the practice context

Apply knowledge of the normal blood glucose range Identify situations when blood glucose should be tested Interpret the results of blood glucose testing and report readings

outside the acceptable range to the appropriate person Identify the signs of hypoglycaemia or hyperglycaemia and act

in a timely way to involve nursing and medical staff Demonstrate a basic knowledge of the types of oral anti-

hyperglycaemic agents insulin and GLP-1 receptor agonists, and how they work

Demonstrate knowledge of the appropriate referral system to the diabetes specialist team, and use where appropriate

Act with regard to the patient’s diabetes treatment regimen and

21.2 Modify routine musculoskeletal interventions in recognition of a patient's diabetic condition, as relevant to the practice context

21.3 Provide patients with diabetic conditions with information relevant to altering their health behaviours and improving their health status

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Element




Performance cues


device or delivery systems Identify the need for and carry out foot screening for people with

diabetes, inclusive of a thorough neurovascular assessment Demonstrate awareness of complications and prevention of

neuropathy Describe measures to prevent tissue damage in people with

diabetes Demonstrate an awareness that all people with diabetes are at

risk of nephropathy and the implications of this on medication use

Demonstrate awareness that all people with diabetes are at risk of retinopathy and consider the impact of this in the management and follow-up plan

Encourage people with diabetes to participate in safe, healthy and active lifestyle behaviours as part of their recovery process

21.4 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with diabetes and act to obtain their involvement

21.5 Apply evidence-based practice to managing musculoskeletal condition in patients with diabetes

22. Implement care of acute and persistent pain conditions in patients with cancer-related conditions

22.1 Modify routine musculoskeletal assessment in recognition of a patient’s cancer-related condition, as relevant to the practice context

Demonstrate an understanding that pain is common in cancer and that many patients have more than one site and source of pain

Identify that pain in cancer can be nociceptive (somatic and/or visceral), neuropathic or a combination of these

Perform a comprehensive subjective and objective assessment that incorporates an understanding of the structural pathology that may accompany cancer-related pain, and seek to incorporate this with a review of laboratory, radiographic tests and appropriate further investigations alongside expert colleagues

Demonstrate common syndrome recognition, such as the direct effects of the tumour – for example, bony metastases, anti-cancer therapies, surgery, drugs, general debility, pressure sores and factors unrelated to the disease or its treatment

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Element




Performance cues


Identify an increase in pain intensity following a stable period and understand that this necessitates new evaluation of the underlying aetiology and pain syndrome

Identify common emergencies in cancer patients that present with pain – for example, back pain due to spinal cord compression or pathological fracture – and act to seek prompt evaluation and treatment

Monitor distress as well as pain and understand that a psychological or psychiatric response may accompany the pain, and act to facilitate specialist evaluation

Identify that therapies for pain may include both primary anti-cancer therapy (intended to prolong life) and palliative care

Demonstrate an understanding of the role of physical therapy and modalities – for example, heat and cold – in managing cancer pain

Demonstrate a balance between the benefits and burdens of treatment

Identify that treatments aimed at the underlying pathology may also be useful in managing cancer pain – for example, radiotherapy, pharmacotherapy (chemotherapy, hormonal, biological and antibiotic therapy) and surgery

Demonstrate an understanding of the role of invasive techniques (such as nerve blocks, spinal drug delivery, neurostimulation and surgery) as well as physical and psychological approaches

Identify that pain management is part of a broader therapeutic endeavour known as palliative care. Apply the knowledge that palliative care provides a model for continuing management, including control of pain and symptoms, maintenance of function, psychosocial and spiritual support for the patient and the family and comprehensive care at the end of life

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Learning needs analysis Part A and B: pain clinicThe Learning needs analysis is a self-assessment using the Competency standard self-assessment tool (Part A) and the underpinning Knowledge and skills self-assessment tool (Part B). Part B an extensive list that varies from having a basic awareness to advanced knowledge of the different skills and knowledge an advanced musculoskeletal physiotherapist may require. It should be completed with Part A prior to developing the Learning and assessment plan.

Both Part A and B of the Learning needs analysis should first be completed by the individual (approximately no more than half an hour should be spent doing this – it is a tool designed to identify gaps in knowledge). Part A and B are then reviewed jointly with the physiotherapists and clinical lead or mentor. The key areas for development to be addressed in the learning program should be prioritised with help from the clinical lead or mentor according to relevance to the role and the most common conditions that are likely to present to the organisation. The non-clinical time available to the physiotherapist also needs to be considered when prioritising what areas need to be addressed first.

It is not expected that ALL of what is listed in Part B will need to be addressed in order to achieve competency. Part B is merely a tool to help identify what the physiotherapist does not know and direct learning accordingly. A tailored Learning and assessment plan should then be developed to direct the use of the learning modules (accessible on the Victorian Department of Health website).

Additionally, the Learning needs analysis Part A and B, once completed, can also be used as evidence as having met the performance criteria (2.1, 3.1–3) of the competency standard by the method of self-assessment.

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Competency standard self-assessment tool – Part A of the learning needs analysis: pain clinicClinicians used self-assessment to help them reflect meaningfully and identify both strengths and their own learning needs. This allows tailoring of the training and assessment program to meet that identified learning need.

The Competency standard self-assessment tool is a self-assessment against the elements and performance criteria, listed in the Competency standard. It also is Part A of the Learning needs analysis. If needed refer to the performance cues on the competency standard to assist with this self-assessment process.

Candidate’s name: Date of self-assessment:

INDICATE YOUR LEVEL OF CONFIDENCE AGAINST THE FOLLOWING PERFORMANCE CRITERIA1. I require training and development in most or all of this area2. I require further training in some aspects of this area3. I am confident I already do this competentlyELEMENTS AND PERFORMANCE CRITERIARefer to the competency standard for further details

RO

LE R

ELEVAN

CE

Confidence rating scale

o If 1 or 2 on the confidence rating scale document action plan

o If 3 on the confidence rating scale provide/document evidence of competency

1 2 3

PROFESSIONAL BEHAVIOURS1. Operate within scope of practice 1.1 Identify and act within own knowledge base and scope of practice1.2 Work towards the full extent of the role2. Display accountability2.1 Take responsibility for own actions, as it applies to the practice context LIFELONG LEARNING3. Demonstrate a commitment to lifelong learning3.1 Engage in lifelong learning practices to maintain and extend professional competence3.2 Identify own professional development needs, and implement strategies for

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achieving them3.3 Engage in both self-directed and practice-based learning3.4 Reflect on clinical practice to identify strengths and areas requiring further development3.5 Formulate learning objectives and strategies for addressing own limitationsCOMMUNICATION4. Communicate with colleagues 4.1 Use concise, systematic communication at the appropriate level when conversing with a range of colleagues in the practice context4.2 Present all relevant information to expert colleagues when acting to obtain their involvement PROVISION AND COORDINATION OF CARE5. Evaluate referrals5.1 Discern patients who are appropriate for advanced physiotherapy management in accordance with individual strengths or limitations, any legal or organisational restrictions on practice, the environment, the patient profile/needs and within defined work roles5.2 Discern patients who are appropriate for management in a shared care arrangement in accordance with individual strengths or limitations, any legal or organisational restrictions on practice, the environment, the patient profile/needs and within defined work roles5.3 Defer patient referrals to relevant professionals (including other physiotherapists) when limitations of skill or job role prevent the client’s needs from being adequately addressed, or when indicated by local triage procedure5.4 Prioritise referrals based on patient profile/need, organisational procedure or targets and any local factors5.5 Communicate action taken on referrals using established organisational processes6. Perform health assessment/examination6.1 Design and perform an individualised, culturally appropriate and effective patient interview with common and/or complex conditions/presentations 6.2 Formulate a preliminary hypothesis and differential diagnoses for a patient with common and/or complex conditions, as relevant to the practice context 6.3 Perform complex modifications to routine musculoskeletal assessment in recognition

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of factors that may impact on the process such as the patient profile/needs and the practice context6.4 Design and conduct an individualised, culturally appropriate and effective clinical assessment that:

is systems-based includes relevant clinical tests selects and measures relevant health indicators substantiates the provisional diagnosis

6.5 Identify when input is required from expert colleagues and act to obtain their involvement6.6 Ensure all ‘red flags’ are identified in the assessment process, link ‘red flags’ to diagnoses not to be missed and take appropriate action in a timely manner6.7 Ensure ‘yellow flags’ are identified in the assessment process and take appropriate action in a timely manner

7. Apply the use of radiological investigations7.1 Anticipate and minimise risks associated with radiological investigations 7.2 Determine the indication for imaging based on assessment findings and clinical decision-making rules7.3 Select the appropriate modality consistently and act to gain authorisation as required7.4 Convey all required information on the imaging request consistently7.5 Interpret plain-film radiological images using a systematic approach for patients with common and/or complex conditions, as relevant to the practice context7.6 Identify when input is required from expert colleagues and act to obtain their involvement 7.7 Meet threshold credentials and/or external learning and assessment processes set by the organisation, governing body or state/territory legislation8. Apply the use pathology tests in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)8.1 Anticipate and minimise risks associated with pathology tests8.2 Determine the indication for pathology testing based on assessment findings and clinical decision-making rules with consultant and/or GP8.3 Identify the appropriate test(s) consistently and act to gain authorisation as required8.4 Convey all required information to appropriate personnel when initiating pathology tests

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8.5 Interpret pathology test results for patients with common and/or complex conditions, as relevant to the practice context and in consultation with expert colleagues when required 8.6 Meet threshold credentials and/or external learning and assessment processes set by the organisation, governing body or state/territory legislation9. Use therapeutic medicines in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)9.1 Determine the indication and appropriate medication requirements from information obtained from the history taking and clinical examination and liaise with relevant health professionals regarding this9.2 Demonstrate knowledge of pharmacokinetics, indications, contraindications and precautions, adverse effects, interactions, dosage and administration of medications commonly used to treat musculoskeletal conditions, applicable to the practice context9.3 Apply knowledge of the legal and professional responsibilities relevant to recommending, administering, using, supplying and/or prescribing medicines under the current legislation, as relevant to the practice context 9.4 Comply with national and state/territory drugs and poisons legislation9.5 Identify when input is required from expert colleagues and act to obtain their involvement9.6 Apply relevant knowledge of the medicine involved when recommending and informing patients of the risks and benefits of use9.7 Exercise due care, including assessing properly the implications for individual patients receiving therapeutic medicine, as relevant to the practice context 9.8 Maintain proper clinical records as they relate to therapeutic medicine9.9 Meet threshold credentials and/or external learning and assessment processes set by the organisation, governing body, national, state/territory legislation10. Advanced clinical decision making10.1 Synthesise and interpret findings from clinical assessment and diagnostic tests to confirm the diagnosis 10.2 Demonstrate well-developed judgement in implementing and coordinating a patient management plan that synthesises all relevant factors 10.3 Use finite healthcare resources wisely to achieve best outcomes11. Formulate and implement a management/intervention plan11.1 Formulate complex, evidence-based management plans/interventions as

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determined by agreed level of autonomy to act as an agent for the specialist, relevant to the practice context and in collaboration with the patient 11.2 Identify when guidance is required from expert colleagues and act to obtain their involvement11.3 Facilitate all prerequisite investigations/procedures prior to consultation, referral or follow-up, as relevant to the practice context11.4 Assess the need for referral or follow-up and arrange if necessary11.5 Identify when input to complement care is required from other health professionals and act to obtain their involvement11.6 Provide appropriate education and advice to patients with common and/or complex conditions, as relevant to the practice context11.7 Conduct a thorough handover to ensure patient care is maintained12. Monitoring and escalation12.1 Monitor the patient response and progress throughout the intervention using appropriate visual, verbal and physiological observations12.2 Identify and respond to atypical situations that arise when implementing the management plan/intervention

13. Obtain patient consent13.1 Explain own activity to the patient as it specifically relates to the practice context and check that the patient agrees before proceeding13.2 Consider the patient’s capacity for decision making and consent13.3 Inform the patient of any additional risks specific to advanced practice proposed treatments and ongoing service delivery and confirm their understanding13.4 Employ strategies for overcoming barriers to informed consent as relevant to the practice context14. Document patient information14.1 Document information in the patient health record, fully capturing the entire intervention and consultation process and addressing areas of risk and consent (include any referral or follow-up plans)ADDITIONAL ADVANCED PRACTICE CLINICAL TASKS SPECIFIC TO PRACTICE CONTEXT15. Implement management of acute and persistent pain conditions

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15.1 Identify the complexity, multidimensional and individual nature of the pain experience15.2 Identify the impact of pain on society15.3 Formulate a preliminary hypothesis, differential diagnoses and patient-centred management plan15.4 Act to ensure that management plans are designed to optimise patient compliance/treatment adherence15.5 Design and deliver an individualised culturally appropriate and effective education program15.6 Design and conduct an individualised, culturally appropriate and effective intervention15.7 Design and deliver a group-based culturally appropriate and effective education program15.8 Design and conduct a group-based, culturally appropriate and effective intervention16. Develop and implement a management plan for patients presenting with spinal pain16.1 Perform complex assessment for patients presenting for musculoskeletal assessment of spinal pain, including the evaluation of surgical versus non-surgical management16.2 Perform sufficient neurological examination that incorporates upper motor neurone, lower motor neurone and peripheral nerve examinations, with consistency in documentation16.3 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with spinal pain and act to obtain their involvement16.4 Apply evidence-based practice to managing acute and persistent spinal pain17. Develop and implement a management plan for patients presenting with limb pain17.1 Perform complex assessment for patients presenting for musculoskeletal assessment of limb pain, including the evaluation of surgical versus non-surgical management17.2 Perform sufficient neurological examination that incorporates upper motor neurone, lower motor neurone and peripheral nerve examinations, with consistency in documentation17.3 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with limb pain and act to obtain their involvement

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17.4 Apply evidence-based practice to managing acute and persistent limb pain18. Implement appropriate care of acute and persistent pain conditions in patients who have psychological and psychiatric comorbidities18.1 Exercise due care in managing patients with acute and persistent pain or with psychological and psychiatric comorbidities, including on referral of patients with poorly managed psychological symptoms or who are considered at risk of self-harm18.2 Demonstrate knowledge of the common psychological and psychiatric comorbidities associated with acute and persistent pain19. Implement care of acute and persistent pain conditions in individuals with limited ability to communicate due to cognitive impairment19.1 Perform complex modifications to routine musculoskeletal assessment in recognition of the patient’s cognitive abilities, as relevant to the practice context19.2 Determine and minimise risks and limitations associated with investigations performed on patients with cognitive impairments19.3 Formulate an appropriate management plan in collaboration with the parent/caregiver that meets the needs of the patient and family19.4 Identify when input is required from expert colleagues in the care of cognitively impaired patients and act to obtain their involvement19.5 Apply evidence-based practice to managing acute and persistent pain conditions in the cognitively impaired population19.6 Communicate at an appropriate level with patient and caregiver, ensuring all relevant information regarding diagnosis, management and follow-up is provided and understood19.7 Function in accordance with legislation, common law, health standards and policies pertinent to the provision of healthcare to patients with cognitive impairment20. Implement care of acute and persistent pain conditions in paediatric populations20.1 Perform complex modifications to routine musculoskeletal assessment in recognition of the patient’s age, as relevant to the practice context20.2 Determine and minimise risks associated with investigations unique to paediatrics20.3 Maintain close lines of consultation with expert colleagues when interpreting investigations when managing paediatric patients, where applicable20.4 Act to ensure the medication requirements of paediatric patients are met and applied safely and effectively, as relevant to the practice context20.5 Formulate an appropriate management plan in collaboration with the parent/caregiver that meets the needs of the child and family

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20.6 Identify when input is required from expert colleagues in the care of paediatric patients and act to obtain their involvement20.7 Apply evidence-based practice to managing acute and persistent pain conditions in the paediatric population20.8 Communicate at an appropriate level with children and their parent/caregiver, ensuring all relevant information regarding diagnosis, management and follow-up is provided and understood20.9 Function in accordance with legislation, common law, health standards and policies pertinent to paediatric and child health21. Implement care of acute and persistent pain conditions in patients with diabetes21.1 Modify routine musculoskeletal assessment in recognition of a patient’s diabetic condition, as relevant to the practice context21.2 Modify routine musculoskeletal interventions in recognition of a patient’s diabetic condition, as relevant to the practice context21.3 Provide patients with diabetic conditions with information relevant to altering their health behaviours and improving their health status21.4 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with diabetes and act to obtain their involvement21.5 Apply evidence-based practice to managing musculoskeletal condition in patients with diabetes22. Implement care of acute and persistent pain conditions in patients with cancer-related conditions22.1 Modify routine musculoskeletal assessment in recognition of a patient’s cancer-related condition, as relevant to the practice context22.2 Modify routine musculoskeletal interventions in recognition of a patient’s cancer-related condition, as relevant to the practice context22.3 Provide patients with cancer-related conditions with information relevant to altering their health behaviours and improving their health status22.4 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with cancer-related conditions and act to obtain their involvement22.5 Apply evidence-based practice to managing musculoskeletal condition in patients with cancer-related conditions

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Identified learning needs, action plan and timeframe

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Knowledge and skills self-assessment – Part B of the learning needs analysis: pain clinics

This Learning needs analysis has been modified and adapted with written permission from Symes, G 2009, Resource manual and competencies for extended musculoskeletal roles: chartered physiotherapists with an extended scope of practice, Scotland.

Candidate’s name: Date of self-assessment:

INDICATE YOUR LEVEL OF CONFIDENCE AGAINST THE FOLLOWING PERFORMANCE CRITERIA1. I require training and development in most or all of this area2. I require further training in some aspects of this area3. I am confident I already do this competentlyUnderpinning skills and knowledge

RO

LE

RE

LEV

AN

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Confidence rating scale

Learning strategies

1 2 3

1. Neuromusculoskeletal PresentationsBackground knowledgeThe advanced musculoskeletal physiotherapist (AMP) has advanced knowledge in:

Anatomy of the neuromusculoskeletal systems Surface anatomy Neurovascular supply Functional anatomy Physiology of the neuromusculoskeletal

systems Biomechanics of the neuromusculoskeletal

systems Nociceptive and neuropathic pain mechanisms Sympathetically maintained pain

History takingThe AMP is able to obtain an accurate clinical history from patient’s presenting with

If pain is the main feature then the likely dominant pain mechanism

Red flags — the symptoms indicate possible

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signs and symptoms

The AMP identifies the following:

serious pathology such as tumour, fracture, infection, cauda equina

Yellow flags – psycho-social factors are exacerbating the presenting complaint

Blue flags – psychosocial factors related to the workplace are contributing to symptoms

A problem list that priorities main issues for the patient

Clinical assessmentThe AMP demonstrates advanced knowledge and assessment skills in the following areas specific to pain:

NEUROPATHIC PAINCharacteristics include:

burning pain electric shock like pain pain paroxysms dysethesia paraesthesia

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mechanical and thermal allodynia and hyperalgesia

temporal and spatial summation sensory loss weakness muscle atrophy neuroma signs referred sensations swelling skin flare and discolouration hyper and hypohydrosis trophic changes

Common neuropathic pain syndromes such as:1. Painful focal neuropathies

Compression of peripheral nerves or nerve roots such as lumbar and cervical radiculopathies, carpal and tarsal tunnel syndromes

Syndromes related to inflammation of peripheral nerves such as acute herpes zoster, Guillain-Barré syndrome

Syndromes related to ischemia / infarction of peripheral nerves such as diabetic neuropathy

Syndromes associated with nerve injury, with or without neuroma formation such as post-mastectomy pain, stump pain, postherniorrhaphy

Common syndromes with unknown aetiology such as intercostal neuralgia

2. Painful polyneuropathies HIV Mixed small and large diameter fibre

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neuropathies such as diabetes Small fibre neuropathies such as

idiopathic, Fabry’s disease3. Post-herpetic neuralgia4. Trigeminal and other cranial neuropathies5. Phantom limb pain6. Brachial plexus avulsion7. Central post-stroke pain8. Other common central pain syndromes such as spinal cord injury, spinal cord tumour, tethered cord syndrome, multiple sclerosis, syringomyelia9. Cancer-associated neuropathic pain such as tumour, invasion of nerve and plexus, epidural metastases10. Complex regional pain syndromeCOMPLEX REGIONAL PAIN SYNDROMESensory signs and symptoms

Continuous burning pain in the distal part of the affected extremity

Pain is disproportionate in intensity to the inciting event and usually increases when the extremity is in the dependent position

Stimulus evoked pains include mechanical and thermal allodynia and/or hyperalgesia and deep somatic allodynia (pain due to touching the joints and movement of joints)

Sensory abnormalities are most pronounced distally and have no consistent spatial relationship to individual nerve territories or to the sit if the inciting lesion

Common autonomic abnormalities Swelling of the distal extremity, especially

in the acute phase

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To perform an accurate clinical assessment of patients, the AMP describes accurately, and includes the following:

The AMP is capable of

Hyper- or hypohydrosis Vasodilation or vasoconstriction Change in skin temperature

Common trophic changes Abnormal nail growth Increased or decreased nail growth Fibrosis Thin glossy skin Osteoporosis

Common motor abnormalities Weakness Coordination deficits Tremor Dystonia Neglect like symptoms or symptoms of

disturbed body perception of the affected extremity

Sympathetically maintained pain may occur; there may be an evolution of signs and symptoms of variable durations

Observation of posture and any associated spinal problem, muscle wasting, skin integrity, absence or presence of deformity or swelling, or protective posturing

Conducts a baseline assessment Conducts a neurovascular assessment where

indicated – inclusive of peripheral nerve assessment and/or thorough neurological assessment

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describing and performing additional tests as appropriate and relevant to the practice context, for example:

Examination techniques as appropriate, for example:o Palpationo Functional testso Range of motion testso Muscle strength testso Special tests as indicated

SHOULDER

Hawkins-Kennedy impingement test Neer’s sign and test Yocum’s test Jobe’s test O’Brien’s test Belly press test Gerber’s lift-off test Apprehension tests Drawer tests Relocation tests Sulcus sign Thoracic outlet tests Neurodynamic tests

ELBOW

Tennis elbow (Cozen’s test) Mill’s test Lateral epicondylalgia test for extensor

digitorum Tinel’s sign for ulnar nerve Pinch grip test for the anterior interosseus

nerve Collateral ligament varus/valgus stress test

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WRIST AND HAND

Upper limb tension tests and reflexes Finkelstein’s test Tinel’s test Phalen’s test Watson’s (scaphoid shift or radial stress

test) Triangular fibrocartilage complex (TFCC)

test (ulnar grind) Resisted active finger extension with wrist

in flexion Piano key test Pinch test (scaphoid) Axial compression through thumb

(scaphoid)

HIP

Straight leg raise Femoral nerve stretch test Faber (Patrick’s/Figure 4) test sacroiliac joint (SI) pain provocation tests Trendelenburg’s test Leg length test Thomas test Rectus femoris test Ober’s test Hamstring contracture test Sign of the buttock (straight leg raising) test Squeeze test

KNEE

Lachman’s test Joint line palpation Anterior and posterior drawer Medial collateral ligament (MCL) and

lateral collateral ligament (LCL) tests

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Pivot shift test Tibial sag sign McMurray’s test Loomer’s (dial) test for posterolateral

instability Patella tests such as

o Waldron testo McConnell’s critical testo Passive patellar tilto Lateral pull testo Zohler’s signo Frund’s signo Patella inhibition testo tracking testo flexion testo Sage sign

FOOT AND ANKLE

Talar rock Gait analysis Hubscher’s (Jack test) Tinel’s test Tibialis posterior tests Windlass test Mulder’s test Neurodynamic tests

SPINE

Upper and lower limb reflexes Babinski sign Straight leg raise, active and passive Femoral nerve stretch test Neurodynamic tests Froment’s sign

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Cranial nerve tests SI pain provocation tests Segmental instability test One-leg lumbar extension test Spurling’s test Coordination tests Tests for clonus and upper motor neurone

lesions (UMNL)Investigations

The AMP is aware of the, role, indications, risks and clinical decision pathways related to investigations for the diagnosis and management of the above disorders:

Blood tests Biochemistry – urine analysis and joint

aspirations X-rays MRI CT Nerve conduction studies (NCS) Ultrasound Common peripheral nerve blocks Common spinal nerve blocks Common infusions such as ketamine Sympathetic blocks such as cervical and

lumbar

The AMP is also capable of interpreting investigations (plain films, blood tests and urine tests) in order to assist in the diagnosis and/or management of the disorders stated above. The AMP is also able to identify the point at which referral for a secondary care opinion is appropriate, if applicable.

Differential Diagnosis

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The AMP shows awareness of and can identify the following differential diagnoses:

Referred pain from visceral organs inclusive of cardiac presentations

Infection Malignancy and tumour Osteomyelitis Rheumatological conditions DVT, thrombosis Herpes zoster and post-herpetic neuralgia Fibromyalgia Complex regional pain syndrome Depression Anxiety Obsessive compulsive disorder Psychotic illness – somatic symptom disorders

such as functional neurological symptom disorder (conversion disorder) and factitious disorders

Malingering

SHOULDER

Thoracic outlet syndrome Brachial plexus neuritis Parsonage-Turner syndrome Neuralgic amyotrophy Suprascapular nerve entrapment Long thoracic nerve injury Polymyalgia rheumatica

ELBOW Chronic impingement of radial and/or posterior

interosseus nerve Irritation of the articular branches of the radial

nerve Traumatic periostitis of the lateral epicondyle

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Calcific tendinopathy Chondromalacia of the radial head and

capitellum Psoriatic arthropathy

WRIST AND HAND

Intersection syndrome Complex regional pain syndrome Aneurysmal bone cysts PVNS Inflammatory arthropathies Gout-related tophi Rheumatoid arthritis (RA)

HIP

Short-leg syndrome Gynaecological and pelvic disorders Hernia

KNEE

Osteochondromas Ollier’s disease Hip lesions (referred) Monoarticular arthritis/ synovitis

FOOT AND ANKLE Monoarticular arthritis/synovitis Charcot-Marie-Tooth disease Peripheral neuropathy

SPINE

Pyrogenic and TB infections UMNL Vascular/metabolic/visceral Paget’s disease

Congenital Problems

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The AMP is aware of the following:

Sprengel’s shoulder Panner’s disease Radial club hand Polydactyly Syndactyly Hip dysplasia Lateral femoral dysplasia Endochondroma or osteochondroma Tarsal coalition Anomalous peroneal tendon Congenital scoliosis Spina bifida occulta Talipes equinovarus Cervical torticollis Slipped upper femoral epiphysis (SUFE) Hip dysplasias and CDH

Management

The AMP is able to:

Diagnose and formulate a management plan for the following acute and persistent pain conditions musculoskeletal conditions:

Diagnose and formulate a

Make a sound diagnosis of the clinical condition based upon the above history, examination and investigations

Identify conditions that are outside of scope of practice and need to be managed or referred to a doctor, specialist, other health professional or hospital

Non-specific low back pain Whiplash associated disorders Neuropathic pain Complex regional pain syndrome Fibromyalgia Temperomandibular joint pain Headache Upper and lower limb pain

SHOULDER

Fracture o clavicle, scapula,

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management plan for the following musculoskeletal conditions:

o humerus–neck/shaft/greater tuberosity Dislocations and subluxation

o humerus (anterior/posterior/inferior )o acromioclavicularo sternoclavicular

Rotator cuff degeneration Rotator cuff tears (acute vs chronic), partial

thickness tears, full thickness tears, full thickness with retraction

Calcific tendinitis Adhesive capsulitis and recalcitrant condition Acromioclavicular joint injuries Sternoclavicular joint injuries Tendinopathy of the rotator cuff Subcoracoid, subacromial and glenohumeral

impingement Biceps ruptures Osteoarthritis

ELBOW

Fracture and dislocationso radial head and necko olecranon, coronoid, capitellumo distal humeruso epicondylaro supracondylar humerus

Lateral and medial tendinopathy Loose bodies/OCD Osteoarthritis Bursitis Extensor tenosynovitis Ligamentous/soft tissue injuries

WRIST AND HAND

Fracture and dislocation

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o distal radius and/or ulnao carpalso metacarpalso phalanges

Osteoarthritis of the wrist, carpus and MCP joints

Tenosynovitis of thumb, flexors, extensors Kienbock’s disease Radio-carpal joint injury Radio-ulnar joint injury CMC joint injury Scapho-lunate injury Peri-lunate injury disruption Mallet finger Boutonniere deformity Swan neck deformity Volar plate injury Tendon injury – FDP, FPS, EPL, EPB Sequelae of fractures

o non-union/Malunion fractures of the scaphoid, hamate, pisiform, triquetral

Tendinopathieso Extensor carpi ulnariso flexor carpi ulnaris

Neurological pathologies or similaro carpal tunnel syndromeo entrapment of the ulnar nerve in

Guyon’s canalo neuritis of the dorsal sensory branch of

the ulnar nerve Dorsal impingement syndromes

o distal radius stress fractureso scaphoid stress fractureso avascular necrosis of the capitateo ulnar carpal abutmento dorsal impingement o occult dorsal ganglion

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Wrist complex Instabilityo scapho-lunate ligament dissociationo dorsiflexion Instability (DISI)o palmar flexion instability (VISI)o scaphoid lunate advanced collapse

(SLAC)o ulnar translocationo dorsal subluxationo TFCC injuries

HIP

Fractureo neck of femuro avulsiono acetabularo stress fractures (femoral neck, femoral

shaft, inferior pubic rami, sacrum) Degenerative joint disease Labral tears Femoral acetabular impingement Trochanteric bursitis Sacroiliac joint problems Avascular joint problems CDH/Perthes’ Slipped upper femoral epiphysis Osteitis pubis Lumbar spine and sacroiliac disorders Occult hernias (conjoint tendon tears) Groin disruption (‘Gilmore’s groin’) Nerve entrapment for example ilioinguinal

genitofemoral, lateral femoral cutaneous

Bursitis such as iliopsoas, ischial, obturator and greater trochanter

KNEE

Fractures o femoralo tibial

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o patellao head of fibula

Degenerative joint disease Meniscal tears Meniscal cysts Ligament strains/tears Chondral fractures Acute stress fractures Osteochondral lesions Knee/patella dislocation Osteochondritis dissecans Bipartite patella with cyst Bipartite patella without cyst Patellofemoral chrondrosis Subchondral cyst Patellar cysts CRPS I/II Loose bodies Excessive lateral compression syndrome

(ELPS) patella Chronic subluxation patella Recurrent traumatic dislocation of patella Congenital dislocating patella Idiopathic patellafemoral chondromalacia Osteonecrosis Referred pain from hip and/or lumbar spine Fat pad impingement Arthrofibrosis Quadriceps tendon tears/rupture Patellar tendon tears/rupture Patellar tendinopathy Synovial hypertrophy Pigmented villonodular synovitis (PVNS) Synovial haemangioma Hoffa’s disease Neuroma Retinacular pain/tear Thigh contusion/myositis ossificans

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Pes anserinus bursitis Pre-patella bursitis Chondrocalcinosis

FOOT AND ANKLE

Fracture and dislocationo tibiao fibulao taluso navicularo calcaneumo cuboido cuneiformso metatarsalo phalanges

Ligament injuries Degenerative joint disease Chondral lesions Lisfranc’s disruption Sinus tarsi syndrome Hallux valgus and hallux rigidus Plantar Fasciitis Tendinopathy Achilles tendon rupture Tibialis posterior disruption Tibio-talar impingement by meniscoid tissue Peroneal tendon tears Recurrent peroneal tendon subluxation or

dislocation Syndesmosis disruption Subtalar instability Cuboid subluxation Osteochondral lesion of the talus Post-traumatic degenerative arthritis CRPS I/II Acute and chronic ankle instability – functional

and mechanical Interdigital neuromas

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Idiopathic MTPJ synovitis Arthritis of the MTPJs Cavus foot with plantar-flexed 1st and 2nd rays Morton’s foot (long second metatarsal, short

first metatarsal) Hyper mobile first ray ‘Turf toe’ Biomechanical related disorders

SPINE

Fractureo VB, end plate, TP, SP, pars

Ligamentous injury Degenerative disease of disc, facet joint, modic

changes, canal stenosis

CERVICAL SPINE

Acute locking (wry neck) Discogenic type Facet type Cervical osteoarthrosis/RA of a facet joint

(usually upper cervical spine) Cervical spondylosis degenerative IVD and

vertebral bodies ‘Whiplash’ syndrome

Cervical myelopathy

THORACIC SPINE

Thoracic disc Osteochondral rib Thoracic myelopathy

LUMBAR SPINE

Spinal stenosis ‘Facet’ joint syndrome Disc pathology Discitis Nerve root syndrome Spondylolisthesis

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Spondylolysis Scoliosis Scheuermann’s disease Osteoporosis Ankylosing spondylitis

2. Differential Diagnosis Of Non-Musculoskeletal Conditions

Psychology/psychiatryThe AMP has awareness of the importance of:

The AMP is able to discuss the signs and symptoms commonly associated with the following:

Inter-relation of psychological/psychiatric comorbidities with acute and persistent pain

Anxiety and panic disorders Depression Post-traumatic stress disorder Bipolar disorder Obsessive compulsive disorder Substance use disorder Somatic symptom and related disorders

o functional neurological symptom disorder (conversion disorder)

o factitious disorder Malingering

RheumatologyThe AMP has awareness of the importance of:

The AMP is able to discuss the signs and symptoms commonly associated with the following:

The longevity of problem (acute vs chronic) Recurring problems Additional symptom development Other areas becoming symptomatic

Ankylosing spondylitis Diffuse idiopathic skeletal hyperostosis (DISH) Reactive arthritis Systemic lupus erythematosus (SLE) Rheumatoid arthritis Psoriatic arthritis

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Enteropathic arthropathies Gout Sicca complex Polymyalgia rheumatica Behcet’s syndrome Fibromyalgia

EndocrinologyThe AMP demonstrates awareness of the:

The AMP is able to discuss the common neuromuscular and systemic signs and symptoms associated with endocrine dysfunction, for example:

Interrelation between ‘neuromuscular’ problems such as carpal tunnel, adhesive capsulitis, peripheral diabetic neuropathy and endocrine problems

The interrelation of other factors such as alcoholism and obesity with endocrine problems

Chondrocalcinosis Hypothyroidism Diabetes mellitus Metabolic alkalosis/acidosis Osteoporosis Osteomalacia Paget’s disease

OncologyThe AMP demonstrates awareness of the possible red flags associated with oncological conditions

The AMP is able to discuss signs and symptoms commonly associated with cancer of the:

Musculoskeletal system Neurological system

and demonstrate knowledge of referred pain patterns from oncological conditions

Visceral/vascular

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The AMP demonstrates knowledge of referred pain patterns from visceral organs, for example:

The AMP demonstrates knowledge of vascular conditions that may present as musculoskeletal conditions, for example:

Heart (and vessels) Lung Kidney Liver Stomach Intestines Gall bladder

DVT Vascular claudication Abdominal aortic aneurysm Thoracic aortic aneurysm

NeurologyThe AMP demonstrates awareness of common symptoms associated with neurological conditions, especially in relation to motor and neuromuscular problems

The AMP is able to discuss signs and symptoms commonly associated with neurological problems, for example:

Multiple sclerosis Motor neurone disease Parkinson’s disease Cerebral vascular disease Neurofibromatosis Polio

3. Radiology

Radiation safetyThe AMP demonstrates awareness of radiation safety

Principles of ionising and non-ionising radiation Risks and contraindications of each modality:

o plain film

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that includes: o CTo MRIo ultrasoundo nuclear medicineo interventional radiology

Pregnancy and protection of the fetusIndications for imaging

The AMP can describe the clinical decision-making rules to determine the need for imaging of the:

Shoulder Elbow Wrist and hand Hip and pelvis Knee

o Ottawa knee ruleso Pittsburgh decision rules

Foot and ankleo Ottawa foot and ankle rules

Spineo Canadian C-spine ruleso NEXUS

The AMP can describe the indications, advantages and disadvantages of the imaging modalities – plain film, CT, MRI, ultrasound, nuclear medicine, interventional radiology (such as injections, nerve blocks) – in the following regions:

Shoulder Elbow Wrist and hand – scaphoid Hip and pelvis Knee Foot and ankle Cervical spine Thoracolumbar spine

The AMP describes the imaging pathway for the following suspected conditions:

Fractures and dislocations Cartilage and osteochondral lesions Tendon and muscle ruptures Ligamentous injuries Degenerative joint conditions Avascular necrosis

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Stress fractures Acute osteomyelitis Bony metastases Soft tissue mass Multiple myeloma DVT (outline Well’s criteria) Recurrent shoulder dislocation Recurrent patellofemoral joint dislocation Recalcitrant tennis elbow

Requesting imagingThe AMP when requesting imaging should be able to:

Describe the principles of requesting imaging Define the ALARA principle Discuss the responsibilities of the referrer Understand informed consent and how this

may be documented Describe the principles in assessing

risk:benefit ratios

Interpretation Of Imaging

The AMP when requesting imaging should be able to interpret plain films using a systematic approach that includes the following:

The AMP has the ability to recognise the musculoskeletal conditions from plain-film imaging, for example:

Routine check of name, date, side and site of injury

Correct patient positioning, view and exposure ABCS (alignment, bone, cartilage, soft tissue) Common sites of injury or pathology Common sites for missed injuries

SHOULDER, CLAVICLE, AC JOINT

Fractures Dislocation

o anterior, posterior, luxato-erecta Calcific tendinopathy OA Chronic degenerative supraspinatus tear

ELBOW, HAND AND WRIST

Fractures

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o for example, Colles’, Barton’s, Smith’s, Bennett’s, Rolando, scaphoid, carpal, boxers, etc.

o Monteggia and Galaezzio buckle and growth plate (Salter–Harris)

VISI and DISI deformities Perilunate dislocation Scapho-lunate dissociation Volar plate Keinböck’s disease CPPD (calcium pyrophosphate dihydrate

deposition) OA

HIP AND PELVIS

Fractureso neck of femur, acetabularo avulsion o AVNo stress fracture

OA Hip dysplasias including Cam and Pincer

deformities SUFE

KNEE

Fractureso Patella, tibial plateau, fibulao Avulsion – Segond fracture

Effusion Tendon ruptures – patella alta OA CPPD

FOOT AND ANKLE

Fractureso Weber classificationo 5th, Joneso Lisfranc

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o calcaneum OA Gout – trophy Tarsal coalitions, heel spurs

SPINE

Fractures Degeneration Spondylolisthesis

The AMP has the ability to identify abnormal findings on plain film of non-musculoskeletal cause that require a medical review and may be diagnosed by the medical team such as:

Acute osteomyelitis Bony metastases Multiple myeloma Foreign bodies Soft tissue mass

PsychologyThe AMP demonstrates awareness of and can briefly describe common psychological techniques and interventions for acute and persistent pain

The AMP is able to recognise

Biopsychosocial assessment Case formulation Motivational interviewing Psycho-education Goal setting Relaxation training Biofeedback Graded exposure therapy Cognitive behavioural therapy Mindfulness Acceptance and commitment therapy Self-hypnosis Distraction

Current predicament, stressors, social situation Current thoughts of suicide Previous suicide attempts or threats

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signs of increased risk of suicide

The AMP is able to screen for suicide risk by asking pertinent questions, for example:

The AMP recognises when further action is required and understands what action should be taken

Drug or alcohol use Impulsiveness

Have things been so bad lately that you have thought you would rather not be here?

Have you had any thoughts of harming yourself?

Are you thinking of suicide? Have you ever tried to harm yourself? Have you made any current plans? Do you have access to a firearm? Access to

other lethal means? Consultation with pain clinic psychology and

medical colleagues Consultation with in house acute psychiatry

liaison clinician and/or emergency department Communication with GP, psychiatrist,

community psychiatry service and family member as required

Provision of resources to patient including contact details for LifeLine, BeyondBlue, MensLine, Kids Helpline, the Salvation Army Suicide Call Back Service, Veterans’ Line

Interventional Pain Management Procedures And Implantable Devices

The AMP understands the role that interventional procedures and implantable devices play in the biopsychosocial management of acute and persistent pain

The role of interventional procedures in the diagnosis and/or treatment of pain

The likelihood of a placebo response and the measures taken to control for this

The potential for procedures and devices to divert the person’s attention away from the functional restoration model and to promote ‘cure-seeking’ behaviours

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The AMP can describe the indications, advantages and disadvantages of the following interventions and implantable devices:

Sympathetic ganglion block Facet joint injection and/or medial branch block Radiofrequency neurotomy Epidural injection and or infusion Ketamine infusion Transforaminal nerve sheath steroid injections Spinal cord stimulator Peripheral nerve stimulator Intrathecal drug delivery device

4. Pharmacology

The AMP demonstrates knowledge of relevant state/ territory legislation regarding use of medicines

The AMP demonstrates an awareness of pharmacology relevant to managing musculoskeletal conditions including:

The AMP demonstrates knowledge about mode of action, indications, precautions and contraindications, drug interactions, adverse reactions and side effects and dosage of the following drug classes:

Clinical pharmacology Pharmacotherapeutics Pharmacokinetics and pharmacodynamics Special considerations for certain populations

(such as paediatrics, older adults) International, national and organisational

clinical guidelines in relation to medicine use

Paracetemol Anti-inflammatories Corticosteroids Opioids Neuropathic medications Local anaesthetics NMDA receptor antagonists such as ketamine Anti-depressants such as TCAs, SSRIs, SNRIs DMARDs Diabetic medications Anti-hypertensives

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Anti-anginals

5. PathologyThe AMP demonstrates a basic understanding of three main areas relating to haematology and problems associated with these areas:

The AMP can interpret simple haematological results and identifies when medical involvement is required

The AMP demonstrates a basic understanding of the key areas of biochemistry and problems associated with these areas:

The AMP can interpret simple biochemistry results and identifies when medical involvement is required

The AMP demonstrates knowledge of when the following tests are indicated and can interpret the results in relation to differential diagnosis of a musculoskeletal condition

The red blood cell The white blood cell Coagulation

Coagulation Anaemia Infection/neoplasia Thrombosis/haemorrhage

Fluid and electrolyte balance Sodium and potassium The kidney Liver function tests and plasma protein Calcium Thyroid function

Dehydration Renal and liver failure Diabetes

Urine analysis Joint aspiration

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6. DiabetesThe AMP will have basic knowledge that includes an understanding of the following:

Normal glucose and fat metabolism Pathophysiology of diabetes Definition of diabetes mellitus and common

comorbid conditions How diabetes is diagnosed Screening measures for diabetes Differences between type 1, type 2 and

gestational diabetes Impaired glucose tolerance and impaired

fasting glucose Risk factors and preventative measures for

type 2 diabetes Role of the physiotherapist in supporting

people with diabetes Need for good diabetes control — blood

glucose, lipids and blood pressure to limit diabetes complications and maintain quality of life

Role of medication in management of diabetes Complications associated with diabetes

o cardiovascular risko macrovascular complicationso microvascular complications –

retinopathy, nephropathy and neuropathy

Hypoglycaemia and hyperglycaemiaThe AMP will have a demonstrated ability to:

Take a history that includes all relevant information required for assessment of a patient with diabetes

Identify when blood glucose should be tested Interpret results of blood glucose test and if

outside normal range make the appropriate referral

Identify when use of urine glucose or ketone monitoring is required

Interpret results and if outside normal range

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make the appropriate referral Recognise signs and symptoms of

hypoglycaemia and hyperglycaemia and know how to act appropriately

Conduct a foot screening assessment Assess for neuropathy and modify

management accordingly Identify patients at risk of nephropathy and

implications of this on management Identify patients at risk of retinopathy and

implications of this on management Minimise tissue damage Identify implications of fasting patients with

diabetes Promote healthy lifestyle behaviours to

patients with diabetes

7. Communication

Verbal CommunicationThe AMP demonstrates advanced skills in communicating at all levels and in particular demonstrates the ability to:

Use concise, systematic approach to verbally presenting cases to expert colleagues

Acknowledge time restraints and competing demands on expert colleagues and approaches only when appropriate

Follows ISBAR approach when indicated and appropriate

Documentation

The AMP will have a demonstrated ability to:

Correctly document in the medical record by following all:

o local policies and procedureso national standardso professional standards

Record accurate and complete clinical notes that are either electronic or legibly hand written

Document clinical notes that are relevant,

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objective, accurate and conciseConsentThe AMP will have a demonstrated knowledge of:

The AMP will have a demonstrated ability to:

Legislation regarding patient rights and consent to treatment

Local organisational guidelines for consenting patients

The barriers that limit patients’ capacity to consent

Clearly educate patients of the risks and benefits of investigations or procedures prior to gaining consent

Identify patients that are not able to consent

Troubleshoot when unable to obtain consent

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Learning and assessment plan: pain clinic (example only)The Learning and assessment plan is separated into two sections: (1) the learning plan and (2) the assessment plan. The learning plan outlines learning resources and describes various learning activities to be undertaken as directed by the Learning needs analysis and as set by the organisation. The assessment plan outlines the methods in which the competency assessment will occur such as work-based observed sessions, case-based presentations and oral appraisals. The assessment is mapped back to the performance criteria of the competency standard and recorded on the Learning and assessment plan. This is a flexible, adaptable document that may vary between organisations and individuals. Each organisation should set and clearly document the minimum acceptable method of assessment to determine competency as agreed with the relevant stakeholders (for example, physiotherapy manager, pain team director) The physiotherapist should keep all documentation regarding the learning activities and assessment undertaken and develop a professional practice portfolio that can then be used as evidence of prior learning should they transfer their employment to another organisation in the future.

To develop the Learning and assessment plan the minimum acceptable method of assessment for each performance criteria should be determined by first reviewing the Cumulative assessment tool. This is a copy of the competency standard with recommended methods of assessment allocated to each performance criteria. For some performance criteria there may be more than one method of assessment recommended on the Cumulative assessment tool. There is an option to select and record the preferred method of assessment indicated and many performance criteria may be assessed more than once and additionally by more than one different method of assessment. The Learning and assessment plan should document the method of assessment and the performance criteria and address all performance criteria that are relevant to the role and are yet to be met. Refer to the Learning and assessment plan for the AMP in the pain clinic as an example of a completed Learning and assessment plan for a trainee engaging in the whole learning and assessment program. The clinical lead physiotherapist is responsible for developing the assessment component of the learning and assessment plan in collaboration with the physiotherapist undertaking the assessment and in accordance with the requirements of the organisation.

An example Learning and assessment plan can be found on the following pages. A template Learning and assessment plan can be found in the Appendix.

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COMPETENCY STANDARD Deliver advanced musculoskeletal physiotherapy in pain clinic

ASSESSMENT TIMEFRAME To be negotiated with clinical lead, assessor and/or line manager.

WORKPLACE LEARNING DELIVERY OVERVIEW

A combination of the following will be implemented: self-directed learning coaching or mentoring workplace application formal external learning.

1. LEARNING ACTIVITIES/RESOURCES

TASK DESCRIPTION (add/delete according to individual and organisational needs) Completed X

1. Complete Learning needs analysis for the work role

Complete Competency standard self-assessment tool and Learning needs analysis (Part A and B) and discuss learning needs, evidence of prior learning and assessment/verification processes with clinical supervisor or line manager. Scope of practice while working under supervision prior to competency being achieved should be discussed at this time.

2. Complete site-specific orientation to Pain clinics

Complete orientation with clinical supervisor or line manager covering all details outlined in the site-specific orientation guideline.Shadow/observations sessions in the pain clinic.

3. Complete self-directedlearning modules based on results from the Learning needs analysis

# must be completed prior to requesting imaging

* Not all learning modules have to be completed prior to commencing competency assessment – this needs to be individually tailored according to need

Learning modules to complete (add or delete learning modules relevant to area of practice): Pain modules 1, 2 and 3 musculoskeletal conditions/presentations specific to area of

practice Radiology (optional for pain clinics)

o Radiation safety#

o Indications for imagingo Requesting imagingo Interpreting imaging

Pharmacology Pathology Differential diagnosis of non-musculoskeletal presentations

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Learning modules and other learning resources can be accessed from the Victorian Department of Health Website

Diabetes (APA diabetes e module or equivalent in-house training) Communication (ISBAR)/consent/documentation

4. Complete formal training if required such as pharmacology, diabetes, other

Pain management, pain treatment, pain conditions, the psychology of pain and pain sciences – for example, University of Sydney single subjects, Noigroup Explain Pain, other online courses as they become available

The University of Melbourne – pharmacology single subject (optional) APA e-modules – Diabetes for Physiotherapists (optional)http://www.learningseat.com/servlet/ShopLearning?categoryName=Browse+

%BB+Physiotherapy/Clinical+Content+%BB+Diabetes+For+Physiotherapists+-+8+CPD+Hours&learningId=38954

5. Complete further individual learning as identified from the Learning needs analysis

Complete further individualised learning as discussed with and directed by clinical supervisor or line manager. This may include material beyond what is covered in the learning modules above. In-service training provided by colleagues from departments such as pharmacy, radiology and pathology can support the learning program etc.Further single subjects or degree courses may be undertaken at the University of Sydney and other tertiary institutions in orofacial pain, neurobiology, musculoskeletal pain, cancer pain, the pharmacology of pain medicine, psychological approaches to pain management, disability, pain in children and older people, cognitive impairment, women’s and men’s health, complementary therapies, acute pain, pain measurement, motivational interviewing, multicultural understanding of pain expression and treatment, occupational health, pain and compensation, the effects of torture and trauma, etc.

6. Undertake supervised clinical practice and feedback sessions

Physiotherapists new to the work role who are undertaking the full learning and assessment pathway will engage in a structured/timetabled work program as advised and negotiated with their clinical supervisor/assessor.

Physiotherapists new to the role should complete an orientation program that includes shadowing and observation.

Until an individual is deemed competent to practice independently within the setting they require access to senior medical staff for clinical supervision.

A graduated process from direct to indirect clinical supervision will be maintained during this period until performance is at an independent standard and physiotherapists will be

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http://www.learningseat.com/servlet/ShopLearning?categoryName=Browse+%BB+Physiotherapy/Clinical+Content+%BB+Diabetes+For+Physiotherapists+-+8+CPD+Hours&learningId=38954



supported by specific, targeted feedback during this time, to address learning needs. A formative assessment should be conducted early into commencing the role and

throughout the supervision period to help the physiotherapist prepare for workplace observation assessment(s) and oral appraisal. The formative assessment may be conducted by the clinical lead physiotherapist; however, the workplace observation could be conducted by a consultant familiar with the competency standard.

7. Review the following documents and become familiar with the content in relation to advanced musculoskeletal physiotherapy

Australian physiotherapy standardshttp://www.physiocouncil.com.au/files/the-australian-standards-for-physiotherapy

• APA scope of practice http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Scope_of_Practice_2009.pdf

• Physiotherapy Registration Board code of conduct http://www.physiotherapyboard.gov.au/Codes-Guidelines.aspx

• Processes for issuing of sick leave certificates/WorkCover certificates or documentation• Local organisational guidelines or clinical governance structure Drugs and poisons legislation: http://www.health.vic.gov.au/dpcs/reqhealth.htm Poisons Standard 2010: http://www.comlaw.gov.au/Details/F2010L02386 International Association for the Study of Pain (IASP) and Australian Pain Society (APS)

fact sheets and clinical updates: http://www.iasp-pain.org http://www.apsoc.org.au/8. Other activities to be advised (document

other activities organised to assist learning – for example, Lightbox radiology course, multi-disciplinary case conferences)

It is recommended that the trainee conduct a self-assessment of their clinical record keeping at intervals during the training program in preparation for the record-keeping audit and using the record-keeping audit assessment tool.

Observe interventional procedures including sympathetic blockade, facet joint blocks, epidural injection and radiofrequency denervation.

Observe psychological assessment and treatment including motivational interviewing, sleep hygiene and relaxation training.

Present a complex case to the multidisciplinary team.

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http://www.apsoc.org.au/

http://www.iasp-pain.org/

http://www.comlaw.gov.au/Details/F2010L02386

http://www.physiotherapyboard.gov.au/Codes-Guidelines.aspx

http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Scope_of_Practice_2009.pdf


http://www.physiocouncil.com.au/files/the-australian-standards-for-physiotherapy

2. ASSESSMENT DETAILS AND LINKAGE (example for pain clinic)

ASSESSMENT TASK Due date


1. Complete self-assessment tool – Learning needs analysis Part A and B (SA)Self-assessment will include the physiotherapist completing the Learning needs analysis Part A and B:

I. prior to commencing in the role II. prior to undergoing competency assessment

III. prior to undergoing annual performance development review.The physiotherapist should discuss the completed self-assessment tool with their clinical lead / experienced physio /mentor and develop an individualised Learning and assessment plan.

2.1, 3.1–2, 3.4, 15.1–2, 15.4–8, 19.1–5, 20.1–3, 20.5–7, 21.1–5, 22.1–5

2. Complete written responses (WR) Provide details of assessment taskPhysiotherapists may be required to complete assigned written tasks such as multiple choice, short answer or online quizzes.

I. WA imaging guidelines radiation safety online module (minimum of 80% correct)If the physiotherapist is required to request imaging it is recommended this module be completed during the orientation process prior to imaging being requested http://www.imagingpathways.health.wa.gov.au/includes/RadiationQuiz/quiz.html

II. Pharmacology quizIII. Pain interventions quiz

7.1, 7.5, 7.7, 9.2, 9.9

3. Participate in direct workplace observation (WO)For an agreed period of time the physiotherapist will work under supervision. When deemed ready by self and supervisor, the physiotherapist will undergo formal observation in the workplace. Refer to the Direct workplace observation assessment checklist.

The physiotherapist’s level of performance will be rated against the standard by the designated assessor using assessment tool(s) during a formal assessment process.

Occasions of direct workplace observation will be negotiated by the assessor with the physiotherapist. It is recommended that these observations of clinical practice are to include patient presentations with signs and

symptoms most common in presentation to area of practice. Who the assessor is will vary depending upon the local organisation’s requirements. The assessor could be a

consultant who is familiar with the assessment process and competency standard requirements. They could also be an experienced musculoskeletal physiotherapist.

Approximately three observations should occur of new assessments including spinal pain, CRPS and a patient with complex medical and/or psychological comorbidities. Additionally, three assessments of group-based interventions should occur, with at least one involving education and one involving exercise. A further observation should occur

1.1, 4.1, 5.1–5, 6.1–7, 7.1,–7, 9.1–2, 9.5–7, 9.9, 10.1–3, 11.1–7, 12.1–2, 13.1–3, 15.1–8, 16.1–2, 17.1–4, 18.1, 19.1–3, 19.6, 20.1–9, 21.1–2, 22.1–2

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http://www.imagingpathways.health.wa.gov.au/includes/RadiationQuiz/quiz.html

for a midway review of a patient and a discharge session. 4. Maintain a professional practice portfolio (PF)

The professional practice portfolio required is consistent with the requirements of the APA’s requirements and should include relevant information regarding attendance and participation in formal and informal education and learning opportunities specific to advanced musculoskeletal physiotherapy area of practice.This may include:

self-reflective journal/diaries in-services, lectures, journal clubs, continuing education programs attended or given quality projects research activities and publications conference attendance mentoring/supervision sessions an electronic clinical log of types of conditions seen.

Please refer to: APA continuing development guidelines

www.physiotherapy.asn.au/APAWCM/Learning_and_Development/CPD_Overview/APAWCM/LearningDevelopment/CPD_Overview.aspx

AHPRA guidelines for continuing education www. physiotherapy board.gov.au/documents/default.aspx

1.2, 3.1–3

5. Provide documentary evidence (DE)For example:Participation in a record-keeping audit – It is recommended that physiotherapists are required to provide documentary evidence of predetermined number of health record entries, which will be audited using an audit assessment tool by an assessor such as the clinical lead physiotherapist or a peer. Performance will be rated as satisfactory if at least 80% of the applicable criteria are included in the samples. Feedback will be provided to the physiotherapist and recommendations for improvement documented with a plan to ensure recommendations are implemented. Record-keeping practice should be in line with the local organisation’s policies and the APA position statement on health records.

Review of patient management plans/programs – individualised and group-based Review of documentation for referral for pathology tests, radiology, assessment by other health professionals Review of individual and team-based correspondence Review of email-based communication with a patient

7.4, 8.4, 9.8, 14.1, 15.3, 15.5–8, 16.1–2, 17.1–2, 18.1, 19.3–4, 19.6, 20.4–6, 20.8, 21.3–4, 22.3–4

6. Give case-based presentations (CBP)It is recommended that physiotherapists present a predetermined number of cases (five) to colleagues at a frequency designated by the assessor / clinical lead / supervisor – Case based presentation assessment tool.

3.4, 4.2, 5.1–3, 5.5, 6.1–7, 7.2, 7.5, 7.7, 8.1–3, 8.5, 9.1–2, 9.5–

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http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Health_Records_2010.pdf

http://www.physiotherapyboard.gov.au/documents/default.aspx

http://www.physiotherapy.asn.au/APAWCM/Learning_and_Development/CPD_Overview/APAWCM/LearningDevelopment/CPD_Overview.aspx


It will be supported by verbal questioning by the assessor, centring on advanced clinical decision making. The level of performance will be rated against the standard by the designated assessor using the appropriate CBP

assessment tool(s). The presentations should address the required performance criteria as identified in this learning and assessment plan. Additional performance criteria may be added and addressed in case-based presentations. Topics to be covered include persistent spinal pain, acute CRPS, chronic CRPS, predominant psychosocial factors, medical comorbidities that influence ability to exercise, communication difficulties, complex pharmacological management and treatment withdrawal.Provide details of assessment task (for example, number of case presentations, topics to be covered)

7, 9.9, 10.1–3, 11.1–7, 12.1–2, 15.3, 16.3–4, 17.3–4, 18.2

7. Participate in performance appraisal (PA)A performance appraisal should be conducted at the completion of an agreed timeframe by a nominated medical consultant or advanced practice musculoskeletal physiotherapist who has worked regularly with the physiotherapist. This appraisal is based on an informal observation of clinical practice over a period of time. This appraisal will include the following areas:

working to full potential of the role accountability ability to work within limitations and legislation overall clinical practice communication with colleagues including

o presentation of cases o recognition of when to involve colleagues

management of workload use of resources.

Refer to the Performance appraisal assessment tool.

1.2, 2.1, 3.3–4, 4.1–2, 6.1–7, 7.6, 8.4, 9.5–7, 10.3, 11.5–7, 19.7, 20.9

8. Undertake external qualification/training (Q/T) It is recommended the physiotherapist undertakes further external training. Examples of this include:

University of Sydney graduate certificate, graduate diploma or master’s degree in pain management (distance learning)

University of Melbourne single subject in radiology University of Melbourne single subject in pharmacology APA diabetes learning modules 1–4 other relevant external course such as Noigroup Explain Pain

This is to be guided by local organisation policies and guidelines.

7.7, 9.9

9. Participate in oral appraisal (OA)An oral appraisal can be conducted to assess aspects of workplace performance, as required and at the discretion of the assessor (consultant or clinical lead physiotherapist) in relation to the relevant performance criteria. Refer to the Oral appraisal assessment tool.

1.1, 5.4, 9.3–4, 13.4, 16.3–4, 18.2, 19.7, 20.9, 21.4, 22.4

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For example, the physiotherapist may be asked about: scope of practice knowledge about legislation/policies and procedures relevant to practice evidence-based practice prioritisation of workload and use of resources clinical reasoning and decision making processes regarding use of investigations, medications comorbidities associated with pain conditions indications for making referrals to specialists and consulting with expert colleagues in a timely manner.

It is recommended that this oral appraisal is conducted when the physiotherapist is ready to submit all forms of evidence for a final assessment of competency to the designated assessor, who may be the clinical lead physiotherapist or nominated consultant.

The physiotherapist is responsible for collating all assessment undertaken and recording this on the Cumulative assessment tool.

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Workplace learning programOne aspect of the workplace learning program includes self-directed learning modules that use the adult learning principles.1 These principles support the self-directed approach rather than the traditional didactic teaching method. The learning modules can be accessed on the Victorian Department of Health website. Ideally the modules should be accompanied by other learning activities such as in-services provided by other specialty departments within the organisation (anaesthetics, pharmacy, pathology, psychology, diabetes educators, etc.). All learning activities undertaken should be documented in the professional practice portfolio. Other examples of learning activities are included in the Learning and assessment plan and include attendance at case conferences, external courses and lectures and conferences.

Learning modules

The learning modules for the ‘Advanced musculoskeletal physiotherapy services – pain’ are divided into key areas. All of these modules do not need to be completed prior to starting in these roles; however, if radiology requesting is included in the learning and assessment plan, it is recommended the section on radiation safety in the radiology module be completed during the initial orientation process and prior to commencing the requesting of imaging.

How to use the learning modules

It is presumed a combination of team-based and individual learning approaches will be used. The gaps identified in Learning needs analysis (Part A and B) should direct the focus for the learning modules. The learning modules can be divided up among the team to complete and present back to the musculoskeletal physiotherapy team at professional development sessions. Some elements of the module may need to be completed individually as per the individualised Learning and assessment plan agreed upon together with the clinical lead or mentor. There may be some learning objectives in the modules that are not relevant to all organisations (such as paediatrics) and/or some learning objectives previously achieved and therefore do not need to be completed. Additionally there is repetition and overlap in learning objectives across the modules. This is deliberate to allow the learning modules to be a stand-alone document. It is not expected that every question in the learning modules, particularly questions already addressed in other modules, need to be answered – time should be spent on the areas identified as needing development and areas of high priority and most likely presentations relevant to the practice context.

How much time should it take?

Non-clinical time must be allocated to complete the learning modules and this should be protected time away from a clinical workload. The amount of time for learning should be negotiated as early as possible and be dependent on the needs of the individual. The timeframe to complete the training program will be dependent on the number of hours working in the role (full time or part time) and should be determined in consultation with the clinical lead. The physiotherapist is responsible for ensuring the modules are completed in a timely way in preparation for the work-based competency assessment.

The learning modules assume a level of musculoskeletal skills and knowledge equivalent to that of clinicians working at an APA titled master’s level. Hence, physiotherapists who have not completed their master’s, or gone through the APA experiential titling pathway, may be required to undergo additional competency assessment to address performance gaps that cannot be addressed within the scope of this clinical education framework.

1 Knowles M S 1975, Adult education: new dimensions, Educational Leadership, 75, retrieved 26 November 2013,

<http://www.ascd.org/ASCD/pdf/journals/ed_lead/el_197511_knowles.pdf>.

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http://www.ascd.org/ASCD/pdf/journals/ed_lead/el_197511_knowles.pdf

It is important to note that not all parts of all the learning modules are required to successfully complete the competency assessment. Some of the learning modules are for more experienced advanced musculoskeletal physiotherapists (such as differential diagnosis module) and can be left to a later stage. The modules can be used as an ongoing tool to support learning in the future even after competency has been achieved.

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Example of learning modules for the advanced musculoskeletal physiotherapy service in the pain clinic

Module Domain

1 Musculoskeletal presentationsShoulderElbowWrist and handHipKnee Foot and ankleSpinal

2 Radiology*Radiation safety#

Indications for imagingRequesting imagingInterpreting plain-film imaging

3 PainThe science of painThe interdisciplinary pain teamPain measurement and outcomes assessment

4 *

5 Pharmacology** University of Melbourne pharmacology module

6 Pathology

7 Differential diagnosis of non-musculoskeletal presentations

8 Paediatrics

9 Diabetes – APA diabetes module^ or in-house equivalent

10 Communication (ISBAR)/consent/documentation

*The University of Melbourne Radiology for Physiotherapists subject is conducted in the first semester and complements the radiology self-directed learning module. Information about this subject can be accessed at the University of Melbourne website: https://handbook.unimelb.edu.au/view/2012/RADI90001

** The University of Melbourne pharmacology subject is conducted in first semester by the School of Pharmacy and complements the pharmacology self-directed learning module. Organisations may stipulate this as a requirement for particular scope of practice such as physiotherapist initiated analgesia. While optional, for some specific practice context it is recommended that trainees engage in formal education in this area.

^ APA diabetes module is located at: http://www.learningseat.com/servlet/ShopLearning?learningId=38954&categoryName=Diabetes+For+Physiotherapists+-+8+CPD+Hours

* Module 4 is for wounds and not included for the pain clinics

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http://www.learningseat.com/servlet/ShopLearning?learningId=38954&categoryName=Diabetes+For+Physiotherapists+-+8+CPD+Hours

http://www.learningseat.com/servlet/ShopLearning?learningId=38954&categoryName=Diabetes+For+Physiotherapists+-+8+CPD+Hours

https://handbook.unimelb.edu.au/view/2012/RADI90001

Competency-based assessment and related toolsBackground

‘Competency based assessment is a purposeful process of systematically gathering, interpreting, recording and communicating to stakeholders, information on candidate performance against industry competency standards and/or learning programs’ (National Quality Council 2009)

Assessment is an important part of any training system, not only for the learner but for the clinical educator and for stakeholders.

For the learner, assessment provides feedback to guide their future learning and monitor their own progress. For clinical educators, assessment allows them to verify that learning is taking place in line with the required standard of performance and to determine their success in facilitating the learning process. For stakeholders, assessment provides a way of knowing if people have the required knowledge, skills and behaviours for the job. In this instance, the key stakeholders would include employers and clinical supervisors from a variety of professions. As it stands now, competence assessment of AMPs is not required to satisfy any professional association or legal requirements but is broadly applied in some shape or form across the health sector.

Providing proof of competency achievement involves a process of gathering information (evidence), matching it against the requirements of the competency standard and applying it in the workplace using sound assessment principles. This process is assisted by using a variety of assessment tools and instructions listed under the assessment resources section.

Assessing competence in the workplace using evidence

The type and amount of evidence required to support decisions of competence is not prescribed here; however, recommendations regarding assessment methods mapped against the competency standard are made to provide some guidance on how this might be done. These recommendations are outlined in the Cumulative assessment tool and the Learning and assessment plan and are supported by a number of other assessment checklists and tools, listed below. They provide a guide only. Ultimately the amount and type of evidence to support decisions of competence for AMPs is at the discretion of the organisation.

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Principles of assessment

The principles of validity, reliability, flexibility, fairness and sufficiency should be applied to assessment processes and decisions.

Principles of competency-based assessment as it applies to advanced musculoskeletal physiotherapistsPrinciple Key ideasValidity (assessing what it claims to assess)

The assessor’s knowledge and skill is crucial to enhancing the validity of the assessment process – this is enhanced by ensuring workplace assessors meet specific criteria

The assessor gathers evidence about performance to justify assessment judgements

Assessment includes the range of knowledge and skills needed to demonstrate competency with their practical application

Where possible, includes judgements based on evidence from a number of sources, occasions and across a number of contexts

Reliability (consistent and accurate decisions)

Clear instruction for the assessor as to what must be identified and what constitutes the required performance level – this is enhanced by the competency standard, performance cues and use of assessment tools and instructions

This is also enhanced by ensuring workplace assessors meet specific criteria and that consistent conduct is used during assessments

Consideration is given to the amount of error included in the evidenceFlexibility (when it can accommodate the needs of learners, a variety of delivery modes and delivery sites)

Assessment should reflect the candidate’s needs It must provide for recognition of knowledge, skills and attitudes,

regardless of how they have been acquired Assessment must be accessible to learners through a variety of

methods appropriate to context and the candidate

Fairness (when it places all learners on equal terms)

Assessor considers the needs and characteristics of the candidate and includes reasonable adjustment where applicable

Assessment is based on a participative and collaborative relationship between the assessor and the candidate

Assessment procedure is clear to all learners before assessment – this is enhanced by learners having access to instructions and tools prior to assessment

Assessor is open and transparent about all assessment decision making and maintains impartiality and confidentiality throughout the assessment process

Assessment decisions can be challenged and appropriate mechanisms are made for reassessment as a result of the challenge

Sufficiency (relates to the quantity and quality of the evidence assessed)

Refers to evidence as well as assessment methods Enough appropriate evidence needs to be collected and assessed to

ensure all aspects of the competency standard have been satisfied – this is enhanced by a well-developed assessment plan that includes evidence recommended by subject matter experts

Evidence should accurately reflect real workplace requirements and include the range and complexity of patient presentations found in the practice context

Includes a range of methods mapped to the competency standard Provides evidence from the assessment process that is acceptable to

stakeholdersAdapted from: National Quality Council 2009, Guide for developing assessment tools, DEEWR, Canberra, pp. 24–28. © Commonwealth of Australia

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Assessment resources

A number of assessment resources have been developed to support implementation in the workplace. Some tools relate to establishing the suitability of the assessor and some can be used as a recording tool during occasions of assessment; others help to ensure consistent processes are used and that candidates are aware of how the assessment task will be conducted.

Not all assessment tools will be used in the competence assessment of individual candidates. The tools used will depend on what assessment methods have been decided on by the organisation and mapped in the Learning and assessment plan, the competences specific to the practice context and the individual needs of the candidate. The assessment resources and a description of purpose and use are included below.

Assessment resourcesNo. Name Purpose How to use the resourceAssessment tools to assess candidates1.1 Cumulative assessment

toolTo inform recommended assessment methods for performance criteria assessment and collate all evidence to enable a final decision on workplace competence

Use this tool as a starting and endpoint.At the beginning, the Cumulative assessment tool provides a guide to the assessment methods recommended for specific performance criteria, as relevant to the work role. By using these recommendations, the Learning and assessment plan for the individual can be refined. At the endpoint this tool is used to collate all the evidence collected from assessment processes and indicate the overall outcome of assessment made by the assessor.

1.2 Competency standard self-assessment tool: Part A, Learning needs analysis

To help clinicians reflect meaningfully and to identify strengths and their own learning needs as they relate to the standards

Use this tool as a self-assessment against the elements and performance criteria at the beginning of the program to assist in establishing the learning needs of the individual and to allow tailoring of the learning and assessment plan.

1.3 Knowledge and skills self-assessment tool: Part B, Learning needs analysis

To help clinicians reflect meaningfully and to identify strengths and their own learning needs as they relate to underpinning knowledge and skills

Use this tool as a self-assessment against the underpinning knowledge and skills at the beginning of the program to assist in establishing the learning needs of the individual and to allow tailoring of the Learning and assessment plan.

1.4 Direct workplace observation (WO) (adult): assessment checklist

Includes a modified checklist

To record performance during a direct observation assessment against designated performance criteria for an adult patient

After adequate preparation of the learner and due consideration of the assessment context and conditions (see additional resources below) the tool is used to record performance during a WO assessment. The number of WO assessments is not fixed and may vary depending on the

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range of clinical presentations relevant to the practice context, the level of performance of an individual in earlier assessments or prior work experience and training of an individual. See the Learning and assessment plan for details.One tool should be used for each WO. Ratings against all performance criteria may not be possible on the one assessment occasion, but for each occasion an overall rating should be given and effective performance feedback given.

1.5 Direct workplace observation (WO): follow-up questions

To provide consistent questions that can be used to clarify performance against specific performance criteria

Assessors can select from this list of questions to target performance criteria that may not have been observed in the WO, or to clarify the candidate’s understanding in performance criteria where performance may fall short of the expected standard.

1.6 Case-based presentation (CBP): assessment instructions and summary

To help candidates and assessors collate the evidence collected by case presentations and inform learners on assessment requirements using this method

Candidates use the tool to collate evidence across a number of focus areas and assessment occasions.

1.7 Case-based presentation (CBP): assessment checklist

To record performance during a case-based presentation assessment against designated performance criteria

The assessment tool is used to record performance during a CBP assessment. As per the application in the adult population, the number of WO assessments is not fixed and may vary. See the Learning and assessment plan for details.One tool should be used for each WO. Ratings against all performance criteria may not be possible on the one assessment occasion, but for each occasion an overall rating should be given and recorded and constructive feedback given.

1.8 Record-keeping audit: assessment tool

To record performance of a candidate’s record keeping against designated criteria

This assessment tool is used by the assessor to collate evidence over a number of health record entries and provide feedback to target areas for improvement.

1.9 Clinical audit: recording tool

To record feedback by peers given during a clinical audit of random health records

This recording tool is used by peers to record feedback after reviewing the content of medical record entries against evidence-based practice and best practice. Constructive feedback will be provided to the physiotherapist and recommendations for improvement documented with a plan to ensure recommendations are implemented.

1.10 Performance appraisal (PA): assessment tool

To capture the overall performance of a

A performance appraisal should be conducted at agreed times by a

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candidate over an agreed timeframe as rated by a consultant who has worked regularly with the candidate against designated criteria

consultant who has worked regularly alongside the physiotherapist. This appraisal is based on an informal observation of clinical practice and addresses designated criteria not easily captured elsewhere. It may provide supplementary evidence in instances where engagement of consultants in formal assessment processes is difficult, such as a WO, and is designed to promote collaborative working relationships.

1.11 Oral appraisal (OA): assessment tool

To record a candidate’s performance against designated criteria not covered by other methods of assessment

An oral appraisal takes place between the candidate and the clinical lead or consultant in a question and answer format and addresses areas such as legislation and scope of practice. The assessor rates the answers on the assessment tool.

Additional resources for assessment preparation2.1 Pre-assessment

checklist for workplace assessors: self-assessment tool

To establish the suitability of the workplace assessor in accordance with recommended minimum criteria

All workplace assessors should complete the checklist to establish their suitability as a workplace assessor prior to assessing the competency of candidates. This is to be used as a guide only where there are no legislated requirements or additional organisational requirements to be applied.

2.2 Conditions and context for assessment: instructions

To inform candidates and assessors of the contexts and conditions required for workplace assessment

These instructions can be adapted as needed but in their current format provide general principles and instructions to guide the assessment process.The candidate should have access to these instructions and any assessment tool(s) prior to the assessment task. An opportunity for clarification of these instructions prior to assessment would also be given to the candidate.

2.3 Assessment preparation checklist

To promote consistent conduct and adequate preparation of the candidate prior to assessment

This checklist is to be used by the assessor prior to the assessment to promote adequate preparation for the ensuing assessment and to ensure the candidate has been fully informed. It is particularly applicable for direct WO assessments.

2.4 Guidelines for assessors’ conduct during a direct workplace observation assessment

To promote consistent conduct by assessors during direct observation assessment

This provides a guide to how an assessor should conduct themselves during a direct observation assessment. It is particularly applicable for direct WO assessments, but the principles can and should be applied to other forms of assessment.

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Cumulative assessment tool – pain clinicsCandidate’s name: Assessment timeframe:

Name(s) of assessor(s) and designation: Practice context area: Pain clinic

ELEMENTS AND PERFORMANCE CRITERIA

Did the candidate provide evidence of the following?

* The candidate must be rated as independent in all performance criteria to achieve competency.

RO

LE RELEVA

NC

E (RR

)(indicate)

Performance Rating Scale

Recommended Assessment (Ax)

Indicate MethodsOf Assessment Used

Dependent (D

)M

arginal (M)

Assisted (A

)Supervised (S)Independent (I)

Self-assessment (SA) Written responses (WR) Oral appraisal (OA) Documentary evidence (DE) Workplace observation

(WO) Case-based presentation

(CBP) Qualification/training record

(Q/T) Portfolio (PF) Performance appraisal (PA)

PROFESSIONAL BEHAVIOURS1. Operate within scope of practice1.1 Identify and act within own knowledge base and scope of practice OA, WO1.2 Work towards the full extent of the role PF, PA 2. Display accountability2.1 Demonstrate responsibility for own actions as it applies to the practice context SA, PALIFELONG LEARNING3. Demonstrate a commitment to lifelong learning3.1 Engage in lifelong learning practices to maintain and extend professional competence PF, SA3.2 Identify own professional development needs and implement strategies for achieving them

PF, SA

3.3 Engage in both self-directed and practice-based learning PF, PA3.4 Reflect on clinical practice to identify strengths and areas requiring further development CBP, SA, PACOMMUNICATION4. Communicate with colleagues 4.1 Use concise, systematic communication at the appropriate level when conversing with a range of colleagues in the practice context

WO, PA

4.2 Present all relevant information to expert colleagues when acting to obtain their CBP

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involvement PROVISION AND COORDINATION OF CARE5. Evaluate referrals 5.1 Discern patients who are appropriate for advanced physiotherapy management in accordance with individual strengths or limitations, any legal or organisational restrictions on practice, the environment, the patient profile/needs and within defined work roles

CBP, WO

5.2 Discern patients who are appropriate for management in a shared care arrangement in accordance with individual strengths or limitations, any legal or organisational restrictions on practice, the environment, the patient profile/needs and within defined work roles

CBP, WO

5.3 Defer patient referrals to relevant professionals (including other physiotherapists) when limitations of skill or job role prevent the client’s needs from being adequately addressed, or when indicated by local triage procedure

5.45.5 Prioritise referrals based on patient profile/need, organisational procedure or targets and any local factors

WO, OA

5.65.7 Communicate action taken on referrals using established organisational processes CBP, WO6. Perform health assessment/examination6.1 Design and perform an individualised, culturally appropriate and effective patient interview with common and/or complex conditions/presentations

WO, CBP, PA

6.2 Formulate a preliminary hypothesis and differential diagnoses for a patient with common and/or complex conditions, as relevant to the practice context 6.3 Perform complex modifications to routine musculoskeletal assessment in recognition of factors that may impact on the process such as the patient profile/needs and the practice context6.4 Design and conduct an individualised, culturally appropriate and effective clinical assessment that:

o is systems-based and includes relevant clinical tests o selects and measures relevant health indicatorso substantiates the provisional diagnosis

6.5 Identify when input is required from expert colleagues and act to obtain their involvement6.6 Act to ensure all ‘red flags’ are identified in the assessment process, link ‘red flags’ to diagnoses not to be missed and take appropriate action in a timely manner

6.7 Act to ensure ‘yellow flags’ are identified in the assessment process and take appropriate action in a timely manner7. Apply the use of radiological investigations7.1 Anticipate and minimise risks associated with radiological investigations WR, WO

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7.2 Determine the indication for imaging based on assessment findings and clinical decision-making rules

CBP, WO Other – as determined by local radiology department7.3 Select the appropriate modality consistently and act to gain authorisation as required

7.4 Convey all required information on the imaging request consistently DE, WO7.5 Interpret plain-film images accurately using a systematic approach for patients with common and/or complex conditions, as relevant to the practice context

CBP, WO, WR


WO, PA


Q/T, WR, WO, CBP

Q/T = University of Melbourne radiology subject

8. Apply the use of pathology tests in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)8.1 Anticipate and minimise risks associated with pathology tests CBP 8.2 Determine the indication for pathology testing based on assessment findings and clinical decision making rules8.3 Identify the appropriate test(s) consistently and act to gain authorisation as required8.4 Convey all required information to appropriate personnel when initiating pathology tests DE, PA8.5 Interpret routine pathology test results for patients with common and/or complex conditions, as relevant to the practice context and in consultation with expert colleagues

CBP


Q/T No Q/T Not presently available

9. Use therapeutic medicines in advanced practice (under the direction and supervision of a consultant)9.1 Determine the indication and appropriate medication requirements from information obtained from the history taking and clinical examination and liaise with relevant health professional regarding this

WO, CBP

9.2 Demonstrate knowledge of pharmacokinetics, indications, contraindications and precautions, adverse effects, interactions, dosage and administration of medications commonly used to treat musculoskeletal conditions, as relevant to the practice context

WR, CBP, WO

9.3 Apply knowledge of the legal and professional responsibilities relevant to recommending, administering, using, supplying and/or prescribing medicines under the current legislation, as relevant to the practice context

OA

9.4 Comply with national and state/territory drugs and poisons legislation OA9.5 Identify when input is required from expert colleagues and act to obtain their involvement

WO, CBP, PA

9.6 Apply relevant knowledge of the medicine involved when recommending and informing patients of the risks and benefits of use

WO, CBP

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9.7 Exercise due care, including assessing properly the implications for individual patients receiving therapeutic medicine, as relevant to the practice context9.8 Maintain proper clinical records as they relate to therapeutic medicine DE9.9 Meet threshold credentials and/or external learning and assessment processes set by the organisation, governing body and national and state/territory legislation

Q/T, WO, CBP, WR

Q/T = University of Melbourne pharmacology subject

10. Advanced clinical decision making10.1 Synthesise and interpret findings from clinical assessment and diagnostic tests to confirm the diagnosis

WO, CBP

10.2 Demonstrate well-developed judgement in implementing and coordinating a patient management plan that synthesises all relevant factors 10.3 Use finite healthcare resources wisely to achieve best outcomes PA, WO, CBP11. Formulate and implement a management/intervention plan11.1 In collaboration with the patient formulate complex, evidence-based management plans/interventions as determined by patient diagnosis that are relevant to the practice context

WO, CBP

11.2 Identify when guidance is required from expert colleagues and act to obtain their involvement11.3 Facilitate all prerequisite investigations/procedures prior to consultation, referral or follow-up, as relevant to the practice context 11.4 Assess the need for referral or follow-up and arrange if necessary11.5 Identify when input to complement care is required from other health professionals and act to obtain their involvement

WO, CBP, PA

11.6 Provide appropriate education and advice to patients with common and/or complex conditions, as relevant to the practice context11.7 Conduct a thorough handover to ensure patient care is maintained12. Monitoring and escalation12.1 Monitor the patient response and progress throughout the intervention using appropriate visual, verbal and physiological observations

WO, CBP

12.2 Identify and respond to atypical situations that arise when implementing the management plan/intervention13. Obtain patient consent13.1 Explain own activity to the patient as it specifically relates to the practice context and check that the patient agrees before proceeding

WO

13.2 Evaluate the patient’s capacity for decision making and consent WO13.3 Inform the patient of any additional risks specific to proposed advanced practice treatments and ongoing service delivery and confirm their understanding13.4 Employ strategies for overcoming barriers to informed consent as relevant to practice OA

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context14. Document patient information14.1 Document information in the patient health record, fully capturing the entire intervention, consultation process, addressing areas of risk and consent and including any referral or follow-up

DE

ADDITIONAL ADVANCED PRACTICE CLINICAL SKILLS SPECIFIC TO PRACTICE CONTEXT15. Implement care of acute and persistent pain conditions15.1 Identify the complexity, multidimensional and individual nature of the pain experience SA, WO

15.2 Express the impact of pain on society SA, WO15.3 Formulate a preliminary hypothesis, differential diagnoses and patient-centred management plan

WO, DE, CBP

15.4 Act to ensure that management plans are designed to optimise patient compliance / treatment adherence

SA, WO

15.5 Design and deliver an individualised, culturally appropriate and effective education program

SA, WO, DE

15.6 Design and conduct an individualised, culturally appropriate and effective intervention SA, WO, DE15.7 Design and deliver a group-based, culturally appropriate and effective education program

SA, WO, DE

15.8 Design and conduct a group-based, culturally appropriate and effective intervention SA, WO, DE16. Develop and implement a management plan for patients presenting with spinal pain16.1 Perform complex assessment for patients presenting for musculoskeletal assessment of spinal pain including the evaluation of surgical versus non-surgical management

WO, DE

16.2 Perform sufficient neurological examination that incorporates upper motor neurone, lower motor neurone and peripheral nerve examinations with consistency in documentation16.3 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with spinal pain and act to obtain their involvement

OA, CBP

16.4 Apply evidence-based practice to managing acute and persistent spinal pain17. Develop and implement a management plan for patients presenting with limb pain17.1 Perform complex assessment for patients presenting for musculoskeletal assessment of limb pain, including the evaluation of surgical versus non-surgical management

WO, DE

17.2 Perform sufficient neurological examination that incorporates upper motor neurone, lower motor neurone and peripheral nerve examinations with consistency in documentation17.3 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with limb pain and act to obtain their involvement

CBP, OA

17 .4 Apply evidence-based practice to managing acute and persistent limb pain18. Implement appropriate care of acute and persistent pain conditions in patients who have psychological conditions including anxiety, depression and post-traumatic stress disorder

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18.1 Exercise due care in managing patients with acute and persistent pain with psychological comorbidities including on referral of patients with poorly managed psychological symptoms or considered at risk of self-harm

WO, DE

18.2 Demonstrate knowledge of the common psychological comorbidities associated with acute and persistent pain

OA, CBP

19. Implement care of acute and persistent pain conditions in individuals with limited ability to communicate due to cognitive impairment19.1 Perform complex modifications to routine musculoskeletal assessment in recognition of the patient’s cognitive abilities, as relevant to the practice context

SA, WO

19.2 Determine and minimise risks and limitations associated with investigations performed on patients with cognitive impairments

SA, WO

19.3 Formulate an appropriate management plan in collaboration with the parent/caregiver that meets the needs of the patient and family

SA, WO, DE

19.4 Identify when input is required from expert colleagues in the care of cognitively impaired patients and act to obtain their involvement

SA, OA, DE

19.5 Apply evidence-based practice to managing acute and persistent pain conditions in the cognitively impaired population

SA

19.6 Communicate at an appropriate level with patient and caregiver, ensuring all relevant information regarding diagnosis, management and follow-up is provided and understood

WO, DE

19.7 Function in accordance with legislation, common law, health standards and policies pertinent to the provision of healthcare to patients with cognitive impairment

OA, PA

20. Implement care of acute and persistent pain conditions in paediatric populations20.1 Perform complex modifications to routine musculoskeletal assessment in recognition of the patient’s age, as relevant to the practice context

SA, WO

20.2 Determine and minimise risks associated with investigations unique to paediatrics20.3 Maintain close lines of consultation with expert colleagues when interpreting investigations when managing paediatric patient(s), where applicable 20.4 Act to ensure the medication requirements of paediatric patient(s) are met and applied safely and effectively, as relevant to the practice context

DE

20.5 Formulate an appropriate management plan in collaboration with the parent/caregiver SA, WO, DE20.6 Identify when input is required from expert colleagues in the care of paediatric patients and act to obtain their involvement

SA, WO, DE

20.7 Apply evidence-based practice to managing musculoskeletal condition in paediatrics SA20.8 Communicate at an appropriate level with child and parent/caregiver, ensuring all relevant information regarding diagnosis, management and follow-up is provided and understood

WO, DE

20.9 Function in accordance with legislation, common law, health standards and policies OA, PA

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pertinent to paediatric and child health21. Implement care of acute and persistent pain conditions in patients with diabetes21.1 Modify routine musculoskeletal assessment in recognition of a patient’s diabetic condition, as relevant to the practice context

SA, WO

21.2 Modify routine musculoskeletal interventions in recognition of a patient's diabetic condition, as relevant to the practice context

SA, WO

21.3 Provide patients with diabetic conditions with information relevant to altering their health behaviours and improving their health status

SA, DE

21.4 Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with diabetes and act to obtain their involvement

SA, OA, DE

21.5 Apply evidence-based practice to managing musculoskeletal condition in patients with diabetes

SA

21. Implement care of acute and persistent pain conditions in patients with cancer-related conditions22.1. Modify routine musculoskeletal assessment in recognition of a patient’s cancer-related condition, as relevant to the practice context

SA, WO

22.2. Modify routine musculoskeletal interventions in recognition of a patient's cancer-related condition, as relevant to the practice context

SA, WO

22.3. Provide patients with cancer-related conditions with information relevant to altering their health behaviours and improving their health status

SA, DE

22.4. Identify when input is required from expert colleagues to assess and manage musculoskeletal conditions in patients with cancer-related conditions and act to obtain their involvement

SA, OA, DE

22.5. Apply evidence-based practice to managing musculoskeletal condition in patients with cancer-related conditions

SA

OVERALL COMPETENCY RESULT achieved in assessment timeframe(*Independent rating required in all performance criteria to achieve competency)

Competent Not yet competent

Date: Signature of candidate:

Date: Signature of assessor(s):

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If competency NOT achieved, document performance criteria to be addressed and action plan

ORGANISATIONAL RECORDING PROCESSES COMPLETED Yes No

Author: Last review date:

Version: Next review date:

BONDY RATING SCALE

Scale label Standard of procedure Quality of performance Level of assistance required

Independent (I) SafeAccurate

Achieved intended outcomeBehaviour is appropriate to context

ProficientConfidentExpedient

No supporting cues required

Supervised (S) SafeAccurate


ProficientConfidentReasonably expedient

Occasional supportive cues

Assisted (A) SafeAccurate

Achieved most objectives for intended outcomeBehaviour generally appropriate to context

Proficient throughout most of the performance when assisted

Frequent verbal and occasional physical directives in addition to supportive cues

Marginal (M) Safe only with guidanceNot completely accurate

Incomplete achievement of intended outcome UnskilledInefficient

Continuous verbal and frequent physical directive cues

Dependent (D) Unsafe Unable to demonstrate behaviour Lack of insight into behaviour appropriate to context

UnskilledUnable to demonstrate behaviour/procedure

Continuous verbal and physical directive cues

X Not observed

Adapted from: Bondy K N 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing Education, 22(9):376–381.

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Direct workplace observation (WO) (pain clinic): assessment checklist

Candidate’s name: Date:

Assessment linkage to competency standard: 1.1, 4.1, 5.1–5, 6.1–7, 7.1–7, 9.1–2, 9.5–7, 9.9, 10.1–3, 11.1–7, 12.1–2, 13.1–3, 15.1–8, 16.1–2, 17.1–4, 18.1, 19.1–3, 19.6, 20.1–9, 21.1–2, 22.1–2

Workplace observation no. (circle): 1 2 3 additional as required 4 5 6Assessor’s name and designation:

Candidate to indicate the type of patient presentation included in this workplace observation: Acute and persistent pain(15.1–8) Limb pain (17.1–2) Paediatric (20.1–3)

Spinal (16.1–2) Psychological condition

(18.1) Diabetic (21.1–5)

Cognitive impairment (19.1–3,6) Cancer-related conditions (22.1–2)

ELEMENTS AND PERFORMANCE CRITERIADid the candidate provide evidence of the following?

ink to comp.

standard

Performance rating scale CommentsXorN/A

Dependent

Marginal

Assisted

Supervision

Independent

COMMUNICATION4. Communicate with colleagues Communication with expert colleagues is concise, systematic and at appropriate level

4.1

All relevant information presented to expert colleagues 4.2

PROVISION AND COORDINATION OF CARE5. Evaluate referrals

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Appropriate patients included for advanced physiotherapy management 5.1

Shared care management applied appropriately 5.2Patients deferred to other professionals appropriately 5.3 Referrals prioritised according to need 5.4Action taken on referrals communicated 5.5 6. Perform health assessment/examinationIndividualised, culturally appropriate and effective patient interview evident

6.1

Preliminary hypothesis formed 6.2Differential diagnoses identified 6.2

Complex modifications to routine musculoskeletal assessment, evident and appropriate

6.3

Individualised, appropriate and effective musculoskeletal assessment evident, that is:

systems-based and includes relevant clinical tests selects and measures relevant health indicators substantiates the provisional diagnosis

6.4 16.1 17.1 19.1 20.1 21.1 22.1

Input from expert colleagues obtained appropriately in assessment phase 6.5 16.3 17.3 19.4 20.6 21.4 22.4

‘Red flags’ are identified, with appropriate action taken 6.6‘Yellow flags’ are identified, with appropriate action taken 6.77. Apply the use of radiological investigations in advanced musculoskeletal physiotherapyRisks associated with radiological investigations minimised 7.1Imaging selected is indicated and appropriate modality selected 7.2

7.3Authorisation gained as required 7.3

All required information conveyed on imaging request 7.4Plain-film images are interpreted systematically

accurately7.5

Input on imaging is sought from expert colleagues appropriately 7.6 20.3

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8. Apply the use of pathology tests in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)Risks associated with pathology tests are minimised 8.1 Indication for pathology tests are determined appropriately 8.2Authorisation gained as required 8.3All required information conveyed to appropriate personnel when initiating pathology tests

8.4

Pathology tests and results are interpreted appropriately in consultation with expert colleagues as appropriate

8.5

9. Apply the use of therapeutic medicines in advanced musculoskeletal physiotherapy (under the direction and supervision of a consultant)Indicators and appropriate medication needs are identified and

addressed9.1 9.2 9.5 9.6 9.7

Appropriate input on medications is sought from expert colleagues 9.1 9.5

Applies knowledge of pharmacokinetics, indications, contraindications, precautions, adverse effects, interactions, dosage and administration of medications commonly used to treat musculoskeletal conditions is applied

9.2 9.6

10. Advanced clinical decision makingFindings interpreted and synthesised to confirm the diagnosis 10.1Management plan shows well-developed judgement, with synthesis of all relevant factors

10.2

11. Formulate and implement a management/intervention planPlan is evidence-based, appropriate and made in collaboration with patient

11.1

Input on plan is sought from expert colleagues appropriately 11.2 16.3 17.3 20.621.4 22.4

Facilitate all prerequisite investigations or procedures prior to consultation or referral

11.3

Complex modifications to routine musculoskeletal intervention evident and includes providing appropriate patient and carer education

11.6,

Referral and follow-up arranged appropriately 11.4

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Provided appropriate education and advice to patient 11.6Thorough handover conducted 11.712. Monitor and escalate careMonitor the patient response and progress throughout the intervention appropriately

12.1, 12.2

13. Obtain patient consentExplain own activity as it specifically relates to the practice context and check that the patient agrees before proceeding

13.1

Consider the patient’s capacity for decision-making and consent 13.2Inform of risks and confirm understanding 13.3OPTIONAL FOLLOW-UP QUESTIONS FOR THE ASSESSOR TO CONSIDER

What are the risks associated with ordering plain x-rays?What are the key principles to apply to minimise risk associated with plain x-rays?

7.1

What are the indications for imaging the following regions:o peripheral joints (UL and LL)?o spinal?

What are three examples of clinical decision making rules for imaging?

7.2

What are the risks associated with pathology tests and what do clinicians requesting pathology tests need to do to minimise these risks?

8.1

Provide an example of what and when pathology tests may be indicated.What tests can be initiated by a physiotherapist?

8.2

What is the process when pathology tests are indicated but can’t be initiated by a physiotherapist?

8.3

In what situations should expert colleagues be consulted in relation to medicines and what important information needs to be conveyed?

9.512.2

When is over-the-counter analgesia indicated and what is the relevant information to inform patients of when recommending over-the-counter analgesia?

9.6, 9.7

When is over-the-counter analgesia not indicated? 9.7Explain your clinical decision making. 10.1

-2Provide an example of a situation where you have faced an atypical situation and discuss how you managed the situation.

12.2

Provide an example of when input is required from expert colleagues in the care of a patient with spinal pain.Provide an example of when input is required from expert colleagues in

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the care of a patient with limb pain.OVERALL COMPETENCY/RESULT PERFORMANCE LEVEL

Dependent Marginal Assisted Supervised Independent

Date:Signature of assessor(s):Signature of candidate:

SPECIAL QUESTIONS / COMMENTS / FURTHER ACTION

ORGANISATIONAL RECORDING PROCESSES COMPLETED Yes No Author: Last review date:Version: Next review date:BONDY RATING SCALEScale label Standard of procedure Quality of performance Level of assistance requiredIndependent (I) Safe

AccurateAchieved intended outcomeBehaviour is appropriate to context












Incomplete achievement of intended outcome

UnskilledInefficient





X Not observedAdapted from: Bondy K N 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing Education, 22(9):376–381.

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Direct workplace observation (WO) (adult): modified assessment checklist (pain clinics)


Assessment linkage to competency standard: 1.1, 4.1, 5.1–5, 6.1–7, 7.1,–7, 9.1–2, 9.5–7, 9.9, 10.1–3, 11.1–7, 12.1–2, 13.1–3, 15.1–8, 16.1–2, 17.1–4, 18.1, 19.1–3, 19.6, 20.1–9, 21.1–2, 22.1–2

Within each workplace observation not all performance criteria may be appropriate to be assessed. Performance criteria may be carried over for assessment in the next workplace observation. Once all performance criteria have been assessed as independent no further workplace observations will be required.

Workplace observation no. (circle): 1 2 3 additional as required 4 5 6Assessor’s name and designation:

Candidate to indicate the type of patient presentation included in this workplace observation: Acute and persistent pain (15.1–8) Limb pain (17.1–2) Paediatric (20.1–3)

Spinal (16.1–2) Psychological condition (18.1) Diabetic (21.1–5)

Cognitive impairment (19.1–3,6) Cancer-related conditions (22.1–2)

BONDY RATING SCALEScale label Standard of procedure Quality of performance Level of assistance requiredIndependent (I) Safe

AccurateAchieved intended outcomeBehaviour is appropriate to context












Incomplete achievement of intended outcome UnskilledInefficient





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X Not observedAdapted from: Bondy K N 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing Education, 22(9):376–381.

ELEMENTS AND PERFORMANCE CRITERIADid the candidate provide evidence of the following?

Link to comp. standard

Performance rating scale XorN/A

Dependent

Marginal

Assisted

Supervision

Independent

CommunicationCommunication with expert colleagues is concise, systematic and at appropriate level and includes liaising regarding:

assessment and management plan differential diagnosis use of medicines and imaging

(16.4 spinal pain; 17.3 limb pain; 19.4 cognitive impairment; 20.3,20.6 paediatrics; 21.4 diabetes; 22.4 cancer-related conditions – please circle)

4.17.6 9.5 6.511.2 15.5

All relevant information presented to expert colleagues 4.2

Communicates effectively with patient and caregiver 19.620.8

Provision and coordination of careIdentifies patients appropriate to be seen and prioritises referrals 5.1

5.4Shared care management instigated appropriately 5.2

Defers patients to other professionals appropriately and a thorough handover is conducted as required 5.35.511.4–5 11.7

Acts within scope of practice 1.1

Perform health assessment/examinationConducts an individualised, culturally appropriate and effective patient interview 6.1

Preliminary hypothesis formed and differential diagnosis identified 6.215.3

Conducts an individualised, appropriate and effective musculoskeletal assessment (16.1-2 spinal pain; 17.1-2 limb pain; 19.1 cognitive impairment; 20.1 paediatrics; 21.1 diabetes; 22.1 cancer-related conditions)

6.36.4

‘Red flags’ and ‘yellow flags’ are identified, with action taken 6.6–7

Apply the use of radiological investigations in advanced musculoskeletal physiotherapy

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Imaging selected is indicated, risks are minimised and appropriate modality selected and required information conveyed

7.1–419.220.1

Radiological images are interpreted systematically and accurately 7.5

Apply the use of medicines (under the direction and supervision of a consultant)Acts to ensure use of medicines is indicated, safe and effective 9.1–2

6.7Advanced clinical decision makingFindings interpreted and synthesised to confirm the diagnosis 10.1

Management plan shows well-developed judgement, with synthesis of all relevant factors 10.2

Formulate and implement a management/intervention planPlan is evidence-based, appropriate and made in collaboration with patient/family to optimise compliance in accordance with comorbidities (16.4 spinal pain; 17.4 limb pain; 19.3,19.5 cognitive impairment; 20.5 paediatrics; 21.2 diabetes; 22.2, 22.5 cancer-related conditions — please circle)

11.115.418.1

Facilitates all prerequisite investigations and information prior to consultation/referral 11.3

Referral and follow-up arranged appropriately 11.4

Provides appropriate education and advice to patient 11.6

Conducts effective education programs 15.5–8

Monitor and escalate care, consentMonitors the patient response and progress throughout the intervention 12.1–2

Fulfils all the requirements relating to obtaining consent including assessment of patients capacity to consent

13.1–3

OPTIONAL FOLLOW-UP QUESTIONS FOR THE ASSESSOR TO CONSIDER

What are the risks associated with ordering plain x-rays?What are the key principles to apply to minimise risk associated with plain x-rays?

7.1

What are the indications for imaging the following regions:operipheral joints (UL and LL) and spinal?

What are some examples of clinical decision-making rules for imaging?

7.2

What are the risks associated with pathology tests and what do clinicians requesting pathology tests need to do to minimise risks?

8.1

Provide an example of what and when pathology tests be indicated.What tests can be initiated by a physiotherapist?

8.2

What is the process when pathology tests are indicated but can’t be initiated by a physiotherapist? 8.3

In what situations should expert colleagues be consulted in relation to medicines and what important information needs to be conveyed?

9.512.2

When is over-the-counter analgesia indicated and what is the relevant information to inform patients of when recommending over-the-counter analgesia?

9.6, 9.7

Demonstrate your knowledge of pharmacokinetics, indications, contraindications, precautions, adverse 9.2

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effects, interactions, dosage and administration of medications commonly used to treat musculoskeletal conditions is applied (such as paracetamol, NSAIDs, opioids).

9.69.7

Explain your clinical decision making. 10.1–2

Provide an example of a situation where you have faced an atypical situation and discuss how you managed the situation.

12.2

Describe the complexity, multidimensional nature of pain on the individual and the impact on society. 15.1–2

Provide an example of when input is required from expert colleagues in the care of paediatric patients. 20.6

OVERALL COMPETENCY/RESULT PERFORMANCE LEVELDependent Marginal Assisted Supervised Independent

Date:Signature of assessor(s):Signature of candidate:


ASSESSMENT ADDED TO ASSESSMENT RECORD Yes No N/A

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Case-based presentation (CBP): assessment checklist


Assessment linkage to competency standard: 3.4, 4.2, 5.1–3, 5.5, 6.1–7, 7.2, 7.5, 7.7, 8.1–3, 8.5, 9.1–2, 9.5–7, 9.9, 10.1–3, 11.1–7, 12.1–2, 15.3, 16.3–4, 17.3–4, 18.2

Case presentation no. (circle): 1 2 3 4 5Assessor’s name and designation: Audience:

Candidate to indicate the patient profile/condition(s) or assessment focus included in this presentation:

History and examination findings of patients with conditions of:

Limb pain (17.3–4) Spinal pain (16.3–4)

Patient profile/condition Acute and persistent pain (15.3) Pain + psychological conditions (18.2)

Management/intervention required Imaging Pathology Pharmacological requirements

Patient care required Shared model of care/ transfer of care (circle) Escalation, in response to an atypical situation

Reflection on clinical practice Evidence of advanced clinical decision making and formulation of complex management

plansDid the candidate provide evidence of the following?Satisfactory = S Not satisfactory = NS Not applicable = N/A Not observed = X


S NS N/A orX

Comments: Areas performed well, areas for improvement, criteria still requiring evidence, for example, N/A or NS

Referrals

Shared care arrangement applied appropriately 5.2

Patients deferred to other professionals appropriately 5.3/5.5

Health assessment/examination

Appropriate and effective patient interview evident 6.1

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Preliminary hypothesis formed and differential diagnosis

identified

6.2, 15.3

Complex modifications to routine musculoskeletal assessment evident

6.3

Appropriate, effective, individualised musculoskeletal assessment evident – that is:

o systems-based o includes relevant clinical tests o selects and measures relevant health indicatorso substantiates the provisional diagnosis

6.4

Input from expert colleagues obtained appropriately in assessment phase

6.5, 16.3, 17.3

‘Red flags’ are identified, with appropriate action taken 6.6

‘Yellow flags’ are identified, with appropriate action taken 6.7

Radiological investigations

Imaging selected is indicated and appropriate 7.2, 7.3Input on imaging is sought from colleagues appropriately 7.3Radiological images accurately and systematically interpreted 7.5Pathology tests Pathology tests and results are interpreted appropriately 8.1, 8.2,

8.3Input on pathology tests sought from colleagues appropriately 8.3Therapeutic medicinesIndicators and appropriate medication needs of the patient are identified and addressed

9.1, 9.2, 9.5, 9.6, 9.7

Appropriate input on medications is sought from colleagues 9.1, 9.5Knowledge of pharmacokinetics, indications, contraindications and precautions, adverse effects, interactions, dosage and administration of medications commonly used to treat musculoskeletal conditions is applied

9.2

Advanced clinical decision makingFindings interpreted and synthesised to confirm the diagnosis 10.1Management plan shows well-developed judgement, with synthesis of all relevant factors

10.2

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Management/intervention plan

Plan is evidence-based and appropriate to diagnosis 11.1, 16.4, 17.4

Plan is made in collaboration with patient/family 11.1

Input on plan is sought from colleagues appropriately and handover is adequate when indicated

11.2,

Complex modifications to routine musculoskeletal intervention evident and includes providing appropriate patient and carer education

11.6

Referral and follow-up appointments/investigations arranged appropriately and resources used wisely

10.3, 11.3, 11.4, 11.5

Monitoring and escalation

Monitor and escalate when atypical situations arise and implement the management plan/intervention appropriately

12.1, 12.2

Lifelong learning

Reflection on clinical practice to identify strengths and areas requiring further development is evident

3.4

Specific to practice contextDemonstrates knowledge of common psychological conditions associated with acute and persistent pain

18.2

OVERALL PERFORMANCE (circle to indicate)Satisfactory Not satisfactory

Signature of assessor(s):

Signature of trainee:


ASSESSMENT TASK ADDED TO ASSESSMENT RECORD Yes No N/A

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Case-based presentation (CBP): assessment instructions and summary

Candidate’s name:

Assessment linkage to competency standard: 3.4, 4.2, 5.1–3, 5.5, 6.1–7, 7.2, 7.5, 7.7, 8.1–3, 8.5, 9.1–2, 9.5–7, 9.9, 10.1–3, 11.1–7, 12.1–2, 15.3, 16.3–4, 17.3–4, 18.2

Assessment instructions:

1. Candidates must satisfactorily complete a minimum of five case-based presentations, which when tracked on the table below cover the full range of assessment focus areas.

2. The frequency and timing of the CBP will be designated by the assessor / clinical lead / supervisor.3. Please confirm any additional requirements with the assessor such as access to patient’s medical number, access to patient’s imaging, de-identified notes.4. Each presentation should attempt to address as many of the performance criteria listed on the CBP assessment tool, as possible.5. The candidate needs to track performance criteria yet to be observed or satisfactorily completed in table below.6. At the completion of the five CBPs, all performance criteria need to have been observed and satisfactorily completed; these can be tracked in the table

below.7. CBPs will be supported by oral appraisal by the assessor, centring on advanced clinical decision making.

CBP no. CBP 1 CBP 2 CBP 3 CBP 4 CBP 5

Date of completion

Result S / NS

List performance criteria yet to be observed or satisfactorily completed

Assessor’s name and designation

Assessment focus areaTrack the content of the CBP by ticking the assessment focus areas below

CBP 1 CBP 2 CBP 3 CBP 4 CBP 5

History and examination findings of patients with conditions of: Limb pain

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Spinal painPatient profile/condition

Acute and persistent pain (15.3) Pain + psychological conditions (18.2)

Management/intervention required Imaging Pathology Pharmacological requirements

Patient care required Shared model of care / transfer of care Escalation, in response to an atypical situation

Reflection on clinical practiceEvidence of advanced clinical decision making and formulation of complex management plansKnowledge of pain conditions and associated psychological comorbiditiesOVERALL PERFORMANCE for all assessed case-based presentations (circle to indicate)Satisfactory Not satisfactory

Signature of assessor(s) and designation: Date:

Signature of candidate: Date:

ORGANISATIONAL RECORDING PROCESSES COMPLETED Yes No Author: Last review

date:Version: Next review

date:

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Advanced musculoskeletal physiotherapy – clinical and record-keeping audit guideline

TARGET AUDIENCE

Musculoskeletal physiotherapists

Physiotherapy manager

Medical directors of relevant unit (emergency, orthopaedics and neurosurgery)

PURPOSE

The purpose of this guideline is to provide a tool to audit the performance of advanced musculoskeletal physiotherapists to ensure patient safety and quality of care is maintained at the highest level.

GUIDELINE

Audits have been identified as a clinical governance activity in the Advanced musculoskeletal physiotherapy clinical governance guideline to assist in the process of demonstrating clinical effectiveness of advanced musculoskeletal physiotherapists. Two different audit activities that will be undertaken will be described in this guideline.

Definitions

Record-keeping audit

A record-keeping audit is a process that establishes whether physiotherapy documentation, within the medical record, referral or handover, meets accepted legal, professional and statutory requirements.

For both audit activities medical records will be used; however, for the clinical audit the relevance of the clinical content documented in the medical record will be discussed against clinical standards and evidence-based practice (whether what was done or not done was appropriate for the context). The record-keeping audit will assess the way it was recorded in terms of health record-keeping standards.

Clinical audit

Clinical audit is a systematic, critical analysis of the quality of clinical care that is reviewed by peers against explicit criteria or recognised standards, and then used to further inform and improve clinical practice. Its ultimate goal is improving quality of care for patients. Its purpose is to examine whether what you think is happening really is, and whether current performance meets existing standards. The environment in which audit and peer review takes place should be one of open discussion, based on accurate data and an understanding of the role of systems issues.

AUDIT METHODS


This involves a random sample of 10 records (medical records of patients will be selected by the clinical lead physiotherapist for each advanced musculoskeletal physiotherapist). The medical UR number will be selected from the electronic clinical log (Access database). The patient’s medical

115

history and their corresponding UR numbers will be accessed on PowerChart by the clinical lead. The record-keeping audit assessment form can be completed by the clinical lead or an allocated peer (Tool 1) for three patients. The results of this assessment will be discussed with the advanced musculoskeletal physiotherapist and recommendations of areas for improvement will be made with a plan to address the recommendations. If the results of the record-keeping audit are not satisfactory further medical records may be accessed and/or the record-keeping audit repeated again after a period of time once the recommendations to the physiotherapist have be implemented.

Self-assessment

A self-assessment of record keeping should be conducted by the advanced musculoskeletal using the assessment form throughout the training period and on a regular basis using the record-keeping assessment tool.

Clinical audit (peer reviewed)

From the sample of 10 records used in the record-keeping audit or from any other cases identified, the clinical lead physiotherapist will select up to three medical records to be used for the clinical audit (they may be the same records used for the record-keeping audit or be a different three patients – this will be up to the discretion of the clinical lead). The clinical lead will review the content of the medical records and be rated according to evidence-based practice and best practice standards. The clinical audit assessment form will be completed (Tool 2). A medical consultant may also be involved in this process as determined by the relevant individual medical units. A peer review process with feedback to the advanced musculoskeletal physiotherapist will be scheduled with the clinical lead (with or without a medical consultant). The peer review process should be documented with recommendations of actions to address areas requiring improvement and the plan to evaluate and monitor the implemented actions. The advanced musculoskeletal physiotherapist should keep a copy of the documentation for their professional practice portfolio, which will contribute to their work-based competency assessment and the ongoing assessment of competency.

The clinical lead may decide to present the case to the team of advanced musculoskeletal physiotherapist to share the opportunity for learning at a scheduled continuing education session. This must be done with the permission of the advanced musculoskeletal physiotherapist and with identity of the people involved removed to protect patient and staff privacy. Further audits may be required at the discretion of the clinical lead.

Reporting

The clinical lead physiotherapist for the advanced musculoskeletal physiotherapy service will be responsible for reporting the results of the clinical audit and record-keeping audit to the physiotherapy manager and medical director annually.

Advanced musculoskeletal physiotherapy trainees will be expected to complete the clinical audit and record-keeping audit requirements prior to undertaking their work-based competency assessment. Once deemed competent all advanced musculoskeletal physiotherapist will be expected to participate in the clinical and record-keeping audit annually.

KEY RELATED DOCUMENTS

Advanced musculoskeletal physiotherapy clinical governance guideline

Advanced musculoskeletal physiotherapy clinical education framework – work-based competency standard and assessment

Allied health clinical governance guideline

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Australian Physiotherapy Association documentation standards http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Health_Records_2010.pdf

Key legislation, Acts and standards:

Charter of Human Rights and Responsibilities Act 2006 (Vic)2

RESOURCES

Guild Insurance record-keeping self-test: retrieved 18 March 2013, <http://www.riskequip.com.au/surveys/records-in-physiotherapy>.

Centre for Clinical Governance Research in Health, UNSW 2009, Clinical audit: a comprehensive view of the literature; retrieved 18 March 2013, <http://clingov.med.unsw.edu.ai>.

Australian Medicare Locals Alliance 2013, Guidelines for conducting clinical audits, ATAPS clinical governance implementation resource kit, retrieved 18 March 2013, <http://www.amlalliance.com.au/medicare-local-support/primary-mental-health/ataps-clinical-governance-framework/ataps-clinical-governance-resource-kit>.

AUTHOR / CONTRIBUTORS

* denotes key contact

Name Position Service /program

* insert name Grade 4 Musculoskeletal Physiotherapist

Physiotherapy

2 REMINDER: Charter of Human Rights and Responsibilities Act 2006 – All those involved in decisions based on this guideline have an obligation to ensure all decisions and actions are compatible with relevant human rights.

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Tool 1: ADVANCED MUSCULOSKELETAL PHYSIOTHERAPY RECORD-KEEPING AUDIT ASSESSMENT TOOL

Audit date: Mark as appropriate below, each health record entry against each criteria 1–40: X N/A

Physiotherapist:

Health record entry number: 1 2 3

Assessor’s name (role) for each entry:

UR number:

General

Consent requirements met

Legible

Date of consult

Time of consult

Physiotherapy heading

Signature

Printed name

Page has UR sticker

Black or blue pen

All notations and abbreviations used are meaningful to those other than physiotherapists

Are personable comments excluded from all records

Single line through errors

Reason for alterations stated

Alterations initialled

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Subjective assessment

Allergies noted

HOPC

Special questions – red flags, yellow flags, population-specific questions assessed

Past medical and surgical history

Current health status

Medications taken on the day and usual regimen

Social history

Smoker/alcohol/drugs

Objective assessment

Neurovascular status

Skin integrity

Other observations

Vital signs if indicated

Palpation findings

Functional status

Range of movement

Special tests / neuro

Investigations – referral information adequate, outcome documented

Reviewed by consultant?

Working diagnosis/impression

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Management

Treatment

Warnings

Reassessment / action taken

Written information provided

Consultations

Name, position, outcome of consultation

Follow-up plan

Referrals

Discharge letter

Education and advice to patient

OVERALL RESULT: S = satisfactory; NS = not satisfactory

(80% correct of applicable criteria, required for satisfactory result) S NS S NS S NS

Signature of assessor:

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Main areas identified for improvement (overall) Action plan and timeframe

General



121

Management/consultations

Follow-up plan

Signature of clinical lead / consultant: Signature of physiotherapist:

Date:

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TOOL 2: ADVANCED MUSCULOSKELETAL PHYSIOTHERAPY CLINICAL AUDIT ASSESSMENT TOOL

Assessor (role): Physiotherapist: Date:

UR number: Presenting condition:

Main areas identified for improvement Evidence-based practice / best practice Action plan (as agreed with physiotherapist)



Diagnosis/impression (clinical reasoning)

Management/consultations

Follow-up plan

Signature of assessor: Signature of physiotherapist: Date:

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Advanced musculoskeletal physiotherapist – performance appraisal

Physiotherapist’s name: Date:Performance criteria: 1.2, 2.1, 3.3–4, 4.1–2, 6.1–7, 7.6, 8.4, 9.5–7, 10.3, 11.5–7, 19.7, 20.9

Please circle:

Designs and performs an individualised, culturally appropriate and effective patient interview Yes No 6.1

Acts to ensure all ‘red flags’ and ‘yellow flags’ are identified in the assessment process and takes appropriate action in a timely manner Yes No 6.6

6.7

Performs complex modifications to routine musculoskeletal assessment in recognition of factors that may impact on the process such as the patient profile/needs

Yes No 6.3

Designs and conducts an individualised, culturally appropriate and effective clinical assessment that:

is systems-based includes relevant clinical tests selects and measures relevant health indicators substantiates the provisional diagnosis

Yes No 6.4

Formulates a preliminary hypothesis and differential diagnoses for a patient with common and/or complex conditions Yes No 6.2

Identifies when input is required from expert colleagues and acts to obtain their involvement Yes No

6.5 7.6 9.5

Uses concise, systematic communication at the appropriate level when conversing with colleagues Yes No 4.1

Presents all relevant information to expert colleagues, when acting to obtain their involvement Yes No 4.2

8.4

Identifies when input to complement care is required from other health professionals and act to obtain their involvement Yes No 11.5

Uses finite healthcare resources wisely to achieve best outcomes Yes No 10.3

Provides appropriate education and advice to patients with common and/or complex conditions Yes No 11.6

Conducts a thorough handover, to ensure patient care is maintained Yes No 11.7

Works towards the full extent of their role Yes No 1.2

Takes responsibility for own actions and functions accordance with legislation, health standards and organisational policies and procedures Yes No

2.1,

19.7,

20.9

Comments:

Consultant’s name: Consultant’s signature:

Oral appraisal (OA) assessment tool (pain clinic)


Assessment linkage to competency standard: 1.1, 5.4, 9.3, 9.4, 13.4, 16.3, 16.4, 18.2, 19.4, 19.7, 20.9, 21.4, 22.4

Assessor’s name and designation:

ELEMENTS AND PERFORMANCE CRITERIA

Did the candidate satisfactorily answer the following questions?

Satisfactory = S Not satisfactory = NS


Performance rating scale

Comments

S NS

PROFESSIONAL BEHAVIOURS

1. Operate within scope of practiceCan you describe the scope of practice relevant for the role and provide an example of what you might encounter that would be outside the scope of practice?

What is the definition of advanced scope of practice and how does it differ from extended scope of practice?

1.1

PROVISION AND COORDINATION OF CARE

5. Evaluate referrals Can you describe the patients who are appropriate for this advanced musculoskeletal physiotherapy role in the context of the individual physiotherapist?

5.4

Can you prioritise from the attached list of referrals who should be seen in the pain clinic? (this will be different for each advanced musculoskeletal physiotherapy service)

5.4

9. Apply the use of therapeutic medicines in advanced musculoskeletal physiotherapyWhat legislation and registration requirements relating to medicines apply to physiotherapists working in advanced physiotherapy roles?

What responsibilities apply to physiotherapists in relation to the recommending the use of medicines to

9.3 9.4

patients?

13. Obtain patient consentWhat is the process if a patient refuses to be seen by a physiotherapist and requests to be seen by a doctor?

13.4

Specific to practice context

Describe situations when input from expert colleagues has been required in different patient conditions.

Discuss what evidence-based practice is in managing pain.

What are the legislative issues, health standards and policies relating to providing healthcare services in the pain clinic for the physiotherapist to be aware of and abiding by?

16.317.3 19.4 21.4 22.4

16.4 17.4

19.720.9

OVERALL COMPETENCE RESULT Satisfactory / unsatisfactory

Date: Signature of assessor(s):

Date: Signature of candidate:


ORGANISATIONAL RECORDING PROCESSES COMPLETED Yes No

Author: Last review date:

Version: Next review date:

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PRE-ASSESSMENT CHECKLIST FOR WORKPLACE ASSESSORS: SELF-ASSESSMENT TOOL

Tacit knowledge of assessment area

Recent and broad experience in the area being assessed

Expertise in performance assessment processes

Working knowledge of the competency standard content

Working knowledge of the assessment plan and tool

Working knowledge of the responsibilities as an assessor including:

Ensures assessment takes part in the practice setting Ensures the candidate has appropriate preparation for and information about

the assessment process Conducts assessments fairly Provides effective performance feedback Records results, maintaining confidentiality in accordance with organisational

requirements

Has relevant clinical competencies at least to the level being delivered or assessed by virtue of a qualification, training or experience

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CONDITIONS AND CONTEXT FOR ASSESSMENT: INSTRUCTIONS

Self-assessment using the Learning needs analysis tools is recommended for the candidate prior to engaging in a work-based learning and assessment program (self-assessment will not be used as a stand-alone method to make a decision of competence).

Assessment tasks will be planned throughout the timeframe negotiated between the candidate and the assessor. A combination of assessment occasions and methods will be used and are mapped on the learning and assessment plan. The Cumulative assessment tool collates all of the evidence gathered through the assessment and, based on this evidence, the assessor makes and records an overall assessment about the learner’s competence.

The assessment(s) will be conducted at a time that is mutually agreeable to both the assessor and the candidate (making allowances for the impact access to appropriate patients may have on this).

When the assessment task requires direct workplace observation, this will be conducted in reality, with patient(s) appropriate for advanced musculoskeletal physiotherapy and within the practice context setting. (The use of simulated contexts is discouraged and will only be implemented when there is no other available, appropriate and timely method of assessment.)

Access to relevant guidelines, standards and procedures will be given during the assessment task.

To achieve competency, the candidate will provide sufficient evidence through planned assessment activities, as determined by the assessor.

All competency elements and performance criteria must be satisfactorily met for the candidate to be deemed competent.

The assessment must be conducted by a workplace assessor who meets the recommended minimum criteria for assessors.

It is implicit that the candidate demonstrates appropriate knowledge during the whole assessment task.

If the candidate does not meet the expected standard of performance:

A plan will be made to address the performance gap. This may include opportunity for additional teaching and supervised clinical practice. This will be made available prior to subsequent assessments.

An additional assessment will be rescheduled at a time negotiated between the assessor and candidate.

The candidate is permitted to engage another assessor if available/appropriate.

ASSESSMENT PREPARATION CHECKLIST:

Have you prepared all necessary equipment or assessment tools, prior to the assessment?

Have you introduced yourself?

Have you verified the candidate is ready for assessment?

Have you informed the candidate about confidentiality issues regarding the assessment?

Have you provided an explanation of the parameters of the assessment (including method and context)?

Have you explained that in the event of unsafe practices the assessment will be terminated?

Have you invited the candidate to ask questions before the assessment begins?

Have you described the assessment scenario in a clear and non-ambiguous manner?

GUIDELINES FOR ASSESSORS DURING A DIRECT WORKPLACE OBSERVATION ASSESSMENT

Use ‘non-prompting’ and ‘non-involvement’ behaviour.

Provide succinct clarification on request, without suggestive prompting.

Use follow-up questioning at the conclusion of the direct observation to clarify or address outstanding performance criteria (a list of potential clarifying questions has been included with the direct work observation tool).

Inform the candidate of the outcome of the assessment in a timely manner.

Provide effective feedback at the completion of the assessment: Be concise. Focus on behaviour, not personality, and engage the candidate in a discussion about

performance. Discuss areas performed well. Discuss areas requiring improvement. Document the outcome of the assessment on the tool.

Communicate effectively with a candidate, who is ‘not yet competent’ about the performance rating given.

Communicate objective reasons for non-competence / the rating. Negotiate an action plan with the candidate to develop skills for successful completion /

performance improvement. Agree on a timeframe for an ongoing Learning and assessment plan. If applicable/available, offer an alternate assessor.

Curriculum overviewOrientation program

One of the requirements in the Learning and assessment plan is to complete an orientation program for the role. All new staff to the organisation should undergo the routine staff orientation process in

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addition to the specific orientation program developed for the role of advanced musculoskeletal physiotherapist (refer to orientation manual developed at local site and included in the operational guidelines). An orientation program will be specific to the advanced musculoskeletal physiotherapy service. For example, in the pain clinics a minimum of one session of observing/shadowing with either an experienced physiotherapist already working in the role prior to seeing patients is recommended. For a physiotherapist new to the advanced practice role a reduced clinical load with direct access to the clinical lead physiotherapist during the clinic may be recommended for the first two clinical sessions. Prior to observing a session, the physiotherapist should achieve the following objectives:

Complete the organisation’s staff orientation process. Complete an orientation specific to the pain clinic and advanced practice role. Complete an orientation to the physiotherapy department. Complete an orientation and introduction to the pain clinic team as appropriate including

consultants and registrars where practicable. Complete the workplace observation (skills checklist) with relevant personnel. Get familiar with the hospital and clinic IT system(s) and acquire necessary IT access. Completed the online radiation safety module:

http://www.imagingpathways.health.wa.gov.au/index.php/radiation-training-module. Complete Learning needs analysis Part A and B and meet with a mentor to discuss the

Learning and assessment plan. Complete module 10 on communication (ISBAR).

Curriculum development

An example of how the curriculum might look is provided below. Not all the self-directed learning modules may be applicable, depending on the model of care being implemented. Wounds, for example, may not be required and some self-directed learning modules may be considered for more advanced learning and experience, and therefore used at a later stage such as differential diagnosis, pharmacology and diabetes. The focus of the learning program should be directed at assisting the physiotherapist to acquire the necessary underpinning skills and knowledge to perform as per the performance criteria described in the competency standard.

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http://www.imagingpathways.health.wa.gov.au/index.php/radiation-training-module

Example of a curriculum timeline (full-time physiotherapist who has met the selection criteria working as an advanced musculoskeletal physiotherapist in the pain clinics)

ORIENTATION Block 1 Block 2 Block 3 Block 4

Orientation program

Workplace observation (skills checklist) with consultant

LEARNING MODULES(not all modules may be required**)Radiology

Radiation safety Complete quiz (80%

pass rate)

Communication

Complete Learning needs analysis Part A and B and discuss in collaboration with clinical lead to develop individualised Learning and assessment plan

SELF-DIRECTED LEARNING MODULES

Pain conditions Cervical spine Thoracic Lumbar spine

Radiology Indications for

imaging Requesting imaging

IN-SERVICE: Orthopaedic surgeon what makes a good surgical candidate?


Pain conditions Upper limb Lower limb

Radiology Interpreting plain-

film imaging

IN-SERVICE: Hand surgeon: What makes a good surgical candidate for secondary wrist surgery


Pain conditions Visceral, head and

face

Pharmacology

IN-SERVICE:Pharmacy or anaesthetics – analgesia


Pain conditions Fibromyalgia Rheumatological

Differential diagnosis of non-musculoskeletal conditions

IN-SERVICE: Rheumatology: inflammatory conditions

MEET WITH MENTORDiscuss Learning needs analysis Part A and B

OBSERVE/SHADOW CLINIC ONE (1) CLINIC

REDUCED CLINICAL LOAD WITH ACCESS TO CLINICAL LEAD TWO (2) CLINICS

MEET WITH MENTORFormative assessment

CASE-BASED PRESENTATION 1

Block 5 Block 6 Block 7 Block 8 Block 9WORK-BASED COMPETENCY ASSESSMENT


Pathology

IN-SERVICEPathologyRoutine bloods


Psychology:Understanding common psychological conditions

IN-SERVICEPsychologist: How anxiety and depression affect the experience of pain


Psychology: motivational interviewing

IN-SERVICEPsychologist: An introduction to motivational interviewing


Diabetes APA modules 1, 2

IN-SERVICE: Diabetes educator

REVISION

Diabetes APA modules 3, 4

IN-SERVICE:Physical educator / EP: enhancing physical activity levels in people with chronic illness

Present clinical log and professional practice portfolio

Oral appraisal Direct workplace

observation x 1–2 Written test/quiz Performance

appraisal Further case-based

presentations as required

Skills assessment (consultant)






MEET WITH MENTOR

Prepare for work-based competency assessment

Repeat Competency standard self-assessment tool

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GlossaryRefer to the manual of the Advanced musculoskeletal physiotherapy clinical education framework.

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Charlton 2005, Core curriculum for professional education in pain. Seattle, WA: IASP press.

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Suckley, J 2012, ‘Core clinical competencies for extended-scope physiotherapists working in musculoskeletal interface clinics based in primary care: a delphi consensus study’, Professional Doctorate thesis, University of Salford.

Symes, G 2009, Resource manual and competencies for extended musculoskeletal roles: chartered physiotherapists with an extended scope of practice, Scotland, UK

http://www.ascd.org/ASCD/pdf/journals/ed_lead/el_197511_knowles.pdf

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.

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Appendix

Learning and assessment plan template

TITLE OF COMPETENCY STANDARD(S) TO BE ACHIEVED

Deliver Advanced Musculoskeletal Physiotherapy in the insert area of practice

ASSESSMENT TIMEFRAME To be negotiated with clinical lead physiotherapist, assessor &/or line manager

WORKPLACE LEARNING DELIVERY OVERVIEW

A combination of the following will be implemented

Self-directed learning In-house in-services Coaching or Mentoring Workplace application Formal external learning

1. LEARNING ACTIVITIES / RESOURCESTASK DESCRIPTION Completed

X1. Complete Learning Needs

Analysis for the work roleComplete Learning Needs Analysis Part A and B, and discuss learning needs, evidence of prior learning, and assessment/ verification processes with clinical lead physiotherapist/supervisor/ mentor

2. Complete site specific orientation to ED

Complete orientation covering all details outlined in the site specific orientation guideline

3. Complete self-directed learning modules as required from the Learning Needs Analysis.

Select self-directed learning modules to complete (delete or add additional learning modules relevant to area of practice):

1. Musculoskeletal conditions/presentations

2. Radiology

3. Modules specific to area of practice

4. Wounds

5. Pharmacology

6. Pathology

7. Differential Diagnosis

8. Paediatrics

9. Diabetes (APA diabetes e module)

10. Communication(ISBAR)/Consent/Documentation

4. Complete formal training e.g. Radiology, Pharmacology and Diabetes

(add or delete)

University of Melbourne Radiology single subject

Subject Code: RADI90001 Radiology for Physiotherapists

University of Melbourne Pharmacology single subject (TBC)

APA e modules Diabetes for Physiotherapists


Other

5. Complete further individual learning as required from the Learning Needs Analysis

Complete further individualised learning as discussed with and directed by clinical supervisor/ line manager. This may include material beyond what is covered in the learning modules above.

List below:

6. Undertake supervised clinical practice & feedback sessions

Physiotherapists new to the work role who are undertaking the full learning & assessment pathway our encouraged to engage in a structured/timetabled work program as advised and negotiated with their clinical supervisor/assessor.

Physiotherapists new to the role should complete an orientation program which includes shadowing and observation

Until an individual is deemed competent to practice independently within the setting

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it is recommended they have access to senior medical /physiotherapy staff for clinical supervision.

A graduated process from direct to indirect clinical supervision should be maintained during this period until performance is at an independent standard and physiotherapists will be supported by specific targeted feedback during this time, to address learning needs

A formative assessment should be conducted early into commencing the role and throughout the supervision period to help the physiotherapist prepare for work place observation assessment(s) and oral appraisal. The formative assessment may be conducted by the clinical lead physiotherapist however the work place observation could be conducted by an ED consultant familiar with the Competency Standard.

7. Review the following documents and become familiar with the content in relation to advanced musculoskeletal physiotherapy

Australian Physiotherapy Standards


• APA scope of practice http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Scope_of_Practice_2009.pdf

• AHPRA Code of conduct/registration requirements http://www.physiotherapyboard.gov.au/Codes-Guidelines.aspx

• Processes for issuing of sick leave certificates/WC

• Local organisational guidelines /clinical governance structure

State Drugs and Poisons act : http://www.health.vic.gov.au/dpcs/reqhealth.htm

Poisons Standard 2010: http://www.comlaw.gov.au/Details/F2010L02386

• Paediatric legislation/standards

8. Other activities to be advised 1. It is recommended the trainee conduct a self-assessment of their clinical record-keeping at intervals during the training program, in preparation for the record keeping audit and using the record-keeping audit assessment tool.

Insert other learning activities.

140

http://www.comlaw.gov.au/Details/F2010L02386

http://www.physiotherapyboard.gov.au/Codes-Guidelines.aspx




2. ASSESSMENT DETAILS & LINKAGEASSESSMENT TASK Due date Performance

Criteria**Add Performance Criteria from Competency Standard to assessment task

1. Complete written responses (WR)Provide details of assessment task

7.1, 7.5

2. Participate in direct workplace observation (WO)For an agreed period of time the physiotherapist will work under supervision, and the physiotherapist when deemed ready by self and supervisor, will undergo formal observation in the workplace.

The physiotherapist’s level of performance will be rated against the standard by the designated assessor, using assessment tool(s) during a formal assessment process.

Occasions of direct workplace observation will be negotiated by the assessor with the physiotherapist.

It is recommended that these observations of clinical practice are to include patient presentations with signs and symptoms most common in presentation to area of practice

Who the assessor is will vary depending upon the local organisation’s requirements. The assessor could be a consultant or an experience physiotherapists who is familiar with the assessment process and competency standard requirements.

Provide details of assessment task

6.1-6.7, 7.1-2, 7.5, 9.1, 10.1-2, 11.1-4, 13.1-3, 17.1-6, 17.9-10

Add performance criteria where required

3. Maintain a professional practice portfolio (PF)The professional practice portfolio required is consistent with the requirements of the APA’s requirements

3.3

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and should include relevant information regarding attendance and participation in formal and informal education and learning opportunities specific to advanced musculoskeletal physiotherapy area of practice.

This may include: self-reflective journal/diaries in-services, lectures, journal clubs, continuing education programs attended or given quality projects research activities and publications conference attendance mentoring/supervision sessions an electronic clinical log of types of conditions seen

Please refer to: APA continuing development guidelines

www.physiotherapy.asn.au/APAWCM/Learning_and_Development/CPD_Overview/APAWCM/LearningDevelopment/CPD_Overview.aspx

APHRA guidelines for continuing education www. physiotherapy board.gov.au/documents/default.aspx

4. Provide documentary evidence (DE)For Example:Participation in a record keeping audit – It is recommended that physiotherapists are required to provide documentary evidence of pre-determined number of health record entries, which will be audited using an audit assessment tool, by an assessor such as the clinical lead Physiotherapist or a peer. Performance will be rated as satisfactory if at least 80% of the applicable criteria are included in the samples. Feedback will be provided to the physiotherapist and recommendations for improvement documented with a plan to ensure recommendations are implemented. Record keeping practice should be in line with the local organisation’s policies and the APA Position Statement on health records.

7.4, 9.8, 14.1

5. Give case based presentations (CBP)It is recommended that physiotherapists present a predetermined number of cases (insert number) to colleagues at a frequency designated by the assessor/clinical lead/supervisor

It will be supported by verbal questioning by the assessor, centring on advanced clinical decision

6.1-7, 8.1, 8.5, 9.1, 10.1-2, 11.1-4, 16.1-5, 17.1-3, 17.5-6

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http://www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Health_Records_2010.pdf

http://www.physiotherapyboard.gov.au/documents/default.aspx



making. The level of performance will be rated against the standard by the designated assessor, using the

appropriate case based presentation assessment tool(s). The presentations should address the required performance criteria as identified in this learning and assessment plan. Additional performance criteria may be added and addressed in case based presentations.

Add performance criteria where required

6. Participate in performance appraisal (PA)It is recommended that a performance appraisal should be conducted at the completion of an agreed timeframe by an allocated consultant or experienced physiotherapist who has worked regularly with the physiotherapists being assessed. This appraisal is based on an informal observation of clinical practice over a period of time.

Insert performance criteria

7. Undertake external qualification/training (Q/T) It is recommended the physiotherapist undertakes further external training. Examples of this may include:

University of Melbourne single subject in Radiology APA Diabetes learning modules 1-4

To be guided by local organisation policies and guidelines.


8. Participate in oral appraisal (OA)An oral appraisal can be conducted to assess aspects of workplace performance, as required and at the discretion of the assessor (Consultant or Clinical Lead physiotherapist) in relation to the relevant performance criteria. Refer to the OA assessment tool.

It is recommended that this oral appraisal is conducted when the physiotherapist is ready to submit all forms of evidence for a final assessment of competency to the designated assessor who maybe the Clinical Lead physiotherapist or nominated Consultant.


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