Evaluation of a novel physiotherapist-led assessment clinic within the Princess Alexandra Hospital (PAH) Maxillofacial Department

MR Rod Mclean¹, Mr Damien Nolan², Ms Louise  Matthews², Dr George Chu³, Dr Alistair Reid³

¹Metro South Health, Woolloongabba, Australia, ²Princess Alexandra Hospital Physiotherapy Department, , Australia, ³Princess Alexandra Hospital Oral Maxillofacial Surgery, , Australia

Introduction

Temporomandibular dysfunction (TMD) is a common problem (3.5% to 12% of population) and most cases can be managed without specialist medical input.  Historically, lengthy outpatient (OPD) wait times existed (mean of 387 days) for category 2 and 3 TMD presentations referred to the PAH Maxillofacial department. Alternative models of care involving physiotherapist-led clinics in orthopaedic services have been proven effective in the timely assessment and management of patients. A similar model was explored.

AIMS

1. Decrease wait-times for Category 2 and 3 patients with TMD
2. Reduce burden on Maxillofacial surgeon OPD Clinics
3. Improve patient outcomes
4. Patient satisfaction

Methods

In April 2017, a physiotherapist-led Jaw Assessment Clinic (JAC) was established by the PAH Maxillofacial and Physiotherapy Departments. Maxillofacial consultants triaged appropriate Category 2 and 3 patients to undergo assessment by an advanced musculoskeletal physiotherapist. Subsequent allied health intervention was facilitated within the clinic. Patients included in this project were assessed at the JAC from April 2017 – Sept 2018. Outcomes included appointment wait-times, number of patients requiring consultant input, patient-reported measures, and patient satisfaction.

Results

1. Mean wait-time for an OPD appointment reduced from 387 days to 62 days post implementation.
2. 75% of patients were managed conservatively through the JAC without consultant input.
3. Patient reported outcome measures (ongoing) at baseline and discharge included: Jaw functional scale, Neck disability index, DASS 21, PSEQ, NRS pain, HAQ and GROC.
4. Patient satisfaction surveys revealed high satisfaction levels with the service.

Conclusion

Advanced musculoskeletal physiotherapists can effectively manage TMD patients referred to a Maxillofacial department in a timely manner with high consumer satisfaction. This service model demonstrates an innovative approach to reducing waiting lists and improving patient outcomes within a Maxillofacial service and is a first, to our knowledge, in Australia. Future directions include demonstrating cost-effectiveness of this model and implementing similar physiotherapy-led clinics within Maxillofacial departments at other hospital sites.

Biography:

Rod McLean is an Advanced Musculoskeletal Physiotherapist at Metro South Health