Affiliations: Orthopaedic Department, Bolton One, Bolton Hospitals NHS Trust, Bolton, UK | Physiotherapy, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
Abstract: STUDY DESIGN: Retrospective diagnostic test study (N = 120). BACKGROUND: Due to reorganisation of healthcare provision to meet rising demands, traditional medical roles such as the diagnosis of meniscal tears is now being undertaken by Extended Scope Practitioners (ESP) with a background in physiotherapy. There are limited studies supporting the diagnostic expertise of these clinicians. OBJECTIVE: To compare diagnostic accuracy of Orthopaedic Extended Scope Practitioners (ESP, N = 7) with Consultant Orthopaedic Surgeons (COS, N = 3) in the diagnosis of meniscal tears of the knee. METHODS: The records of 120 patients seen by seven ESP and three COS between July 2006 and July 2007 were accessed. The initial diagnosis given was compared with the findings at MRI scan. Sensitivity (Sn), specificity (Sp), accuracy (Acc), positive predictive value (PPV) and negative predictive value (NPV) were calculated for each profession. A Pearson's chi squared test (χ2) was undertaken to determine if there was a statistically significant difference between ESP and COS in the proportions of patients with the clinical diagnosis of a meniscal tear that was subsequently confirmed at MRI scan. RESULTS: ESP had higher Sensitivity, Accuracy and Positive Predictive Value (82.5%, 77.7%, and 82.9%) than COS (70%, 71.6%, and 77.4%) but lower Specificity and Negative Predictive Value (65%, 65%) than COS (75%, 66.5%). Pearson's χ2 analysis showed that there was no significant difference between these groups in the proportions of patients correctly diagnosed as having a meniscal tear (p = 0.19, χ2 = 1.726). CONCLUSION: In the diagnosis of meniscal tears in a single Orthopaedic clinic, ESP appeared to possess diagnostic capability comparable with COS.
