Reducing Wait-Times for Orthopaedic Consultations for Patients with Knee Osteoarthritis Through Advanced Practice Physiotherapy.

Jennie SCARVELL; Danealle Gilfillan; Tahlia Stewart; Carol McCrum; Angela Fearon; Joseph Lynch; Thomas Ward; Theo NIYONSENGA

doi:10.1177/11786329261461056

Reducing Wait-Times for Orthopaedic Consultations for Patients with Knee Osteoarthritis Through Advanced Practice Physiotherapy.

Jennie SCARVELL
, Danealle Gilfillan
, Tahlia Stewart
, Carol McCrum
, Angela Fearon
, Joseph Lynch
, Thomas Ward
, Theo NIYONSENGA

Research output: Contribution to journal › Article › peer-review

Abstract

Long wait-times for orthopaedic consultation in public hospitals, particularly for knee osteoarthritis patients, may be ameliorated when Advanced Practice Physiotherapists (APPs) are integrated into clinical pathways. APPs provide expert comprehensive assessment, accurately identifying patients not requiring surgery. This study aimed to quantify wait-time between general practitioner (GP) referral and consultation with an APP or surgeon outcomes following service changes including increased resourcing of the APP clinics.
Method
This knowledge translation project was evaluated by comparing wait-time to consultation for three, 6-month cohorts from 1 March to 30 September, totalling 563 patients, at baseline in 2022, and post-intervention at year 1 (2023) and year 2 (2024). Evidence-based service changes included expanding APP clinic capacity and improving referral pathways to community osteoarthritis and obesity programs. The proportion of patients seen by APPs rose from 20% at baseline (2022) to 81% in 2023 and 76% in 2024. Concurrently, the health service implemented a digital medical records system. Data were analysed for patient characteristics, wait-times, care pathways (APP, surgeon, or both), and consultation outcomes.
Results
Compared to 2022, wait-times to consultation significantly reduced. Median wait-time fell from 114 days in 2022 to 45 days (86% less) in 2023 and 46 days (90% less) in 2024. Patients seen by APPs experienced fewer delays (Incidence risk ratio (IRR): 0.55; 95% CI: 0.43–0.72), including those seen in both APP and surgeon clinics (IRR: 0.54; 95% CI: 0.41–0.70). Total patients listed for surgery declined from 48% in 2022, to 36% in 2023, and 35% in 2024, while patients directed to a surgeon were twice as likely to need knee replacement in 2023, 2024.
Conclusions
Shorter wait-times appear linked to increased APP clinic activity, improved digital systems, and enhanced access to community programs. These changes supported clinical standards and timely care for patients with knee osteoarthritis.

Original language	English
Pages (from-to)	1-17
Number of pages	17
Journal	Health Services Insights
Volume	19
DOIs	https://doi.org/10.1177/11786329261461056
Publication status	Published - 15 Jun 2026

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SDG 3 Good Health and Well-being

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Cite this

@article{e3c1d549e923414a807a7d67dfd33393,

title = "Reducing Wait-Times for Orthopaedic Consultations for Patients with Knee Osteoarthritis Through Advanced Practice Physiotherapy.",

abstract = "Long wait-times for orthopaedic consultation in public hospitals, particularly for knee osteoarthritis patients, may be ameliorated when Advanced Practice Physiotherapists (APPs) are integrated into clinical pathways. APPs provide expert comprehensive assessment, accurately identifying patients not requiring surgery. This study aimed to quantify wait-time between general practitioner (GP) referral and consultation with an APP or surgeon outcomes following service changes including increased resourcing of the APP clinics. Method This knowledge translation project was evaluated by comparing wait-time to consultation for three, 6-month cohorts from 1 March to 30 September, totalling 563 patients, at baseline in 2022, and post-intervention at year 1 (2023) and year 2 (2024). Evidence-based service changes included expanding APP clinic capacity and improving referral pathways to community osteoarthritis and obesity programs. The proportion of patients seen by APPs rose from 20\% at baseline (2022) to 81\% in 2023 and 76\% in 2024. Concurrently, the health service implemented a digital medical records system. Data were analysed for patient characteristics, wait-times, care pathways (APP, surgeon, or both), and consultation outcomes. Results Compared to 2022, wait-times to consultation significantly reduced. Median wait-time fell from 114 days in 2022 to 45 days (86\% less) in 2023 and 46 days (90\% less) in 2024. Patients seen by APPs experienced fewer delays (Incidence risk ratio (IRR): 0.55; 95\% CI: 0.43–0.72), including those seen in both APP and surgeon clinics (IRR: 0.54; 95\% CI: 0.41–0.70). Total patients listed for surgery declined from 48\% in 2022, to 36\% in 2023, and 35\% in 2024, while patients directed to a surgeon were twice as likely to need knee replacement in 2023, 2024. Conclusions Shorter wait-times appear linked to increased APP clinic activity, improved digital systems, and enhanced access to community programs. These changes supported clinical standards and timely care for patients with knee osteoarthritis.",

keywords = "General, JEL code: I10 Health",

author = "Jennie SCARVELL and Danealle Gilfillan and Tahlia Stewart and Carol McCrum and Angela Fearon and Joseph Lynch and Thomas Ward and Theo NIYONSENGA",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).",

year = "2026",

month = jun,

day = "15",

doi = "10.1177/11786329261461056",

language = "English",

volume = "19",

pages = "1--17",

journal = "Health Services Insights",

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T1 - Reducing Wait-Times for Orthopaedic Consultations for Patients with Knee Osteoarthritis Through Advanced Practice Physiotherapy.

AU - SCARVELL, Jennie

AU - Gilfillan, Danealle

AU - Stewart, Tahlia

AU - McCrum, Carol

AU - Fearon, Angela

AU - Lynch, Joseph

AU - Ward, Thomas

AU - NIYONSENGA, Theo

N1 - Publisher Copyright: © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

PY - 2026/6/15

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N2 - Long wait-times for orthopaedic consultation in public hospitals, particularly for knee osteoarthritis patients, may be ameliorated when Advanced Practice Physiotherapists (APPs) are integrated into clinical pathways. APPs provide expert comprehensive assessment, accurately identifying patients not requiring surgery. This study aimed to quantify wait-time between general practitioner (GP) referral and consultation with an APP or surgeon outcomes following service changes including increased resourcing of the APP clinics. Method This knowledge translation project was evaluated by comparing wait-time to consultation for three, 6-month cohorts from 1 March to 30 September, totalling 563 patients, at baseline in 2022, and post-intervention at year 1 (2023) and year 2 (2024). Evidence-based service changes included expanding APP clinic capacity and improving referral pathways to community osteoarthritis and obesity programs. The proportion of patients seen by APPs rose from 20% at baseline (2022) to 81% in 2023 and 76% in 2024. Concurrently, the health service implemented a digital medical records system. Data were analysed for patient characteristics, wait-times, care pathways (APP, surgeon, or both), and consultation outcomes. Results Compared to 2022, wait-times to consultation significantly reduced. Median wait-time fell from 114 days in 2022 to 45 days (86% less) in 2023 and 46 days (90% less) in 2024. Patients seen by APPs experienced fewer delays (Incidence risk ratio (IRR): 0.55; 95% CI: 0.43–0.72), including those seen in both APP and surgeon clinics (IRR: 0.54; 95% CI: 0.41–0.70). Total patients listed for surgery declined from 48% in 2022, to 36% in 2023, and 35% in 2024, while patients directed to a surgeon were twice as likely to need knee replacement in 2023, 2024. Conclusions Shorter wait-times appear linked to increased APP clinic activity, improved digital systems, and enhanced access to community programs. These changes supported clinical standards and timely care for patients with knee osteoarthritis.

AB - Long wait-times for orthopaedic consultation in public hospitals, particularly for knee osteoarthritis patients, may be ameliorated when Advanced Practice Physiotherapists (APPs) are integrated into clinical pathways. APPs provide expert comprehensive assessment, accurately identifying patients not requiring surgery. This study aimed to quantify wait-time between general practitioner (GP) referral and consultation with an APP or surgeon outcomes following service changes including increased resourcing of the APP clinics. Method This knowledge translation project was evaluated by comparing wait-time to consultation for three, 6-month cohorts from 1 March to 30 September, totalling 563 patients, at baseline in 2022, and post-intervention at year 1 (2023) and year 2 (2024). Evidence-based service changes included expanding APP clinic capacity and improving referral pathways to community osteoarthritis and obesity programs. The proportion of patients seen by APPs rose from 20% at baseline (2022) to 81% in 2023 and 76% in 2024. Concurrently, the health service implemented a digital medical records system. Data were analysed for patient characteristics, wait-times, care pathways (APP, surgeon, or both), and consultation outcomes. Results Compared to 2022, wait-times to consultation significantly reduced. Median wait-time fell from 114 days in 2022 to 45 days (86% less) in 2023 and 46 days (90% less) in 2024. Patients seen by APPs experienced fewer delays (Incidence risk ratio (IRR): 0.55; 95% CI: 0.43–0.72), including those seen in both APP and surgeon clinics (IRR: 0.54; 95% CI: 0.41–0.70). Total patients listed for surgery declined from 48% in 2022, to 36% in 2023, and 35% in 2024, while patients directed to a surgeon were twice as likely to need knee replacement in 2023, 2024. Conclusions Shorter wait-times appear linked to increased APP clinic activity, improved digital systems, and enhanced access to community programs. These changes supported clinical standards and timely care for patients with knee osteoarthritis.

KW - General

KW - JEL code: I10 Health

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Reducing Wait-Times for Orthopaedic Consultations for Patients with Knee Osteoarthritis Through Advanced Practice Physiotherapy.

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