Physiotherapy extended scope of practice – who is doing what and why?

ObjectivesTo explore the range, drivers and perspectives of extended or enhanced practitioner roles within physiotherapy.Data sourcesNineteen electronic databases, hand searches, bibliography scanning and personal contact were used to identify published and unpublished resources.Review methodsA systematic review using an expanded approach. Resources were included if they discussed extended scope of practice (intervention) in physiotherapy (profession) and outcome (for patients, other health professionals, and health services delivery) irrespective of patient group, language, year of publication (up to 2005), study design, or health care systems evaluated. All resources were screened against formal inclusion criteria for relevance. Information from relevant resources was extracted and details were entered into an Access database.ResultsOne hundred and fifty-two physiotherapy-related resources were identified, including seven which met appropriate quality standards (using Cochrane methodology). A meta-analysis was not performed due to the paucity of randomised controlled trials.ConclusionsDrivers for the roles in the 152 resources mainly included local or national service demands (34%). Most extended scope of practice roles reported included a form of non-invasive assessment (47%) or non-invasive treatment (37%) of patients that was more traditionally carried out by medical colleagues. None of the resources including data was (a) unsupportive of extended scope of practice or (b) mainly expressing concerns. This review has demonstrated overwhelming support for extended scope of practice; the vast majority of resources were supportive despite being largely descriptive or discursive in nature (76%). There is an urgent need for robust research in order to evaluate the expansion of extended scope of practice roles, underpin further development of those roles, and strengthen the evidence base of extended scope of practice in physiotherapy.