Expanding the scope of Advanced Practice Physiotherapist (APP) in diagnostic imaging: Results of an implementation study and ramifications for widespread adoption

Mr Adam De Gruchy1

1Melbourne Health, Melbourne, Australia, 2University of Melbourne, Melbourne, Australia, 3La Trobe University, Melbourne, Australia



To report outcomes of a study into implementation of independent ordering of diagnostic imaging by APP, the legal and funding arrangements that enabled implementation and how this may limit a state wide adoption.



A study was carried out on APP independent ordering of diagnostic imaging within defined pathways.

Retrospective data was collected to identify time spent in discussion and agreement between medical staff and APP, and number and type of imaging requests.

Working groups representing Orthopaedics, Neurosurgery, Allied Health, Imaging and Legal departments constructed pathways defining scope of practice for APP independent ordering of diagnostic imaging.

Prospective data was collected in order to identify number and type of APP imaging requests, whether pathways had been adhered to and outcome of imaging investigations, including adverse events.



Independent ordering of imaging by the APP was implemented in 3 clinics: Orthopaedic Spinal , Orthopaedic Shoulder and Neurosurgical Spinal. Clinics had specific pathways developed defining scope of practice and Medicare billing under a nominated Consultant.

There was high agreement (95%) between the APP and medical staff in regards to imaging requests. Projected time savings of continuing independent ordering in 3 clinics is 2464 minutes per annum, representing 82 patient appointments, equivalent to running 13 extra APP clinic sessions per annum.

There was no breach of scope during the implementation period and no adverse events.

Significance of the findings to allied health:

Independent ordering of Imaging by an APP may result in cost and time savings in outpatient clinics but there are major legal and funding issues that remain poorly defined and must be resolved to enable widespread adoption of such a model both within public and private health sectors.