“Communicate, communicate, communicate”: Advanced Musculoskeletal Physiotherapy services, enabling factors for multi-site implementation

Ms Bridget Shaw1, Ms Sophie Heywood1, Ms Carolyn Page1, Mr Uyen Phan2, Dr Paula Harding3, Ms Kerrie Walter3, Ms Desiree Terrill4, Dr Catherine  Granger2,5

1Department of Physiotherapy, St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia, 3Department of Physiotherapy, The Alfred, Prahran, Australia, 4Health and Wellbeing Workforce Reform, Department of Health and Human Services, Melbourne, Australia, 5Department of Physiotherapy, The University of Melbourne, Parkville, Australia


To identify the enablers to implementation of 12 Advanced Musculoskeletal Physiotherapy (AMP) services from the perspective of clinical staff.

12 participants (physiotherapists) from 12 different healthcare networks in Victoria (seven metropolitan, three regional, two rural) consented to be involved in this qualitative study using a structured survey. The networks implemented AMP services (orthopaedics postoperative joint replacement review n=10, general orthopaedics n=1, emergency n=1 and neurosurgery n=1) over a 12 month period. Thematic analysis was used and mapped to the validated Theoretical Domains Framework.

Motivation domain enablers included offering a solution to access blocks in specialist clinics; improving patient outcomes; reducing costs and improving efficiency; maximising early and open dialogue with all stakeholders, especially engagement of medical staff; ensuring stakeholders’ knowledge of the AMP clinicians and services; an efficient model of care with clear scope of practice to minimise risk as well as multiple staff willing to further knowledge and skills. Opportunity enablers included regular communication with and support from stakeholders; clear referral processes; time and also the initial restriction of clinic capacity. Capability domain enabling factors included a detailed, relevant, thorough, well-structured learning and assessment framework with a known credentialing standard, supported by senior medical staff; understanding key organisational issues and also having a pool of appropriately skilled, experienced, flexible and dedicated physiotherapists with strong communication skills.

Significance of the finding:
Communication and relationships with stakeholders emerged as critical for successful implementation and should be prioritised along with developing and supporting knowledgeable, adaptable AMP clinicians.


Bridget Shaw has been working in Advanced Scope Physiotherapy roles for 10 years and has been the Advanced Scope Physiotherapy Clinical Leader at St Vincent’s Hospital in Melbourne for the last three years. Bridget has a Masters of Manipulative Physiotherapy. Bridget was a member of the team of the DHHS funded Advanced Musculoskeletal Physiotherapy Implementation project from which this research arose.