Physiotherapy and Point of Care Ultrasonography

Abstract

Point of care ultrasonography (POCUS) is a non-ionizing imaging modality that is performed and interpreted by a primary health care professional in combination with a physical examination in a clinical setting. POCUS can provide time sensitive clinical information to assist in diagnosis of pathology and to monitor response to treatment. POCUS is emerging in physiotherapy clinical practice, education, and research. This dissertation explores physiotherapist performed POCUS and consists of two scoping reviews and an inter-professional agreement study. The first scoping review systematically mapped the research literature to describe the breadth and depth of physiotherapists performed POCUS. Two hundred and nine studies were included, and the majority of the included studies were measurement studies that assessed the psychometric properties of POCUS in adult patients, were published in the United States of America, and imaged the abdominal lumbo-pelvic region. POCUS was found to be a recent application of sonography in physiotherapy practice. This review identified a wide variety of practice settings and a diverse number of patient conditions in which physiotherapists are performing POCUS. This breadth and depth of this review highlighted the need for improved reporting of study methodology and key areas of future research in physiotherapist performed POCUS. The second scoping review explored physiotherapy pre- and post-licensure curricula and pedagogical approaches for POCUS. Fifteen studies were identified. These showed that progress in the development of physiotherapy-specific, competency based, standardized education curricula and pedagogical approaches for POCUS has been limited. There was considerable variability both pre- and post licensure and further research is needed to assess the outcomes of different pedagogical approaches on theoretical knowledge and practical scanning competence. There is a need for internationally accepted terminology for physiotherapist performed POCUS and clear guidelines from local regulatory colleges and licensing bodies. The third study was an inter-professional agreement pilot study between a physiotherapist and a sonographer for the assessment of acute hemarthrosis in 13 patients with hemophilia using POCUS. In this study, the physiotherapist participated in the McMaster University Mohawk College POCUS Training Program for Acute Hemarthrosis and Synovitis. The results indicated a high level of agreement between the physiotherapist and the sonographer performed POCUS for the binary decision on the presence or absence of blood within the joint. The physiotherapist-acquired images demonstrated quality comparable to an expert sonographer. This study provides support that following a short formal training program, a trained physiotherapist can become proficient in the acquisition and interpretation of POCUS images for the assessment of hemarthrosis in patients with hemophilia.