Knee assessment

The aim of this survey study was to investigate musculoskeletal APP rights for physical therapists worldwide and examine the relationship between level of education (entry and post-professional) and direct access for countries that are not members of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT). The driver for this research was that the is limited understanding of the rapidly evolving advanced practice msk roles.

The term “advanced practice” (APP) is one which causes a degree of frustrated confusion in some settings. It is certainly fair to say that the exact definition of APP varies depending on which specialty and setting you work but within this survey the WCPT defintion was used and is below. It is also important to realise that the WCPT supports national bodies to create their own standards so two countries can vary greatly in what they deem APP.

“…the demonstration knowledge and skills beyond those required for entry to basic professional practice” – Advanced Clinical Competence”, 2017.

This is of course without even beginning to discuss the different job titles within the APP banner such as ESP or APP or ASP, these unfortunately muddy the water somewhat and tend to flare emotions as people often become attached and protective of their job titles.

As this survey focussed on MSK practice it is important clarify what areas of practice they were investigating. In essence this study aimed to investigate:

  1. the prevalence of APP rights,
  2. the educational level required for entry to practice as physical therapist and to acquire additional APP rights
  3. discrepancies in APP rights prevalence between countries affiliated or not with IFOMPT,
  4. the association between direct access and the other APP rights allowed within WCPT countries.

146 participants completed the survey, a 72.1% completion rate. The skills they were particularly asking about are “APP Rights” and are listed in the table to the right.


As discussed above, without a clear and agreed definition of APP in MSK settings a comparison and investigation of skills required for APP around the world is really difficult. The clearest finding of all was that for IFOMPT countries joint and soft tissue injections are an APP skill but probably the entry level skill. This is because many clinicians who perform injections require medical supervision or prescriptions written.

For those countries not members of IFOMPT the bar appears to be much lower to be seen as an APP but this is likely due to training at under graduate level not focussing on soft tissue and joint manipulations as much as IFOMPT countries training.

Quite clear the survey demonstrates that direct access roles require a broader scope and require more “APP skills”, however this really does depend on context of work such as location and environment. IFOMPT countries required less additional training to perform these jobs, the opposite was true for non-IFOMPT countries.

The article ends with this summary  “Advanced scope of practice is complex to characterize and further research to classify and thoroughly explain APP rights acquisition is warranted as well as investigations to determine how such changes can benefit patients, healthcare systems and society as a whole”.