There's still no budget for a national roll-out of a successful programme that saw physios triage and treat patients on the waiting list to see a surgeon. Photo: 123rf
- Physio-led programmes in some regions are cutting wait times for orthopaedic patients.
- Physiotherapists say they could do more to help patients in pain.
- No funding for national roll-out.
A highly successful programme with the potential to help thousands of orthopaedic patients waiting in pain for specialist appointments is being stymied by a lack of funding.
A year ago, Health NZ, Physiotherapy NZ and the Orthopaedic Association signed an agreement for physios to triage patients and treat patients on the waiting list to see a surgeon - but there is still no budget for a national roll-out.
Waikato resident Jenny* has been on the waiting list to see a specialist about her crippling neck pain for seven months, and expects to wait another four.
"I pretty much don't sleep ... it's affecting my arms, my grip, I'm dropping things all the time, I spill things all the time. I get terrible headaches."
She was just 38 when she was diagnosed with osteoarthritis in both knees and had surgery in 2020.
Following that, she received intensive physiotherapy and benefited hugely.
Last Monday she got a long-awaited physiotherapy appointment at Waikato Hospital, but it was just 15 minutes.
That was just long enough to "get in a few questions" and be shown some exercises, but not enough time to try them out, she said.
"I'm a bit worried in case I'm doing them wrong.
"I could see the difference between those years to now, a big difference, with them seeming under pressure and being rushed."
Physio gets patients moving
In 2023, there was a five-month pilot using physiotherapists to assess more than 1200 orthopaedic patients in six regions, who had been waiting over a year for a specialist appointment.
The clinician overseeing the Musculoskeletal Pathway programme, Dr Sarah Mitchell from Bay of Plenty, speaking to RNZ late last year, said of those people, only about 30 percent actually required surgery.
"The other patients could have benefited more from a non-surgical management."
Dr Sarah Mitchell. Photo: Supplied / Physiotherapy NZ
Physiotherapists were then able to help deliver the best treatment, whether that was hands-on physiotherapy, exercise programmes, education or some kind of self-management, like weight loss.
Patients who were then assessed as needing an operation could also be helped by "pre-habilitation physiotherapy" to prepare them for surgery.
"Very often these patients are in a functional decline cycle because they can't move much, their function is very limited. So pre-habilitation optimises their function to the best they can do."
Limited to some regions
An internal presentation to Health NZ last week - obtained by RNZ - showed the programme was still working well in some regions, including Bay of Plenty.
However, there was no funding to roll it out nationally, despite the fact all districts were supposed to have implemented it by the end of last year.
Physiotherapy New Zealand president Kirsten Davie said the physio workforce could do more to help the 35,000 orthopaedic patients now waiting for first specialist appointments.
"Once they get that mobility, strength, balance, fitness back, it can delay when they need to go to the next stage [surgery] so they can go back and live their life normally, get back to work, get back to their daily activities," she said.
"They might loop back into the hospital system and outpatient physio department there, or go to their local community based physiotherapy practice and access some advice there - but that will take funding."
Physiotherapy New Zealand president Kirsten Davie. Photo: Supplied / Physiotherapy NZ
Health Minister Simeon Brown was supportive of the programme, she said, which could help realise the government's target of reducing wait times.
Of the estimated 670,000 New Zealanders with osteoarthritis, 48 percent were working age.
The condition costs the health sector just under $1 billion a year, and it costs the country another $1.2b in lost productivity.
Current system not working for patients - Arthritis NZ
Arthritis NZ chief executive Phil Kearney said most sufferers did not even meet the threshold for a referral to a specialist.
"If you didn't then have a specialist appointment - or even if you did have a specialist appointment but didn't then meet the criteria for surgery - you very often get bounced back to the GP. But there's very little option for the GP to assist."
Kearney said wait lists continued to grow, which showed the old system was not working.
"There's no point to just keep on doing what we've always done and expecting improvement.
"And this [physiotherapy-led programme] has been shown overseas to provide a very good alternative pathway."
Health NZ has not yet responded to RNZ's questions about funding for the national rollout of the programme.
However, in a written statement spokesperson Jacqui Lunday said national hospital-based Musculoskeletal Pathway was "made available to all districts for deployment from August 2024", and uptake had increased over consecutive months.
"Districts have moved at different speeds in implementing the pathway, mainly due to the need to train and/or recruit advanced clinical practice physiotherapists where these roles may not have existed previously."
So far more than 2000 patients had been seen nationally through the pathway, and a further 1000 were set to receive their first specialist appointment over the coming weeks.
*Name changed to protect privacy
Sign up for Ngā Pitopito Kōrero, a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
