The Gapps Study Gender and Advanced Physiotherapist Practitioner Satisfaction in Pediatric Rheumatology Opinions of Parents and Teens

Objectives In Canada, Advanced Physiotherapist Practitioners (APP) manage complex rheumatic disease cases in shared care models.[1] The APP role has been studied in adult rheumatology, with little focus on pediatrics or how this role impacts gender.[1] Rheumatic diseases disproportionately affect women with this disparity evident in children, however research is not often tailored to investigate impacts of care based on gender.[2] In a Canadian pediatric rheumatology center with an APP shared care model, we aimed to i) measure and describe parent and patient satisfaction and ii) explore differences between patient and parent responses based on gender. Methods This mixed-methods, cross-sectional study included all parents and patients 12-17 years seen by 1 APP at McMaster Children’s Hospital (June-August 2024). Each family was a unique case with multiple responses (patient and/or parent(s)). Patient and parent demographics were collected. We used an adapted 9-item Visit-Specific Questionnaire (VSQ) with each response reported by 5-point Likert scale (scores transposed to 100) and open-ended questions. Continuous variables were reported using means and 95% confidence intervals, categorical variables using frequencies and proportions. Qualitative responses were analyzed using inductive content analysis. Results Of 43 unique cases, (16 new consults, 27 follow-ups); 44% (n=19) were not rheumatic and 30% (n=13) had juvenile idiopathic arthritis. Of parents (n=50), 64% (n=32) were female, 50% (n=25) and were 41-50 years. Of 16 patients, 69% (n=11) were female and 69% (n=11) were Caucasian. Regardless of gender, both patients and parents reported lower satisfaction for wait time (VSQ1) and discussing arthritis management (VSQ6) (Figure 1). Parents reported >90% satisfaction for explanation of results, technical skills, personal manner and the visit overall (VSQ4,7,8,9). While patients reported >80% satisfaction for personal manner (VSQ8) and >75% for answering questions (VSQ3). Female patients and female parents total VSQ score was 72.2(60.6-84.8); 90.6(86.6-94.7) respectively. Themes that emerged from open-ended questions included: thorough, knowledgeable, friendly and compassionate, provided conservative treatment, value and respect. Figure 1. VSQ-9 Scores and Main Themes from Patient and Parent VSQ-9 Responses Conclusion Parents and patients reported being highly satisfied with APP care in a pediatric rheumatology shared care model. Female patients reported lower satisfaction scores than other groups indicating a need for further investigation of their health care experiences. Lack of validation of the VSQ in pediatric populations may have impacted results as well as relevance of questions regarding arthritis management considering 44% of the sample did not have arthritis. Qualitative descriptions are consistent with APP literature[3] and should be considered when defining important aspects of APP roles. [1.] Ahluwalia V. J Multidiscip Healthc 2021;14:1299-310. [2.] Thierry S. Joint Bone Spine 2014;81(2):112-7. [3.] Fullerton LM. Pragmat Obs Res 2020;11:1-12.

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