For Physios

why joint smart?

COVID has seen a massive backlog in surgical waiting lists worldwide in 2020/21. Globally, Australia has been identified as having the highest rates of elective surgery of the 193 countries in the United Nations. Many of these surgeries could be avoided.

In the next decade (2020- 2030) knee and hip replacements are predicted to rise by more than 278% and 208% respectively (see page 9). These same procedures increased by 38% last decade (2010 – 2020). The urgent need to translate evidence supporting conservative management to a more cost effective health system is now even more critical with Medicare dramatically decreasing the rebate on all orthopaedic surgery as of 1 July 2021.

The JOINT SMART program aims to translate research into a high quality surgical alternative capable of decreasing the cost & unsustainable load of orthopaedic surgeries on the hospital system.

Research & Evidence behind MBCT and Joint Smart

Clinical Pilates MBCT (Movement Based Classification and Treatment) has become a mainstay of Australian physiotherapy practice over the last 30 years and proven successful in military, olympic & high level sporting populations.

Current research shows that joint surgeries (such as hip, knee & shoulder replacements) have greater outcomes with prehab, and often find surgery can be avoided. This extends to other orthopaedic surgeries such as reconstructions of ACL’s, rotator cuff, ankle etc. JOINT SMART utilises MBCT to prescribe an individualised prehab program, specific to each patient (not a generic exercise program). Specificity has been proven to produce greater post operative outcomes for function, pain & physical performance.


  • Individuals with hip, knee, shoulder, back, or other joint pain who are either waitlisted for category 2 or 3 joint surgeries or awaiting an orthopaedic outpatient appointment.
  • Patients with chronic joint problems that have not responded to other treatment approaches (inc PRP, cortisone injection).
  • Patients who have had poor surgical outcomes and experiencing ongoing problems (such as a re-ruptured ACL, poor post op function following hip/knee/shoulder replacements etc).
  • Patients being considered for:
    • Joint replacement (hip, knee, shoulder, ankle)
    • Joint reconstruction (knee, shoulder, ankle)
    • Spinal surgery (fusion, disc replacement, laminectomy, facetotomy)
    • Pelvic surgery
    • Joint Arthroscopy

Joint Smart Program Structure

  • All patients undergo initial screening using the CPMate form
  • Red arrows indicate patients exit to surgery or other management
  • Patients may suitable to exit to self management at the end of Stage 1 or Stage 2
  • Outcome measures will be performed at end of Stage 1 and Stage 2


JOINT SMART is delivered by clinicians who are DMA Clinical Pilates MBCT certified. It is an extension of the MBCT principles applied specifically to the orthopaedic joint surgery population. Clinics will require the appropriate equipment to deliver the JOINT SMART program (see FAQ below).


CPMate software used by JOINT SMART clinicians will record patient data and build MBCT treatment programs. Patient case data will be entered into a central registry to track outcomes.

The CPMate Patient Pre-Treatment Screening Form Is the starting point to determine a patients suitability for undertaking a program.

Accreditation Pathway for Physiotherapists

To administer the JOINT SMART program, physiotherapists require DMA Unit A + Unit B + Certification, as well as the Joint Smart module.

Unit A  – Pathoanatomy, MBCT Clinical Pathway for Exercise Treatment.

3 days face-to-face plus pre course e-learning

  • Clinical Reasoning
  • Acute vs chronic case study management
  • The BEAT decision making tool
  • Exercise treatment using Clinical Pilates matwork, reformer, trapeze

Unit B – Motor Control & Treatment Progression

3 days face-to-face plus pre course e-learning

  • Advanced exercise repertoire
  • Problem solving co-existing pathologies
  • Advanced case studies
  • Cost benefit analysis of physios
  • Health reform changes affecting physio
  • Translating evidence into practice

Unit C – Certification

Online assessment – 4 part exam

  • Demonstrate competency in Clinical Pilates BEAT selection process & MBCT model
  • Preparation for JOINT SMART network


Online module 

  • Osteoarthritis, therapist and patient education
  • Orthopaedic surgery suitability + MBCT
  • JOINT SMART network and processes



    Resources for joint smart physios

    JOINT SMART is a treatment exercise & education program developed by clinicians & researchers in Australia specifically for the Australian healthcare system.

    Powered by the respected DMA Clinical Pilates MBCT approach, JOINT SMART is specific for people with joint pain & dysfunction, especially those considering surgery for osteoarthritis, joint dysfunction & pain. It is focused at identifying patients most likely to benefit from conservative over surgical management.

    JOINT SMART clients are educated to ultimately self manage and apply this to everyday activities to maintain the improvements, keep active and minimise further symptoms.




    by Craig Phillips APAM

    • COVID has presented the physiotherapy profession with one of its greatest opportunities to prove the worth and value of physiotherapists.
    • With major disruption to elective surgeries, we’re now experiencing historically high surgical waiting lists which will take many years to clear.
    • High quality research evidence highlights the value of conservative management with Category 2 and 3 elective surgeries (hip, knee, spine, shoulder etc.) However we still lack an effective mechanism to translate the massive body of evidence supporting physiotherapy into mainstream medicine. 
    • While this has been a major discussion point over the last 2 decades (see reports below), we still have yet to break through the numerous barriers preventing the translation of evidence into practice. Adequate funding is one key, as is the impermeable wall between the public health & private practice systems.   
    • As a result, Australia has been identified as the highest elective surgery country in the world
    • Current predictions published by the Australian Orthopaedic Association predict increases in Hip & Knee replacements alone of 208% & 273% respectively over the next decade compared to 38% last decade. 
    • JOINT SMART aims to lead the profession forward by aggregating data on the value of physiotherapy, reducing hospitalisation and surgery rates. 
    • This project is squarely aimed at addressing the various aims of the myriad of reports that identify a need for change.  

    Useful Links:

    2021 July – The challenge of reforming the health system – APA In Motion

    2020 Oct – Value of Physiotherapy in Australia – APA Report

    2015 Sept – Better Outcomes for People with Chronic and Complex Health Conditions through Primary Health Care – APA Presentation

    2015-2017 – APA Strategic Plan 

    2012-2014 – APA Strategic Plan 

    2009-2011- APA Strategic Plan

    2021 BMJ Effectiveness of Common Elective Orthopaedic Procedures


      Joint smart Physios Facebook Group

      The JOINT SMART physios Facebook group is a great way to connect with other JOINT SMART physios and post questions you may have on patient management.

      Education Material


      Frequently Asked Questions

      How is JOINT SMART different from other OA programs?

      High quality evidence supports exercise, and there are many programs for treatment of joint problems. These generic group programs are an excellent starting point however, JOINT SMART provides the next level and is aimed at people heading to surgery where evidence suggests high level conservative care is a viable alternative.

      JOINT SMART is unique. Each patient is initially assessed & classified against the MBCT treatment outcome prediction tool. This allows an individually-tailored treatment program specific to each patient’s presentation to be developed.

      JOINT SMART is an Australian designed program, specific to the complexities of the Australian healthcare system and Aussie bodies.

      Who is eligible to deliver the JOINT SMART program?

      Physiotherapists or AHPRA registered equivalents (chiropractors, osteopaths) who have completed the JOINT SMART training module.

      How do I become a registered JOINT SMART provider?

      JOINT SMART providers are required to complete DMA MBCT Units A + B + Certification as prerequiste to the Joint Smart training module.

      What equipment/space is needed to provide the JOINT SMART program?

      The JOINT SMART program is designed to be delivered in the private practice setting, making use of specialised Clinical Pilates equipment including:

      • Plinth or floor space/yoga mat for mat exercises
      • Basic physiotherapy exercise apparatus (therabands, hand weights etc.)
      • Reformer
      • Trapeze Table
      How can I bill for delivering the JOINT SMART program?

      The JOINT SMART program is a physiotherapy treatment intervention and should be billed as such.

      Patients can:

      • Claim on their private health insurance using codes 500 and 505 up to their ancillary cap
      • Pay privately as a package
      • Apply for bundled payment from their insurer/compensible body
      Who can take part in JOINT SMART?

      Inclusion criteria for JOINT SMART:

       Individuals with hip, knee, shoulder, back, or other joint pain who are either waitlisted for joint surgery or awaiting an orthopaedic outpatient appointment.

      • Patients who have had surgery but experiencing ongoing problems or failure (such as a re ruptured ACL)
      • Patients being considered for
        • Joint replacement (hip, knee, shoulder, ankle)
        • Joint reconstruction (knee, shoulder, ankle)
        • Spinal surgery (fusion, disc replacement, laminectomy, facetotomy)
        • Pelvic surgery


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      1 Yarra St
      South Yarra VIC 3141

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