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.

• Clinical Pilates vs General Exercise for Chronic Low Back Pain (Wajswelner 2012)
• Direction Bias Gym Programming and Athletic Performance (Leslie 2017)
• DMA Clinical Pilates Directional-Bias Assessment: Reliability and Predictive Validity (Tulloch 2012)
• Interrater reliability of a Pilates movement-based classification system (Yu 2014)
• Defining Pilates to make it Clinical – APA In Motion April 2019
• Individualised Clinical Pilates in Improving Rowing Performance (Turner 2013)

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.

• The Effect of Prehabilitation Exercise on Strength and Functioning After Total Knee Arthroplasty
• Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial
• Back Pain: How to Avoid Surgery?

WhICH PATIENTS can BENEFIT FROM Joint smart?

• 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 DELIVERY

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

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

JOINT SMART module

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.

• JOINT SMART Overview
• Online JOINT SMART Patient Pre-Treatment Screening Form
• Submit patients into the JOINT SMART Registry
• JOINT SMART GDrive resource hub (request access – accredited practitioners)
• Learn more about MBCT Clinical Pilates
• Learn more about CPMate
• Equipment for JOINT SMART

FUTURE OF THE PROFESSION

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

• GP/Physio education flyer Click Here
• Patient education flyer Click Here

Frequently Asked Questions