Background: Early concussion diagnosis is critical for initiating rehabilitation, and delayed diagnosis can lead to delayed recovery. Physiotherapists are at the front-line of identifying potential concussions and ensuring that sportspeople are ready to return to training. Yet, only medical doctors can diagnose and provide clearance for return-to-sports.

Purpose: To explore physiotherapists' perspectives of their scope of practice and current actual clinical practice within sports-related concussion diagnosis and return to sports.

Methods: We recruited 18 physiotherapists working in sports physiotherapy for this qualitative study, using semi-structured individual interviews and focus groups, and Interpretive Description.

Results: Three themes were derived: i) Delayed access to concussion-trained medical doctors; ii) Navigating concussion care in a strained healthcare system, and iii) Proposed expanded role for physiotherapists. Delayed access to medical doctors often delayed formal concussion diagnosis, initiation of concussion care, or medical sports clearance. Yet participants were regularly identifying and managing concussions, feeling confident to do so. Participants working with high performance athletes or in multidisciplinary teams suggested that concussion diagnosis and clearance for return-to-work or -play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.

Conclusion: Participants suggested that current constraints about timely access to medical doctors impeded initiation of concussion care for many individuals. At high performance sport level, medical doctor consultation appears to be considered critical. At community level, many participants were already providing interim diagnoses and clearance for return to sports, advising GPs thereof for formal coding or sign-off.

Implications: The scope of practise for physiotherapists for concussion diagnosis, triaging and return to sports clearance should be reconsidered. Physiotherapists could decrease burden of medical doctors yet improve efficient and effective initiation of concussion care in the community.

Background: In New Zealand, an increasing number of physiotherapists have been engaged in orthopaedic triage and assessment roles within elective orthopaedic departments to help improve timely access to diagnostic assessment and treatment planning for people referred to orthopaedic services. To date, no framework has been available to guide physiotherapists and surgeons in developing these roles.
Purpose: To develop a framework for physiotherapists and trainers to support orthopaedic triage and assessment in New Zealand.
Method: An informal scoping review on education and competencies for advanced practitioners was conducted. A focused discussion between physiotherapists with experience in these roles using ten Cates methodology resulted in the development of an Entrustable Professional Activity (EPA) framework.
Results: The EPA framework identifies five key clinical activities performed in these triage roles and defines the context, limitations, knowledge, skills, attributes, and behaviors needed for each. The EPAs are mapped to existing New Zealand physiotherapy competencies and key competencies identified that are needed before entrustment of these activities with minimal or no supervision.
Conclusion: This EPA framework is intended for use in Elective Orthopaedic Departments, to support the development of physiotherapists working in orthopaedic triage and assessment roles in clinical subspecialty areas.
Implication: This framework provides a tool for the physiotherapy profession to develop into orthopaedic practitioner roles. However, this can be tailored for any advanced subspeciality area.