Musculoskeletal Outpatient Physiotherapy Delegation (MOPeD) study
Research type
Research Study
Full title
Musculoskeletal Outpatient Physiotherapy Delegation (MOPeD): A mixed methods study
IRAS ID
297095
Contact name
Panagiotis Sarigiovannis
Contact email
Sponsor organisation
Keele University
Duration of Study in the UK
3 years, 6 months, 31 days
Research summary
Research Summary:
The overall aim of this research is to develop a ‘best practice’ framework of delegation to physiotherapy assistants in NHS musculoskeletal outpatient physiotherapy services.
The study will use different research designs across three stages.
Stage 1:
I will explore how the culture in physiotherapy services may influence how tasks are delegated to physiotherapy assistants by doing detailed observations in two NHS musculoskeletal outpatient physiotherapy services. One of them will be in Staffordshire (Midlands Partnership NHS Foundation Trust, MPFT) and the second one in Cambridgeshire (Cambridge Community Services). I will also conduct interviews with physiotherapists, physiotherapy assistants, managers and patients to find out about their experiences of and attitudes about delegation. The findings will inform the design of the next stages of the study.
Stage 2a:
I will use a discussion method called Nominal Group Technique to reach agreement about what a ‘best practice’ delegation framework should include. I will work with three separate groups of physiotherapists, physiotherapy assistants and physiotherapy service managers. This involves having a meeting with each group. The meeting will last approximately 3 hours. Participants will be recruited through advertising in professional websites and social media.
Stage 2b:
I will also use findings from the patient interviews in stage one to design a survey to better understand patients’ preferences for receiving physiotherapy treatment from physiotherapy assistants. Specifically, I will use a technique called Discrete Choice Experiment to describe, explain and predict patients’ preferences between care from physiotherapists and physiotherapy assistants. We will recruit patients from the patients who are attending physiotherapy appointments from one of the musculoskeletal physiotherapy departments within MPFT.
Stage 3:
I will bring together all findings to develop a “best practice” framework to guide physiotherapists in delegating clinical work to physiotherapy assistants.Lay summary of study results: Musculoskeletal Outpatient Physiotherapy Delegation (MOPeD): A mixed methods study Thank you Thank you to everyone who took part in this research, including patients, physiotherapists, physiotherapy support workers and managers.
We also thank seven public contributors with experience of musculoskeletal physiotherapy or support worker care. They helped shape the study, review participant information and develop the final guide.About the study
The study was led by Panos Sarigiovannis with Nadine E. Foster, Sue Jowett and Benjamin Saunders. Keele University was the study sponsor.
The lead researcher was funded by a National Institute for Health and Care Research Clinical Doctoral Research Fellowship (NIHR301550). The researchers reported no financial or other interests that could have influenced the study.
The study took place in NHS outpatient physiotherapy services in Staffordshire and Cambridgeshire. It ran from 1 February 2022 to 22 April 2025.Why was the research needed?
Physiotherapy support workers, called physiotherapy assistants in the original study summary, are increasingly involved in NHS care.
Their roles, training and responsibilities can differ between services. There was also limited guidance on how physiotherapists should decide which parts of care to share with support workers. This sharing of care is called delegation. The study explored how delegation works, what helps or hinders it, what good delegation should include, and what matters to patients.Who took part and what happened?
The study had three parts. The researcher spent more than 150 hours observing clinic activity in two NHS services. The researcher also carried out 30 interviews with physiotherapists, managers, support workers and patients to understand how delegation worked in practice.Seven physiotherapists, 10 physiotherapy support workers and 10 managers took part in workshops. They agreed what good delegation should include.
A total of 382 patients completed a survey showing what mattered most when receiving care from physiotherapists or support workers.
The findings from all three parts were then brought together to develop the final delegation framework.What did the study find?
Good delegation depended on clear roles, clear ways of working, suitable training and supervision, and a supportive team culture.
Staff also needed a clear way to return a patient to a physiotherapist when the patient needed care beyond the support worker’s role.
Communication with patients was important. Some patients did not realise they had been treated by a support worker.
However, patients in the interview study who received support worker care were satisfied with that care.
Overall, patients preferred care from a physiotherapist. Patients who had previously seen a support worker were more likely to choose one again.
Waiting time, seeing the same person, follow-up appointments and clinic location also influenced their choices.
The findings were brought together to create a practical delegation guide with seven parts:
• training and development
• clear steps for sharing tasks
• clear roles and responsibilities
• a supportive team culture
• ways to keep care safe
• clear information and communication with patients
• putting the guide into practice and checking how well it worksHow has the study helped?
The guide may help NHS physiotherapy services make delegation more consistent. It may also support clearer roles, better training and better communication with patients.
The guide has not yet been tested in everyday NHS care. We do not yet know whether it improves patients’ health, recovery or waiting times, or whether it helps services use staff more effectively.
For researchers, the study provides a guide that can now be tested in practice.What happens next?
The next step is to introduce the guide into NHS services and assess how well it works for patients and staff.
Future research should examine patient experience, health and recovery, waiting times, and how services use their staff.Where can I learn more?
Five articles related to this programme of research have been published.
The latest paper brings together the findings from the whole study and describes the final delegation framework:Sarigiovannis P, Foster NE, Jowett S, Saunders B. Development of an evidence-based framework to guide delegation of clinical tasks to physiotherapy support workers in musculoskeletal outpatient physiotherapy services. BMC Health Services Research. 2026;26:428.
DOI: https://link.springer.com/article/10.1186/s12913-026-14210-0REC name
South West - Frenchay Research Ethics Committee
REC reference
21/SW/0158
Date of REC Opinion
17 Dec 2021
REC opinion
Further Information Favourable Opinion