Scope of POCUS

Ultrasound imaging (UI) allows for the real-time imaging of a wide range of tissues, organ systems and pathologies. UI is used by a range of professionals and UI may be used for screening, diagnostic, interventional, treatment monitoring and/or biofeedback purposes across a wide range of clinical settings and contexts. The use of UI is rapidly expanding across a wide range of healthcare applications and increasingly physiotherapists are using this technology as part of their own physiotherapy practice (CSP, 2022, PD0138).

Point of Care Ultrasound (POCUS): The use of ultrasound imaging by a clinician to inform and/or support the clinical assessment and/or treatment of their patient. The decision to use ultrasound imaging, performance and interpretation of the ultrasound imaging, reporting of the ultrasound imaging and any subsequent decision-making informed by the ultrasound imaging are all undertaken by that clinician. The remit of the scan is typically narrow and informed by a prior clinical assessment and reasoning (CSP, 2022, PD0139).

This document describes the context and scope of practice of ultrasound imaging, interpretation and informed clinical decision making undertaken by Jenny Blizard BSc (Hons), Chartered Physiotherapist, PGDip and PGCert in Women’s Health Physiotherapy, MCSP, HCPC as part of her *assessment and treatment of adult female pelvic health conditions to include; –

• Urinary Incontinence (Stress / urge/mixed / overflow)
• Pelvic Pain Syndromes
• Pelvic Organ Prolapse (POP)
• Recurrent Urinary Tract Infections (RUTI)
• Diastasis Rectus Abdominis (DRA)
• Faecal Incontinence
• Obstructive Defecation Syndrome
• Constipation
• Obstetric Anal Sphincter Injury

*POCUS is technology used to support the overall physiotherapy management of a client/patient’s condition/presentation (CSP, 2022, PD0138).

Aligning with the scope of clinical practice outlined for physiotherapists working in pelvic health care pathways using point of care ultrasound in the UK, an ultrasound scan is undertaken for the purposes of assessing pelvic floor function and pelvic organ support as an adjunct to pelvic physiotherapy management. The identification of other anatomical or pathological elements is explicitly beyond the scope of practice of the clinician. Therefore, the scan cannot be relied upon to either confirm or exclude any such anatomical, gestational or pathological elements (Smith et al, 2022).

If suspected unknown pathology is identified on a POCUS scan, it is the clinicians (i.e., Jenny Blizard) duty of care to escalate any findings to a relevant professional (and in this clinical setting, the relevant professional would be a GP) with the appropriate expediency.

References

Chartered Society Of Physiotherapy. Information Paper – Context of Physiotherapists using Point of Care Ultrasound (POCUS) in physiotherapy practice. April 2022, PD0138

Chartered Society Of Physiotherapy. Information Paper- Practice Guidance for Physiotherapists using Point of Care Ultrasound (POCUS) in physiotherapy practice. April 2022, PD0139

Smith M. Donnelly GM, Berry L, Innes S, Dixon J. Point of care ultrasound in pelvic health: Scope of practice, education and governance for physiotherapists. Int Urogynecol J. 2022. 10.1007/s00192-022-05200-x.