Review article: A scoping review of physiotherapists in the adult emergency department

Abstract

To provide an overview of the literature that considers physiotherapists working in the ED in relation to their roles, training levels, patient profile, safety, effectiveness, efficiency, cost-effectiveness and the provision of low-value care. We performed a scoping review of the literature. Four databases (PubMed, EMBASE, CINAHL and Cochrane CENTRAL) were searched from their inception to December 2016 and we updated searches on PubMed in September 2017. Two reviewers independently screened studies for eligibility. We performed a narrative synthesis of quantitative data. We included 27 studies: five randomised controlled trials (n = 1434), 12 prospective observational studies (n = 153 767), six retrospective studies (n = 9968), two survey studies (n = 61), one case report (n = 3) and one qualitative study (n = 11). Physiotherapists primarily managed patients with low urgency musculoskeletal conditions. Physiotherapists appeared to have similar clinical effectiveness and costs compared to other health providers (four randomised controlled trials). Physiotherapists were associated with increased efficiency (eight observational studies) and reduced low-value care (one observational study). Three observational studies reported very low adverse event rates. However, none of the studies followed participants to measure adverse events that became apparent after the ED visit, nor did they consider unsafe discharge decisions or suboptimal follow-up care. The available evidence suggests that physiotherapists may be as effective as other health providers in managing low urgency musculoskeletal conditions in the ED. There is uncertainty about appropriate training and a lack of robust studies investigating the efficiency, safety and cost-effectiveness of this model of care.

Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study

“…[15][16][17][18][19] In the ED, a primary contact physical therapy model has been shown to reduce wait times and improve patient flow, directing patients to early effective care, and freeing emergency physicians to focus on other emergent cases. [20][21][22][23][24] A primary contact model involves the Physical Therapist acting as primary provider and autonomous practitioner. This practice is now commonplace in the UK, Canada and Australia.…”

Description and cost‐analysis of emergency department attendances for hand and wrist injuries

“…This is likely due to participation in sport, home renovations, garden maintenance and general activity outside of the home and workplace that typically occurs by most Australians over the weekend period. 26 This observation may provide preliminary support for an on-call advanced practitioner hand therapist in busier EDs over the weekend to assist in triage and timely treatment of injuries that can be conservatively managed, such as dislocations, closed mallet injuries and undisplaced fractures. This approach has been observed in the management of musculoskeletal injuries by physiotherapists with the available evidence suggesting they may be more cost-effective than medical providers in managing low urgency conditions in the ED.…”

“…This observation may provide preliminary support for an on‐call advanced practitioner hand therapist in busier EDs over the weekend to assist in triage and timely treatment of injuries that can be conservatively managed, such as dislocations, closed mallet injuries and undisplaced fractures. This approach has been observed in the management of musculoskeletal injuries by physiotherapists with the available evidence suggesting they may be more cost‐effective than medical providers in managing low urgency conditions in the ED . A well designed economic evaluation, incorporating cost‐effectiveness and cost–benefit methodologies would further validate this proposal.…”

Impact of the primary contact physiotherapy practitioner role on emergency department care for patients with musculoskeletal injuries in New South Wales

“…However, most research has been based on a single or small number of sites, restricted to EDs outside NSW or reported standardised systematic reviews . The evidence generated to date lacks evaluation of key service quality indicators, and may have introduced methodological bias limiting information collected to support benefits of the PCP MoC in EDs at system and provider levels . As a result, a number of unknowns remain after the introduction of the PCP MoC in NSW EDs, with expressed concerns about the efficiency and safety of the model in the acute setting, and suggesting that undifferentiated patients presenting to the EDs should be assessed by doctors before being treated primarily by physiotherapists .…”