Benefits of Musculoskeletal Physical Therapy in Emergency Departments: A Systematic Review

Abstract

Background Over the past few decades, physical therapists have emerged as key health care providers in emergency departments (EDs), especially for patients with musculoskeletal disorders (MSKD). Purpose The purpose of this review was to update the current evidence regarding physical therapist care for patients with MSKD in EDs and to update current recommendations for these models of care. Data Sources Systematic searches were conducted in 5 bibliographic databases. Study Selection The studies selected presented quantitative data related to the care of patients with MSKD by physical therapists in an ED setting. Data Extraction Raters reviewed studies and used the Effective Public Health Practice Project Quality Assessment Tool to assess their methodological quality. Data Synthesis Fifteen studies were included. Two studies, 1 of weak and 1 of strong quality, demonstrated that physical therapist care in EDs was as effective as or more effective than usual medical care for pain reduction, and 6 studies of varying quality reported that physical therapist care in EDs was as effective as usual care in EDs in reducing disability. Eight studies of varying quality reported that physical therapist care could significantly reduce waiting time in EDs. Four studies of varying quality reported that physical therapists ordered no more, or even fewer, medical images than physicians. In terms of health care costs, 2 studies of moderate to high quality found no significant differences in costs between physical therapist care and usual care in EDs. Finally, 6 studies of varying quality reported that patients were as satisfied or more satisfied with physical therapist care as with usual medical care in EDs. Limitations The roles of physical therapists in EDs vary depending on the setting, legislation, and training of providers. Only a limited number of high-quality studies were identified. Conclusions Although the quality of the evidence is heterogeneous, physical therapist care for patients with MSKD in EDs may be beneficial.

Concordance between physiotherapists and physicians for care of patients with musculoskeletal disorders presenting to the emergency department

“…The current literature on APP in EDs indicate that they can be a viable option to improve access to care for patients with MSKD [13, 16–19]. Nevertheless, only a limited amount of studies in EDs has examined the benefits and safety of these models and none have assessed diagnosis and management concordance between physiotherapists and physicians [16, 17, 19, 20]. The evaluation of the potential benefits of such models is highly context-dependent and the evaluation of these models is warranted to support further development and implementation of APP in EDs.…”

Direct‐access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial

“…Indeed, in previous studies, 37,38 patients seen by a direct‐access PT reported greater satisfaction regarding education or first aid advice than those seen by a physician. They attributed this increase to receiving proper information and education and having time to ask questions 38 . Other studies show mixed results for pain outcomes.…”

Direct access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: results of a randomized controlled trial

“…These differences in scores could be partially explained by the quality of the reinsurance and education given by the PT. 43 Other studies show mixed results for pain outcomes. In a study by Lau et al, patients seen by the PT expressed significantly less pain at discharge from the ED and within one week of discharge, but these differences were no longer significant at the 1-month follow-up.…”