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

Abstract

BackgroundOvercrowding in emergency departments (ED) is a major concern worldwide. To answer increasing health care demands, new models of care including advanced practice physiotherapists (APP) have been implemented in EDs. The purpose of this study was to assess diagnostic, treatment and discharge plan concordance between APPs and ED physicians for patients consulting to the ED for minor musculoskeletal disorders (MSKD).MethodsPatients presenting to two EDs in Montréal (Canada) with a minor MSKD were recruited and independently assessed by an APP and ED physician. Both providers had to formulate diagnosis, treatment and discharge plans. Cohen’s kappa (κ) and Prevalence and Bias Adjusted Kappas (PABAK) with associated 95%CI were calculated. Chi Square and t-tests were used to compare treatment, discharge plan modalities and patient satisfaction between providers.ResultsOne hundred and thirteen participants were recruited, mean age was 50.3 ± 17.4 years old and 51.3% had an atraumatic MSKD. Diagnostic inter-rater agreement between providers was very good (κ = 0.81; 95% CI: 0.72–0.90). In terms of treatment plan, APPs referred significantly more participants to physiotherapy care than ED physicians (κ = 0.27; PABAK = 0.27; 95% CI: 0.07–0.45; p = 0.003). There was a moderate inter-rater agreement (κ = 0.46; PABAK = 0.64; 95% CI: 0.46–0.77) for discharge plans. High patient satisfaction was reported with no significant differences between providers (p = 0.57).ConclusionThere was significant agreement between APPs and ED physicians in terms of diagnosis and discharge plans, but more discrepancies regarding treatment plans. These results tend to support the integration of APPs in ED settings, but further prospective evaluation of the efficiency of these types of models is warranted.

Diagnostic concordance between physiotherapist and emergency physicians for patients with a musculoskeletal disorder in the emergency department

“…It can therefore be arduous to compare results between them. 17,25,26 Moreover, diagnostic concordance analyses oftentimes do not allow to consider the level of diagnostic precision provided by each professional. Results from this study must therefore be interpreted with caution.…”

“…In a study conducted in 2019 (n=113), Matifat et al reported a raw agreement between the two professionals of 87% and a Kappa coefficient of 0.81 (95% CI: 0.72-0.90). 17 However, the agreement was lower in regards to treatment modalities to be used and recommended discharge plan. Moreover, in a study by Sutton et al, a PT in the ED managed more than 1300 patients without any misdiagnoses or adverse events (95% CI: 0.0-0.3%).…”

Acceptability of Physiotherapists in the Emergency Department for the Care of Adults With Musculoskeletal Disorders

“…After assessments by both providers, an APP, and an ED physician, participants filled out the acceptability questionnaire. 13 Participants recruited from May through July 2018 at 1 ED in Montreal (Canada) were asked to fill out the questionnaire assessing the acceptability of ED APP care (see Appendix 1).…”

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

“…In high-income settings, these examples of new cadres who are educated and authorised to function autonomously and collaboratively in advanced and extended clinical roles may help to achieve some of the quadruple aims of value-based care. These may include reducing wait times in emergency departments, triaging to surgical consult for total knee or hip joint replacement, re-fracture prevention assessments and investigation, and performing as the lead health professional in supporting people presenting with acute low back pain [ [109] , [110] , [111] , [112] , [113] , [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] ]. Ongoing evaluation of clinical, economic and patient experience outcomes will be important to maintain momentum in optimising workforce configurations.…”