Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain

Pothiawala, Sohil; Hao, Pua Yong; Mark, Leong

doi:10.5847/wjem.j.1920-8642.2017.02.005

Cited by 23 publications

(38 citation statements)

References 14 publications

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“…Finally, our sample should have contained more participants aged 65 and over to be more representative of the general population and to allow for more in-depth analyses of this subgroup of interest. Still, several studies conducted in the ED among people with MSKDs report average ages similar to our own [15, 43–45]. It is therefore reasonable to believe that our sample remains representative of the population consulting the ED for a MSKD.…”

Section: Limitationssupporting

confidence: 72%

Health-related quality of life of patients presenting to the emergency department with a musculoskeletal disorder

Gagnon

Perreault

Robert-Guertin

et al. 2020

Preprint

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Objectives: The purpose of this study was to assess utility scores of patients presenting to the emergency department (ED) with a musculoskeletal disorder and to explore the influence of diverse factors on health-related quality of life. Design: Secondary analysis of data obtained before randomization during a pragmatic randomized controlled trial Setting: Academic ED in Quebec City (Canada) Participants: Participants aged 18-80 years old presenting with a minor MSKD. Main Outcome Measures: Health-related quality of life (five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and utility scores (0 − dead, 100 − perfect health), measured with the EQ-5D-5L, were compared between subgroups and with reference values using descriptive statistics (mean, median), rankFD ANOVAs, and χ2 tests. Results: Sixty-nine participants completed the EQ-5D-5L. Mean and median utility scores were respectively 0.536 (95% CI: 0.479-0.594) and 0.531 (IQR: 0.356-0.760). Participants with higher levels of pain (<4/10: 0.741; 4-7/10: 0.572; >7/10: 0.433) or pain interference on function (<4/10: 0.685; 4-7/10: 0.463; >7/10: 0.294) presented significantly lower utility scores. No significant differences were found for other socio-demographic characteristics. The mean overall VAS score was 58.1 (95% CI: 52.2-64.0). Conclusions: In patients with MSKDs presenting to the ED, higher levels of pain and pain interference on function may influence perceived health-related QoL. These findings need to be confirmed on a larger scale. Trial Registration: This trial was registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT04009369 on July 5, 2019

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Section: Limitationssupporting

confidence: 72%

Health-related quality of life of patients presenting to the emergency department with a musculoskeletal disorder

Gagnon

Perreault

Robert-Guertin

et al. 2020

Preprint

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“…[34] PT has been suggested as an alternative management strategy for managing both acute and chronic pain. [17] A recent study by Kim et. al. was the first to focus on the effect of ED-PT on opioid prescribing in back and neck pain in the ED setting.…”

Section: Plos Onementioning

confidence: 97%

“…[12][13][14] In the primary care setting, early physical therapy (PT) appears to be associated with lower utilization of advanced imaging, lower rates of lumbar spinal injections and lumbar spinal surgery, and improved patient satisfaction. [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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Emergency department based Physical Therapy (ED-PT) has been practiced globally in various forms for over 20 years and is an emerging resource in the US. While there is a growing body of evidence suggesting that ED-PT has a positive effect on a number of clinical and operational outcomes in patients presenting with musculoskeletal (MSK) pain, there are few published narratives that quantify this in the US. Although there are international papers that offer outcome data on reduction of pain, imaging, throughput time, and the ability of physical therapists to appropriately manage MSK conditions in the ED setting, most papers to date have been descriptive in nature. The purpose of this study is to assess the impact of ED-PT on imaging studies obtained, rates of opioids prescribed, and ED length of stay. Methods We prospectively identified patients presenting with musculoskeletal pain to an urban academic ED in Salt Lake City between January 2017 and June 2018. During the study, a physical therapist was in the ED three days (24 hours) per week and was available to evaluate and treat patients after consultation by the ED provider. We noted patient demographic information, imaging performed in the ED, medications administered and prescribed, and ED length of stay. We classified patients as those who received PT in the ED and those who did not and compared clinical outcomes between groups. We performed a subgroup analysis of patients presenting with low back pain and matched patients by age and gender. Results Over the 18-month study period, we identified 524 patients presenting to the ED with musculoskeletal pain. 381 (72.7%) received ED-initiated PT. The PT and non-PT groups were similar in average age (42.8 years vs. 45.1 years, p = 0.155), gender (% female: 53% vs. 46.9%, p-0.209), and primary presenting chief complaint (cervical, thoracic, or lumbar pain:

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“…Early conservative management for ED LBP has been associated with reduced pain and disability even when compared to patients with conservative outpatient physical therapy referrals [ 5 ]. Multiple studies point out integrated ED MSK-specialist (MSK-S) reduced length of stay, imaging utilization, and opioid administration rates [ 6 ], and improved overall ED metrics when compared to patients seen by typical ED providers [ 7 ].…”

mentioning

confidence: 99%

Implementation of musculoskeletal specialists in the emergency department at a level A1 VA Hospital during the SARS-CoV-2 pandemic

Schielke

Babikian

Walsh

et al. 2021

The American Journal of Emergency Medicine

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A 2017 systematic review and meta-analysis demonstrated the unwavering recurrence of low back pain (LBP) presentation in emergency departments (ED) [1]. In early 2020, the SARS-CoV-2 pandemic depleted resources as ED providers tended to COVID-19 patients. Simultaneously, pain management routine care was deemed "non-essential." 1 These unattended pain complaints were likely to present to the overburdened ED. LBP in the ED has become increasingly common and challenging to manage [2]. Efficiently triaging non-emergent LBP may redirect and improve ED service utilization. Less traditional providers may be better suited to manage musculoskeletal (MSK) pain. Appropriate clinical acumen is key in preventing overutilization of diagnostic tests and target interventions for ED LBP patients [3]. Furthermore, current clinical practice guidelines recommend nonpharmacologic treatment for acute or subacute LBP [4].Early conservative management for ED LBP has been associated with reduced pain and disability even when compared to patients with conservative outpatient physical therapy referrals [5]. Multiple studies point out integrated ED MSK-specialist (MSK-S) reduced length of stay, imaging utilization, and opioid administration rates [6], and improved overall ED metrics when compared to patients seen by typical ED providers [7]. Additionally, a 2018 systematic review and meta-analysis supports nonpharmacologic interventions for reduction of overall ED utilization and length of stay, and are effective in reducing pain in the ED with the potential to improve patient satisfaction, outcomes and quality of life [8]. The purpose of this correspondence is to describe how pandemic-related healthcare pressures led to an accelerated implementation of ED MSK-S in VA ED.VA Palo Alto Health Care System (VAPAHCS) 2019 proprietary data revealed approximately 60% of cases presenting to the ED were urgent/emergent MSK complaints, primarily LBP. As the rate of COVID-19 increased, it became vital to preserve VAPAHCS ED resources by reducing ED MSK complaints. On March 31st, 2020, the Santa Clara Public Health Department ordered the postponement of non-essential healthcare. With urgency to fulfill veteran's needs and aid in controlling the pandemic, the immersion of MSK-S into the ED was accelerated. Acknowledgements to Clinton Daniels, DC, MS for providing consultation guidance and recommendations for research formatting and quality assurance of the final manuscript.Integration into the ED went into effect on March 30, 2020 through June 8th, 2020. Designated MSK-S care was provided during peak hours by chiropractic and physical therapy departments.

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Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain

Cited by 23 publications

References 14 publications

Health-related quality of life of patients presenting to the emergency department with a musculoskeletal disorder

Health-related quality of life of patients presenting to the emergency department with a musculoskeletal disorder

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

Implementation of musculoskeletal specialists in the emergency department at a level A1 VA Hospital during the SARS-CoV-2 pandemic

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