What are physiotherapists and occupational therapists doing in services that replace acute hospital admission? A systematic review

Abstract

Background: Alternatives to acute hospital admission are required to accommodate the increasing pressures on health services. Since physiotherapists and occupational therapists are integral to inpatient teams, they may also be integral to admission replacement services, and thus their roles in these services merit investigation.Aims: Primarily to determine the presence and roles of physiotherapists and occupational therapists in services replacing acute hospital admission. The secondary outcome is to determine the impact of therapists in such services.Methods: Five electronic databases were searched, with keywords related to therapy, discharge, and admission replacement. Inclusion criteria were that studies explicitly described at least one therapist role within a service replacing acute hospital admissions. Two authors independently reviewed all potentially eligible studies. Two reviewers independently assessed data extracted from included studies into a standardized data extraction form.Results: Fifteen studies (3 Hospital at Home, 12 Early Supported Discharge) were included. Both clinical (eg, exercise prescription) and non-clinical (eg, organization and study outcome assessments) therapist roles were described in different admission substitution services. Some roles were only reported among teams, not individually ascribed to therapists. Conclusions:The roles of therapists in services that replace hospital admission are rarely described in detail, with wide variation in reported roles, including across service types and patient populations. This review could not determine the impact of individual therapists on patient or service-level outcomes. Future studies need to more clearly define therapist roles and impact.

Core competencies for first contact physiotherapists in a direct access model of care for adults with musculoskeletal disorders: A scoping review

“…Twenty articles used quantitative methodologies, such as cohort, cross‐sectional, and randomized or non‐randomized, controlled designs (Addley et al., 2010; Bishop et al., 2017; Bornhöft et al., 2019; Childs et al., 2005; Domholdt & Durchholz, 1992; Donato et al., 2004; Durant et al., 1989; Gagnon et al., 2021; Gorman et al., 2010; Holdsworth et al., 2007; Jette et al., 2006; Keller et al., 2022; Kilner & Sheppard, 2010; Ludvigsson & Enthoven, 2012; Mitchell & de Lissovoy, 1997; Nordeman et al., 2006; Onyeso et al., 2022; Overman et al., 1988a; Richardson, 2005; Taylor et al., 2011); 9 used qualitative methodologies based on interviews, focus groups, or Delphi methods (Alshareef et al., 2023; Boakye et al., 2016; Burley et al., 2020; Chance‐Larsen et al., 2019; French & Galvin, 2017; Kumar & Grimmer, 2005; Lefmann & Sheppard, 2014; McMahon et al., 2016; Vader et al., 2022); 2 used a mixed methodology (Alkhouri et al., 2020; Fisher, 2020); seven involved knowledge syntheses such as systematic, scoping, critical, and narrative reviews (Boakye et al., 2016; Ferreira et al., 2019; Foster et al., 2012; C. Harris et al., 2020; Lackenbauer et al., 2017; Lin et al., 2020; Ojha et al., 2014); 9 were viewpoints (editorials and clinical commentaries) (Bishop et al., 2013; W. G. Boissonnault et al., 2010; W. G. Boissonnault & Ross, 2012; W. Boissonnault & Goodman, 2006; Crane & Delany, 2013; Fleming‐McDonnell et al., 2010; Juneja et al., 2020; Lebec & Jogodka, 2009; McMahon et al., 2016); and 18 were from grey literature, including international references, books, and theses (APTA, 2012, 2...…”