Musculoskeletal Physiotherapy in the Emergency Department – Evaluation of a New Physiotherapy Service in a Swiss University Hospital

Abstract

Background Many countries report a significant increase in emergency department (ED) visits. Patients with musculoskeletal disorders account for a large proportion of non-urgent cases.

Objective Characterization and evaluation of a new service that provides immediate access to physiotherapy for patients in the ED.

Method To characterize a new service at the Department of Emergency Medicine, Bern University Hospital, and to evaluate first experiences with it, a mixed methods approach was chosen. Data was collected from the electronic patient file and from a logbook kept by the physiotherapists. In addition, guideline-based interviews with involved health care staff were conducted.

Results During the 63 days of the pilot study 79 patients were treated by physiotherapists. The most frequently reported patient complaint was back pain (47 %). Interventions included taking the medical history, performing manual tests and multimodal treatment and developing recommendations for further treatment. In 59 % of patients no medical imaging and in 58 % no additional physiotherapy was prescribed. Patients rated the physiotherapeutic service as very good or excellent (88 %). Physiotherapy was experienced as positive and appreciated by the other professions, and all interviewees emphasized the added value for patients.

Conclusion The pilot study indicates that the physiotherapeutic consultation service has the potential to improve quality of care. The findings of this study are therefore valuable when considering the introduction of such a service in an ED.

Zusammenfassung

Hintergrund Viele Länder berichten über einen signifikanten Anstieg von Behandlungen in der Notaufnahme. Patient*innen mit muskuloskelettalen Erkrankungen machen einen großen Anteil der nicht dringenden Fälle aus.

Ziel Charakterisierung und Evaluation eines neuen Dienstes, der Patient*innen in der Notaufnahme einen sofortigen Zugang zur Physiotherapie bietet.

Methode Um den neuen Dienst im Notfallzentrum des Universitätsspitals Bern zu charakterisieren und erste Erfahrungen zu evaluieren, wurde ein gemischter methodischer Ansatz gewählt. Dabei wurden Daten aus der elektronischen Patientenakte und aus einem von Physiotherapeut*innen geführten Logbuch gesammelt. Zusätzlich wurden Leitfaden gestützte Interviews mit involvierten Gesundheitsfachpersonen durchgeführt.

Ergebnisse Während der 63 Tage der Pilotstudie wurden 79 Patient*innen von Physiotherapeut*innen behandelt. Rückenschmerzen waren die häufigsten Beschwerden (47 %). Die Interventionen umfassten die Erebung der Anamnese, die Durchführung manueller Tests und multimodaler Behandlungen sowie die Entwicklung von Empfehlungen für die weitere Behandlung. Bei 59 % der Patient*innen wurde keine medizinische Bildgebung und bei 58 % keine zusätzliche Physiotherapie verordnet. Die Patient*innen bewerteten die physiotherapeutische Leistung als sehr gut oder ausgezeichnet (88 %). Die Physiotherapie wurde von den anderen Berufsgruppen als positiv erlebt und geschätzt, und alle interviewten Personen betonten den Mehrwert für die Patient*innen.

Schlussfolgerung Die Pilotstudie liefert Hinweise darauf, dass der physiotherapeutische Konsiliardienst das Potential hat, die Qualität der Versorgung zu verbessern. Die Erkenntnisse dieser Studie sind daher bei Überlegungen zur Einführung eines solchen Dienstes in einer Notaufnahme wertvoll.

Key words

musculoskeletal diseases - emergency service - hospital - specialty physical therapy

Schlüsselwörter

Muskuloskelettale Erkrankungen - Notdienst - Krankenhaus - Fachgebiet Physiotherapie

Publication History

Received: 04 May 2021

Accepted: 04 October 2021

Article published online:
16 November 2021

• Literatur

• 1 Canadian Institute for Health Information; Ed. NACRS Emergency Department Visits and Length of Stay by Province/Territory, 2018–2019. Ottawa, ON: CIHI; 2019 Available from (date: 09.02.2020): www.cihi.ca/en/search?query-all=Emergency%20Department%20Visits%20and%20Length%20of%20Stay&Search_Submit=&fs1%5B0%5D=primary_theme%3A676
• 2 Australian Institute of Health and Welfare 2020. Australia’s hospitals at a glance 2018–19. Cat. no. HSE 247. Canberra: AIHW. . Available from (date: 08.11.2021): www.aihw.gov.au/getmedia/c14c8e7f-70a3-4b00-918c-1f56d0bd9414/aihw-hse-247.pdf.aspx?inline=true
• 3 Kmietowicz Z. A&E attendances in England are growing twice as fast as population. BMJ 2018; 362: k3921
• 4 Lawless J, Government of Ireland, Ed. Spending Review 2019. Emergency Departments: Trends 2014–2017. 2019 Oct: 2. Available from (date: 08.11.2021): https://assets.gov.ie/35505/6b8ff6f412464e7aac78f9159c9373b2.pdf
• 5 Vilpert S; Schweizerisches Gesundheitsobservatorium (Obsan), Hrsg. Konsultationen in Schweizer Notfallstationen. Obsan Bulletin 2013. Neuchâtel: Schweizerisches Gesundheitsobservatorium; 2013 Available from (date: 09.02.2020): www.obsan.admin.ch/sites/default/files/publications/2015/obsan_bulletin_2013-03_d.pdf
• 6 Morley C, Unwin M, Peterson GM. et al. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One 2018; 13: 1-42
• 7 Merçay C; Observatoire suisse de la santé (Obsan), Ed. Le recours aux services d’urgence en Suisse. Description des différences cantonales. Obsan Dossier 2018; 64: 7. Available from (date: 09.02.2020): www.obsan.admin.ch/sites/default/files/publications/2018/obsan_dossier_64_0.pdf
• 8 Borczuk P. An evidence-based approach to the evaluation and treatment of low back pain in the emergency department. Emerg Med Pract 2013; 15: 1-23
• 9 Fusco M, Buja A, Furlan P. et al. Older adults in Emergency Department: management by clinical severity at triage. Ann Ig 2014; 26: 409-417
• 10 Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. National Center for Health Statistics; 2017: [tbl p.2o2]. Available from (date: 08.04.2020): www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf
• 11 Edwards J, Hayden J, Asbridge M. et al. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord 2017; 18: 143
• 12 Kamper SJ, Logan G, Copsey B. et al. What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments. Pain 2020; 161: 694-702
• 13 Lin I, Wiles L, Waller R. et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med 2020; 54: 79-86
• 14 Anaf S, Sheppard LA. Describing physiotherapy interventions in an emergency department setting: an observational pilot study. Accid Emerg Nurs 2007; 15: 34-39
• 15 Lebec MT, Jogodka CE. The physical therapist as a musculoskeletal specialist in the emergency department. J Orthop Sports Phys Ther 2009; 39: 221-229
• 16 Kilner E. What evidence is there that a physiotherapy service in the emergency department improves health outcomes? A systematic review. J Health Serv Res Policy 2011; 16: 51-58
• 17 Sutton M, Govier A, Prince S. et al. Primary-contact physiotherapists manage a minor trauma caseload in the emergency department without misdiagnoses or adverse events: an observational study. J Physiother 2015; 61: 77-80
• 18 Lefmann SA, Crane JL. Establishing the diverse value of the emergency department physiotherapist. J Physiother 2016; 62: 1-3
• 19 Bird S, Thompson C, Williams KE. Primary contact physiotherapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: an observational study. J Physiother 2016; 62: 209-214
• 20 Kim HS, Strickland KJ, Mullen KA. et al. Physical therapy in the emergency department: A new opportunity for collaborative care. Am J Emerg Med 2018; 36: 1492-1496
• 21 Ferreira GE, Traeger AC, Maher CG. Review article: A scoping review of physiotherapists in the adult emergency department. Emerg Med Australas 2019; 31: 43-57
• 22 Matifat E, Mequignon M, Cunningham C. et al. Benefits of Musculoskeletal Physical Therapy in Emergency Departments: A Systematic Review. Phys Ther 2019; 99: 1150-1166
• 23 Higgs J, Jones M. Clinical decision making and multiple problem spaces. In: Higgs J, Jones MA, Loftus S. et al. ed. Amsterdam: Elsevier; 2008: 4-19
• 24 Turner DW. Qualitative Interview Design: A Practical Guide for Novice Investigators. The Qualitative Report 2010; 15: 754-760
• 25 Brown V, Clarke V. Using thematic analysis in psychology. Qual Res Psycho 2006; 3: 77-101
• 26 Scascighini L, Angst F, Uebelhart D. et al. Translation, transcultural adaptation, reliability and validity of the Patient Satisfaction Questionnaire in German. Physiotherapy 2008; 94: 43-55
• 27 Anaf S, Sheppard LA. Lost in translation? How patients perceive the extended scope of physiotherapy in the emergency department. Physiotherapy 2010; 96: 160-168
• 28 Gill SD, Stella J, McManus L. Consumer preferences regarding physiotherapy practitioners and nurse practitioners in emergency departments – a qualitative investigation. J Interprof Care 2019; 33: 209-215
• 29 Joseph C, Morrissey D, Abdur-Rahman M. et al. Musculoskeletal triage: a mixed methods study, integrating systematic review with expert and patient perspectives. Physiotherapy 2014; 100: 277-289
• 30 Hussenbux A, Morrissey D, Joseph C. et al. Intermediate care pathways for musculoskeletal conditions – are they working? A systematic review. Physiotherapy 2015; 101: 13-24
• 31 Samsson KS, Bernhardsson S, Larsson ME. Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial. BMC Musculoskelet Disord 2016; 17: 257
• 32 Downie A, Hancock M, Jenkins H. et al. How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years. Br J Sports Med 2019;
• 33 Schulz P, Prescott J, Shifman J. et al. Comparing patient outcomes for care delivered by advanced musculoskeletal physiotherapists with other health professionals in the emergency department-A pilot study. Australas Emerg Nurs J 2016; 19: 198-202
• 34 Lentz TA, Beneciuk JM, George SZ. Prediction of healthcare utilization following an episode of physical therapy for musculoskeletal pain. BMC Health Serv Res 2018; 18: 648
• 35 Pollack CV, Viscusi ER. Improving acute pain management in emergency medicine. Hosp Pract (1995) 2015; 43: 36-45
• 36 Lau PM, Chow DH, Pope MH. Early physiotherapy intervention in an Accident and Emergency Department reduces pain and improves satisfaction for patients with acute low back pain: a randomised trial. Aust J Physiother 2008; 54: 243-249
• 37 Sun E, Moshfegh J, Rishel CA. et al. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open 2018; 1: e185909
• 38 Tanabe P, Thomas R, Paice J. et al. The effect of standard care, ibuprofen, and music on pain relief and patient satisfaction in adults with musculoskeletal trauma. J Emerg Nurs 2001; 27: 124-131
• 39 Sakamoto JT, Ward HB, Vissoci JRN. et al. Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis. Acad Emerg Med 2018;
• 40 Coyle J, Gill SD. Acceptance of primary practitioner physiotherapists in an emergency department: A qualitative study of interprofessional collaboration within workforce reform. J Interprof Care 2017; 31: 226-232
• 41 Ferreira GE, Traeger AC, OʼKeeffe M. et al. Staff and patients have mostly positive perceptions of physiotherapists working in emergency departments: a systematic review. J Physiother 2018; 64: 229-236
• 42 Valuation of Physiotherapy Services in Canada; CPA report using MCDA analysis for determining value of physiotherapy services; Mitton G; Dionne F. 2012. Available from (date: 09.02.2020): www.physiotherapy.ca/sites/default/files/valuePT/cpa_valuept_erdept-en.pdf
• 43 Hoskins R. Evaluating new roles within emergency care: a literature review. Int Emerg Nurs 2011; 19: 125-140
• 44 Taylor NF, Norman E, Roddy L. et al. Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial. Physiotherapy 2011; 97: 107-114