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Matifat E, Mequignon M, Cunningham C, et al. Benefits of Musculoskeletal Physical Therapy in Emergency Departments: A Systematic Review. Phys Ther. 2019 Sep 1;99(9):1150-1166. doi: 10.1093/ptj/pzz082. (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.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

The major weakness of this study design for physical therapists living in the United States is that there were no studies included from US settings. Reducing health care costs and increasing efficiencies of ER in the US is very relevant and timely. Perhaps this study could prompt a shift in practice acts here in the US and change the ER model here in the US as well.
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