Emergency Department Physiotherapist Reduces Use of Opioids & Imaging

It’s a common misconception that physiotherapy is not for acute injuries. In fact, physiotherapists have a lot to offer regardless of the age of an injury - whether it’s from the sidelines of the game or for an injury that happened years ago and never healed correctly. A recent, first-of-its-kind study sheds some light on this.  

While not unusual in Australia, dedicated emergency department physiotherapists remain relatively new. The concept is novel in other parts of the world. Data continues to emerge regarding how it affects care and patient outcomes. Recently, PLoS One published a first-of-its-kind study in this area.¹ Dr. Andrew Pugh and colleagues prospectively tracked patients presenting with musculoskeletal pain to an urban academic emergency department (ED). This emergency department used a dedicated physiotherapist only three days a week. The scenario enabled researchers to compare patients denied ED physio to patients afforded ED physio. Most patients presented with cervical, thoracic, or lumbar pain.

Patients afforded access to a physiotherapist proved 25% less likely to receive imaging and 47% less likely to receive opioids. They also got in and out of the ED 39% faster. The subset of ED patients with low back pain received imaging 56% less often. These results echo studies in outpatient care showing that access to physiotherapy for musculoskeletal pain, especially prompt access to physiotherapy, lowers costs, rates of advanced imaging, the need for injections, and the need for surgery, while raising patient satisfaction.^2-6 

Immediate access to physiotherapy gives people with musculoskeletal pain a musculoskeletal specialist for assessment, safe early mobility, and time dedicated to education and reassurance. Even among patients with concerns severe enough to merit an ED visit, many can be helped and satisfied with conservative approaches and without opioids, when a musculoskeletal specialist is available. Outpatient physiotherapy is no substitute for an ED. Physiotherapists in an ED can quickly refer medical cases to the ED physicians. However, the current study reaffirms that many outpatient cases of acute musculoskeletal pain are appropriate for physiotherapy right away. As clinical guidelines indicate, physiotherapy is not a last resort approach after imaging, strong analgesics, waiting, etc.^7-9 Physiotherapy works best for patients and payors when delivered as early as possible in the course of treating musculoskeletal pain.

 

References

1. Pugh A, Roper K, Magel J, Fritz J, Colon N, Robinson S, Cooper C, Peterson J, Kareem A, Madsen T. Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study. PLoS One. 2020 Apr 23;15(4):e0231476.
2. Arnold E, La Barrie J, DaSilva L, Patti M, Goode A, Clewley D. The impact of timing of physical therapy for acute low back pain on health services utilization: a systematic review. Archives of Physical Medicine and Rehabilitation. 2019.
3. Childs JD, Fritz JM, Wu SS, Flynn TW, Wainner RS, Robertson EK, Kim FS, George SZ. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Services Research. 2015 Jun;15(1):150.
4. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine. 2012 Dec 1;37(25):2114-21.
5. Nordeman L, Nilsson B, Möller M, Gunnarsson R. Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial. The Clinical Journal of Pain. 2006 Jul 1;22(6):505-11.
6. Fritz JM, Lane E, McFadden M, Brennan G, Magel JS, Thackeray A, Minick K, Meier W, Greene T. Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica: A Randomized Controlled Trial. Annals of Internal Medicine. 2020 Oct 6.
7. Chou R, Qaseem A, Snow V, Casey D, Cross Jr JT, Shekelle P, Owens DK. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007 Oct 2;147(7):478-91.
8. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017 Apr 4;166(7):514-30.
9. O'Connell NE, Cook CE, Wand BM, Ward SP. Clinical guidelines for low back pain: a critical review of consensus and inconsistencies across three major guidelines. Best practice & research Clinical Rheumatology. 2016 Dec 1;30(6):968-80.