What evidence is there that a physiotherapy service in the emergency department improves health outcomes? A systematic review

Objective: The nature of care delivered in emergency departments has changed due to increased demand. In response, one relatively new change is the introduction of a physiotherapy service. There have been anecdotal reports that this may reduce patient waiting times and lead to more effective use of other health care staff, though it is unclear how such a service affects health outcomes. The objective was to identify the effect an emergency department physiotherapy service has on health outcomes. Method: Systematic searches were carried out on the following databases: CINAHL, Med line, Web of Knowledge, Scopus, PEDro, Pub Med, Cochrane and Academic Search Premier. Selection criteria included full-text English primary studies published in peer-reviewed journals, investigating physiotherapy services based directly in the emergency department. Papers were appraised using a researcher-developed appraisal of bias tool. Results: Eleven eligible primary studies were identified. For most, the likelihood of methodological bias was high or unknown due to inadequate detail provided. Three studies were judged to have introduced little bias. At system and provider levels, there is insufficient evidence to support benefits of an emergency department physiotherapy service. At patient level, there is high-level evidence of benefits in terms of improved pain control and reduced disability in the short term. Conclusions: Research evidence does not support the use of physiotherapists in emergency departments. Journal of Health Services Research & Policy Vol 16 No 1, 2011: 51-58 (C) The Royal Society of Medicine Press Ltd 2011