Effect of involving physiotherapists in the management of low back pain at emergency departments: a systematic review

Objectives: To conduct a systematic review investigating the effects of physiotherapy in emergency departments (EDs) on health care use and patient-reported outcomes for patients referred to EDs due to low back pain (LBP), compared with usual care. Methods: A search was conducted in PubMed, Cinahl and Embase in April 2023, and rerun in September 2024. Randomised and quasi-randomised trials and observational studies including adult patients referred to an ED due to LBP were eligible. Study quality was assessed using ROBINS-I and PEDro, and the strength of the evidence was assessed using GRADE. Results: Included studies were three retrospective cohorts, two prospective cohorts and two randomised controlled trials, totalling 4,057 patients. Four of six studies were rated as serious risk of bias, primarily due to limitations in the study design, two studies were rated as moderate risk, and one as low risk. Overall, the studies indicated a positive effect of ED physiotherapy in comparison with usual care in relation to length of stay, imaging and patient satisfaction. For the remaining outcomes on health-care use and patient-reported outcomes, findings were inconclusive. For all outcomes, the certainty of the evidence was considered very low or low. Conclusions: The present review indicates that there may be beneficial effects of involving PTs in the management of patients with LBP in EDs. However, given the very low certainty of evidence the findings should be interpreted with great caution. Future high level evidence studies in the field should therefore be a priority. Registration number PROSPERO: CRD42023420107. Contribution of the Paper: • With this study a thorough description and overview is given of the seven existing studies on physiotherapy management of low back pain in an emergency setting. • Although studies indicate a potentially beneficial effect on patient satisfaction and health care use, the systematic review reveals that existing studies are generally of poor quality, with a low to very low certainty of the evidence. • Very poor descriptions of required level of training of physiotherapists as well as organisation of care pathways are provided in the existing literature. • High quality trials with detailed intervention descriptions are needed if we are to make robust conclusions on the contributions of physiotherapy management of patients with low back pain in emergency settings. © 2024 The Author(s)