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Abstract

Purpose: Extended scope physiotherapists (ESPs) are an innovative approach to service delivery that have emerged in response to increasing pressures on emergency departments (EDs). While previous systematic reviews have suggested that ESPs have a positive impact on ED outcomes, clinical practice recommendations based on limited evidence highlight a pressing need for evaluation studies to truly determine their effectiveness and safety in this setting. Therefore, the objective of this systematic review and meta-analysis was to evaluate the clinical effectiveness and safety of ESPs when delivering services in EDs. Method: Systematic literature searches were conducted using the online databases: Medline (Ovid), CINAHL (EBSCOhost), Scopus, PEDro, Cochrane Library and Informit in October, 2019. Randomised controlled trials (RCTs) or cohort studies investigating the clinical effectiveness and safety of ESPs in EDs in comparison with usual ED medical care providers were eligible for inclusion. Data extraction was completed using a form specifically developed for the study. The quality of each study was assessed using the Crowe Critical Appraisal Tool (CCAT) as well as a subjective assessment of bias, and the level of evidence was graded using the National Health and Medical Research Council (NHMRC) evidence hierarchy. Random-effects model meta-analyses were conducted using Stata (version 16.1). Results: Eleven studies met the inclusion criteria for the systematic review. These studies provided III-1 to III-3 evidence, with quality scores ranging from 50% to 93%. Consistent positive results were found regarding ESP clinical effectiveness and safety with meta-analyses demonstrating significant reductions in wait time (Cohen’s d effect size: -0.54; 95% confidence interval [CI]: -0.64 to -0.45) and length of stay (Cohen’s d effect size: -0.79; 95% CI: -0.86 to -0.72) for patients managed by ESPs. Although, confounding of results by treatment urgency made it difficult to establish a clear causal link between ESP services and outcomes. Conclusion: Although it was not able to be suggested that ESPs are an appropriate substitute for usual ED medical care due to the presence of bias and confounding, the results highlighted that ESPs, as an additional staff member in EDs, improve throughput and access to care for patients in lower urgency triage categories.

Author Bio(s)

Brittany Souter, BPhysio(Hons), is a physiotherapist who graduated with First Class Honours from James Cook University in 2020. Her current research interests include extended scope of practice physiotherapy and self-efficacy.

Dr Anne Jones, BSc(Physiotherapy), MPhysiotherapy (rural and remote), GC Health Science (Education), PhD, is an associate lecturer in physiotherapy at James Cook University. She has extensive clinical experience in all areas of physiotherapy with a focus on rural and hospital based practice. Her research interests include cardiorespiratory, renal, simulation, self-efficacy, rural and remote health service delivery and paediatrics.

Lorraine Sheppard, BAppSc (Physio), MBA, PhD, is a professor of physiotherapy and healthcare management, and former Head of the School of Physiotherapy at the University of South Australia. She has also been continuously involved with the Australian Physiotherapy Association, Physiotherapy Board of South Australia and the Australian Physiotherapy Council for more than 20 years.

Dr Michael Crowe, PhD, MBioStat, MInfoTech, BSc (Mgmt), ADMT, is an Adjunct Senior Research Fellow at James Cook University, Australia. He is a biostatistician and research methodologist. His research interests include research methodologies, psychometrics, and health workforce issues. He also has a background working in information technology and survey research.

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