Physiotherapists with musculoskeletal training in an emergency department for patients with non-specific low back pain: A service evaluation

Abstract

Objectives: To evaluate the effectiveness of musculoskeletal physiotherapy management of non-specific low back pain in an emergency department. Design: Observational retrospective analysis of data from emergency department database collected during a period of 6 months. Setting: The emergency department in Malta’s main acute general hospital. Participants: All adults that visited the emergency department with non-specific low back pain, excluding admissions, fractures and serious pathology. Interventions: Management of non-specific low back pain by musculoskeletal physiotherapists was compared to management by emergency medical doctors. Mean percentages were calculated relative to total number of patients for equal comparison. Main Outcome Measures: (1) referrals for x-rays, (2) referrals to orthopaedic out-patients, (3) return rates with the same condition during the study period. Results: Out of 1125 patients admitted to the emergency department with non-specific low back pain in 6 months, 14.6% were seen by a physiotherapist with 49.1% attending after physiotherapy service hours. Outcome comparison revealed minimal difference for x-ray and orthopaedic referrals but a noticeable difference in return rates with 1% of patients returning after seeing a physiotherapist and 5.7% when seen by a medical doctor only. Conclusion: Findings suggest that physiotherapy management of non-specific low back pain in an emergency department have similar outcomes to medical management with less referrals for x-rays and lower return rates and more referrals for orthopaedic follow-up. It is noteworthy that medical doctors and physiotherapists have similarly low referral rates to orthopaedic follow-up and x-rays. Current study only used data from one centre which affects the generalisability of the findings. Further patient-oriented research would reveal clearer outcomes on the quality of the service.