Frontline agreement in diagnosis and treatment for musculoskeletal dysfunctions. A prospective, randomized, controlled study.

Abstract

Introduction: Due to shortages of general practitioners and increasing emergency department (ED) presentations for non-urgent musculoskeletal conditions (MSKDs), Advanced Physiotherapy Practice (APP) roles have been implemented internationally. However, this model remains novel in Switzerland. This study evaluated agreement in diagnosis, treatment, and discharge decisions between physiotherapists and resident physicians compared with senior physicians as the reference standard in the ED of Bethesda Hospital Basel (BSAG).

Methods: A randomized controlled trial was conducted from October to December 2023. Patients presenting musculoskeletal complaints without evidence of serious pathology were allocated to either an intervention group managed by physiotherapists or a control group receiving standard care by resident physicians. Clinical decisions from both groups were reviewed by senior physicians. Agreement was assessed using Cohen's Kappa (κ) and Gwet's AC1 statistics.

Results: A total of 102 patients were included (mean age 52 years, SD 16.3; 61% female; 51% with low back pain). Physiotherapists demonstrated good to excellent agreement with senior physicians for diagnosis (κ = 0.72-0.96; AC1 = 0.73-0.97) and management (κ = 0.69-0.88; AC1 = 0.71-0.89). Residents showed high agreement for diagnosis (κ = 0.85; AC1 = 0.86) and perfect agreement for management (κ = 1.00; AC1 = 1.00). No adverse events occurred. Patient satisfaction was higher in the physiotherapy group (mean 4.79 vs. 4.19/5).

Conclusion: Experienced physiotherapists demonstrated high agreement with senior physicians in diagnosing and managing MSKDs in the ED. APP appears safe and may improve patient satisfaction without increasing adverse events.