J L Citroen, M G King, E C Bell, D Crompton, A Semciw
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引用次数: 0
Abstract
Objective: To determine if physiotherapy input in the Emergency Department (ED) impacts patient re-presentation rates.
Design: Systematic review with meta-analysis and meta-regression.
Methods: Three electronic databases (Medline (Ovid), EMBASE (Ovid) and CINAHL) were searched from inception to November 16th, 2025. Included articles were peer-reviewed randomised controlled trials, observational studies or audits evaluating re-presentation rates for physiotherapy intervention in ED compared to an ED physician. Risk of bias was assessed using The Newcastle-Ottawa Scale The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess level of evidence for the meta-analysis.
Results: Sixteen studies were included in the systematic review. Overall pooled results from ten studies included in the 30-day re-presentation meta-analysis provided low-quality evidence of no difference in the risk of re-presentation following physiotherapy intervention compared with ED physician management (RR 1.04, 95% CI 0.69-1.55). Subgroup analysis by presenting condition demonstrated a lower risk of 30-day re-presentation following physiotherapy intervention for fall presentations (RR 0.66, 95% CI 0.59-0.74), with no differences observed for musculoskeletal presentations (RR 1.17, 95% CI 0.61-2.22) or general ED presentations (RR 0.93, 95% CI 0.66-1.33) compared with ED physician management.
Conclusion: Irrespective of included condition, physiotherapy intervention in ED does not increase the risk of re-presentation within 30 days of initial presentation, and potentially reduces re-presentation rates for fall patients. Further research is required to determine the most effective component of physiotherapy intervention to reduce re-presentation rates and its impact on ED crowding.
目的：探讨急诊科（ED）的物理治疗投入是否会影响患者的再就诊率。设计：采用荟萃分析和荟萃回归进行系统评价。方法：检索自建库至2025年11月16日的Medline （Ovid）、EMBASE （Ovid）和CINAHL三个电子数据库。纳入的文章是同行评议的随机对照试验、观察性研究或审计，评估了与ED医生相比，物理治疗干预在ED中的再呈现率。使用纽卡斯尔-渥太华量表评估偏倚风险，使用建议评估、发展和评价分级（GRADE）工具评估meta分析的证据水平。结果：16项研究被纳入系统评价。纳入30天再发病荟萃分析的10项研究的总体汇总结果提供了低质量的证据，表明物理治疗干预后再发病的风险与ED医生管理相比没有差异（RR 1.04, 95% CI 0.69-1.55）。根据病情进行的亚组分析显示，物理治疗干预后30天再次出现跌倒症状的风险较低（RR 0.66, 95% CI 0.59-0.74），肌肉骨骼症状（RR 1.17, 95% CI 0.61-2.22）或普通ED症状（RR 0.93, 95% CI 0.66-1.33）与ED医生治疗相比无差异。结论：无论纳入的条件如何，ED的物理治疗干预不会增加初次发病后30天内再发病的风险，并可能降低跌倒患者的再发病率。需要进一步的研究来确定物理治疗干预的最有效组成部分，以减少再出现率及其对ED拥挤的影响。
期刊介绍：
Australasian Emergency Care is an international peer-reviewed journal dedicated to supporting emergency nurses, physicians, paramedics and other professionals in advancing the science and practice of emergency care, wherever it is delivered. As the official journal of the College of Emergency Nursing Australasia (CENA), Australasian Emergency Care is a conduit for clinical, applied, and theoretical research and knowledge that advances the science and practice of emergency care in original, innovative and challenging ways. The journal serves as a leading voice for the emergency care community, reflecting its inter-professional diversity, and the importance of collaboration and shared decision-making to achieve quality patient outcomes. It is strongly focussed on advancing the patient experience and quality of care across the emergency care continuum, spanning the pre-hospital, hospital and post-hospital settings within Australasia and beyond.
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