Diagnostic Concordance Between Physiotherapist and Emergency Physicians for Patients With a Musculoskeletal Disorder in the Emergency Department

Abstract

Background: Many patients present to the emergency department (ED) with a musculoskeletal disorder. In consequence, some hospitals have integrated autonomous management of musculoskeletal disorders by physiotherapists after triage. Although potential benefits were demonstrated, few studies have examined the agreement between physiotherapists' and emergency physicians' diagnosis. A better understanding of diagnostic concordance between physiotherapists and emergency physicians could inform the implementation of this care model. Methods and Findings: Secondary analysis of data obtained through a pilot pragmatic randomised clinical trial. Data from patients presenting a minor musculoskeletal disorder managed by a physiotherapist and an emergency physician were used. Diagnostic concordance was examined using raw agreement and Gwet's first-order agreement coefficient. Thirty-six participants were assessed by both professionals (36.8 ± 18.2 years; W: 55.6%). Overall raw agreement was 86.1% and the diagnostic concordance was almost perfect (Gwet's AC1: 0.84, 95% CI: 0.69–0.98). The most common disagreement was when physiotherapists suspected a bone fracture or contusion, whereas emergency physicians diagnosed a ligament or meniscus disorder. Conclusions: Our results show excellent diagnostic concordance between physiotherapists and emergency physicians, thus supporting the safety of physiotherapy care in the ED. More studies are needed to confirm these results with a larger variety of diagnoses and age strata.