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FOTO Rehab Outcomes Blog

Physiotherapy for Neck and Back Pain Delivered in Emergency Department


About 5-6 years ago, I remember the first time I heard a discussion revolving around having physical therapists floating in the emergency department. The abstract below is a bit vague as to whether patients received services from a physiotherapist in the emergency department. 

What this abstract does highlight is the benefit of non-invasive care as the first line of care for people who have neck and back pain. With value based purchasing does including a model that includes physical therapists as a first line provider of care for non-traumatic musculoskeletal complaints? I'm confident that shifting care models will take extra work and communication due to current patient expectations. It's not easy to promote minimalistic care in a world that believes more is better.

Below you will find a quick view of the abstract. 


Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain.




Musculoskeletal complaints, especially non-traumatic neck and back pain, are routinely encountered in the emergency department (ED) and lead to ED overcrowding, a burgeoning wait time for physiotherapy and outpatient orthopedic reviews. The study aimed to evaluate the impact of early physiotherapy evaluation and treatment (EPET) vs. standard care (SC) on clinical outcomes for patients presenting to the ED with non-traumatic neck and back pain.


A retrospective observational study of 125 patients who presented to the ED with non-traumatic neck and back pain with/without peripheral symptoms from July 2010 to February 2011. Neck Disability Index (NDI), Modified Oswestry Low Back Pain Disability Questionnaire (MODI) and 11-point Numeric Pain Rating Scale were used as outcome measures and compared between groups at a mean of 34 days from their initial ED visit.


We identified a total of 125 patients. EPET group comprised 62 patients (mean age, 45 years; men, 63%) and SC group comprised 63 patients (mean age, 45 years; men, 43%). The EPET and SC groups received physiotherapy at a median of 4 and 34 days respectively from their first ED visit. EPET patients had significantly lower levels of disability (9.0% vs. 33.4%, Welch t-test, P<0.001) and pain (median value, 1 vs. 4 points, Mann-Whitney U-test, P<0.001) compared with SC patients.


Early access to physiotherapy in ED was associated with reduced pain and disability levels. EPET protocol can potentially decrease the demand on outpatient orthopedic services, thereby freeing up available resources to treat patients who are more likely to benefit from it.

2017;8(2):110-115. doi: 10.5847/wjem.j.1920-8642.2017.02.005.