Overcrowding in emergency departments (ED) is a major concern worldwide. To answer increasing health care demands, new models of care including advanced practice physiotherapists (APP) have been implemented in EDs. The purpose of this study was to assess diagnostic, treatment and discharge plan concordance between APPs and ED physicians for patients consulting to the ED for minor musculoskeletal disorders (MSKD). Patients presenting to two EDs in Montréal (Canada) with a minor MSKD were recruited and independently assessed by an APP and ED physician. Both providers had to formulate diagnosis, treatment and discharge plans. Cohen’s kappa (κ) and Prevalence and Bias Adjusted Kappas (PABAK) with associated 95%CI were calculated. Chi Square and t-tests were used to compare treatment, discharge plan modalities and patient satisfaction between providers. One hundred and thirteen participants were recruited, mean age was 50.3 ± 17.4 years old and 51.3% had an atraumatic MSKD. Diagnostic inter-rater agreement between providers was very good (κ = 0.81; 95% CI: 0.72–0.90). In terms of treatment plan, APPs referred significantly more participants to physiotherapy care than ED physicians (κ = 0.27; PABAK = 0.27; 95% CI: 0.07–0.45; p = 0.003). There was a moderate inter-rater agreement (κ = 0.46; PABAK = 0.64; 95% CI: 0.46–0.77) for discharge plans. High patient satisfaction was reported with no significant differences between providers (p = 0.57). There was significant agreement between APPs and ED physicians in terms of diagnosis and discharge plans, but more discrepancies regarding treatment plans. These results tend to support the integration of APPs in ED settings, but further prospective evaluation of the efficiency of these types of models is warranted.

中文翻译：

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物理治疗师与医生之间就急诊科肌肉骨骼疾病患者的护理达成一致

紧急部门（ED）的人满为患是全球主要关注的问题。为了满足日益增长的医疗保健需求，急诊室采用了包括高级物理治疗师（APP）在内的新护理模式。这项研究的目的是评估APP和ED医师之间就轻度肌肉骨骼疾病（MSKD）咨询ED的患者之间的诊断，治疗和出院计划的一致性。招募了在蒙特利尔（加拿大）有两名MSKD的两名急诊科就诊的患者，并由APP和ED医师进行了独立评估。两家医疗机构都必须制定诊断，治疗和出院计划。计算了Cohen的κ（κ）以及患病率和偏倚调整的Kappas（PABAK）及其相关的95％CI。卡方检验和t检验用于比较提供者之间的治疗，出院计划方式和患者满意度。招募了113名参与者，平均年龄为50.3±17.4岁，有51.3％患有无创伤性MSKD。提供者之间的诊断性评分者之间的一致性非常好（κ= 0.81； 95％CI：0.72-0.90）。在治疗计划方面，APPs较ED医师对理疗护理的参与者要多得多（κ= 0.27； PABAK = 0.27； 95％CI：0.07–0.45； p = 0.003）。出院计划的评估者之间达成了中等协议（κ= 0.46； PABAK = 0.64； 95％CI：0.46-0.77）。据报道，患者满意度高，提供者之间无显着差异（p = 0.57）。APPs和ED医师在诊断和出院计划方面达成了显着共识，但在治疗计划方面存在更多差异。这些结果倾向于支持将应用程序集成到ED设置中，