Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study

BACKGROUND: Emergency department based Physical Therapy (ED-PT) has been practiced globally in various forms for over 20 years and is an emerging resource in the US. While there is a growing body of evidence suggesting that ED-PT has a positive effect on a number of clinical and operational outcomes in patients presenting with musculoskeletal (MSK) pain, there are few published narratives that quantify this in the US. Although there are international papers that offer outcome data on reduction of pain, imaging, throughput time, and the ability of physical therapists to appropriately manage MSK conditions in the ED setting, most papers to date have been descriptive in nature. The purpose of this study is to assess the impact of ED-PT on imaging studies obtained, rates of opioids prescribed, and ED length of stay. METHODS: We prospectively identified patients presenting with musculoskeletal pain to an urban academic ED in Salt Lake City between January 2017 and June 2018. During the study, a physical therapist was in the ED three days (24 hours) per week and was available to evaluate and treat patients after consultation by the ED provider. We noted patient demographic information, imaging performed in the ED, medications administered and prescribed, and ED length of stay. We classified patients as those who received PT in the ED and those who did not and compared clinical outcomes between groups. We performed a subgroup analysis of patients presenting with low back pain and matched patients by age and gender. RESULTS: Over the 18-month study period, we identified 524 patients presenting to the ED with musculoskeletal pain. 381 (72.7%) received ED-initiated PT. The PT and non-PT groups were similar in average age (42.8 years vs. 45.1 years, p = 0.155), gender (% female: 53% vs. 46.9%, p-0.209), and primary presenting chief complaint (cervical, thoracic, or lumbar pain: 57.7% vs. 53.1%, p = 0.345). Patients who received PT had lower rates of imaging (38.3% vs. 51%, p = 0.009), ED opioid administration (17.5% vs. 32.9%, p<0.001), and a shorter average ED length of stay (4 hours vs. 6.2 hours, p<0.001). Rates of outpatient opioid prescriptions were similar between groups (16% vs. 21.7%, p = 0.129). In a subgroup analysis of patients presenting with low back pain, we found that PT patients had fewer imaging studies (PT 25% vs. non-PT 57%, p = 0.029) but found no difference in average ED length of stay (PT 3.7 hours vs. non-PT 4.6 hours, p = 0.21), opioid administration in the ED (PT 36% vs. non-PT 43%, P = 0.792), nor outpatient opioid administration (PT 17.9%. vs non-PT 17.9%, p = 1.0). CONCLUSION: In our experience, being seen by a physical therapist for MSK pain within the ED was associated with reduced use of imaging and time spent in the ED. Patients seeing a Physical Therapist were also less likely to receive an opioid prescription within the ED, a potentially significant finding given the need for opioid reduction strategies.