[Impact of models of care integrating direct access to physiotherapy in primary care and emergency care contexts in patients with musculoskeletal disorders: A narrative review]

Rehabilitation in emergency departments: A regional scan and future opportunities

Emergency Departments (EDs) have faced mounting pressures in recent years as greater volumes of patients seek care, many with increasingly complex clinical and social needs. However, the potential contributions of rehabilitation professionals to help alleviate these pressures in the ED are not well understood or leveraged. To address this knowledge gap, the authors conducted a literature review of rehabilitation models of care and the impact of rehabilitation professionals in the ED, as well as an environmental scan to understand rehabilitation models of care across two large regions in Ontario. This article outlines these findings, as well as future opportunities related to leading care and patient flow practices based on rehabilitation models in the ED.

Physiotherapists' perspectives on the implementation of direct access to physiotherapy services in Saudi Arabia: a cross-sectional study

OBJECTIVE

This study investigates Saudi Arabian physiotherapists' perspectives on direct access to physiotherapy (DAPT) services, focusing on perceived benefits, barriers and implementation in clinical practice.

METHODS

A cross-sectional observational study design was used. Data collection occurred between December 2022 and June 2023 via an online structured questionnaire distributed through email and text messages. The DAPT section comprised items on awareness, endorsement, obstacles/barriers to implementation in Saudi Arabia, perceived benefits and expected benefits of various resources to guide evidence-based practice for physiotherapists. This section featured closed-ended questions using a 5-point Likert scale. The study included licensed physiotherapists currently working in Saudi Arabia.

RESULTS

The study included 401 participants, with a nearly equal distribution of 203 males (50.6%) and 198 females (49.4%). The most common age group was 25-34 years, comprising 70.6% of the participants. A significant proportion (61.6%) were aware of DAPT, and 88% acknowledged its potential to reduce delays in care. However, 49.9% had not engaged with relevant literature. The primary barriers to DAPT identified were laws and regulations (mean=3.69, SD=1.21), physician support (mean=3.59, SD=0.99), entry-level education (mean=3.45, SD=1.17), patient beliefs (mean=3.38, SD=1.24), self-confidence (mean=3.35, SD=1.15) and professional autonomy (mean=3.34, SD=1.22).

CONCLUSION

Physiotherapists in Saudi Arabia demonstrate substantial awareness of direct access. Organisational initiatives and increased awareness are essential to promote direct access. This study highlights that direct patient access to physiotherapists offers significant benefits to patients, healthcare workers and the broader community.

Can Haglund's Syndrome Be Misdiagnosed as Low Back Pain? Findings from a Case Report in Physical Therapy Direct Access

Background: Haglund’s syndrome (HS) is a painful condition that is caused by an exostosis of the posterior superior part of the calcaneus coupled with Achilles tendinopathy and retrocalcaneal bursitis. Both for the proper musculoskeletal assessment and for the differential diagnosis process of possible concurrent diseases deriving from other anatomical areas, the diagnosis of HS is still a challenge. Case Presentation: A 41-year-old male amateur runner was diagnosed and treated for low back pain and referred leg pain by his general practitioner. Due to ineffective results, he self-presented to a physical therapist (PT) with intense right heel pain, radiating up to the leg and to the lumbopelvic region. Results: The PT’s examination and interview relating to the sports activities led to the correct diagnosis and a proper orthopedic referral. At the one-year follow-up, the patient reported regular pain-free marathon running. Discussion: This case report highlights the central role of PTs working in direct access environments as primary care healthcare professionals for the management of musculoskeletal diseases, and their abilities in identifying patients with suspected pathologic conditions that may need referral for imaging, medical assessment or surgical intervention.