{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:46:23Z","timestamp":1782985583745,"version":"3.54.5"},"reference-count":41,"publisher":"Aboutscience Srl","issue":"1","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch. Physioter"],"abstract":"<jats:p>Introduction: Due to shortages of general practitioners and increasing emergency department (ED) presentations for nonurgent musculoskeletal conditions (MSKDs), Advanced Physiotherapy Practice (APP) roles have been implemented internationally. However, this model remains novel in Switzerland. This study evaluated agreement in diagnosis, treatment, and discharge decisions between physiotherapists and resident physicians compared with senior physicians as the reference standard in the ED of Bethesda Hospital Basel (BSAG).Methods: A randomized controlled trial was conducted from October to December 2023. Patients presenting musculoskeletal complaints without evidence of serious pathology were allocated to either an intervention group managed by physiotherapists or a control group receiving standard care by resident physicians. Clinical decisions from both groups were reviewed by senior physicians. Agreement was assessed using Cohen\u2019s Kappa (\u03ba) and Gwet\u2019s AC1 statistics.Results: A total of 102 patients were included (mean age 52 years, SD 16.3; 61% female; 51% with low back pain). Physiotherapists demonstrated good to excellent agreement with senior physicians for diagnosis (\u03ba = 0.72-0.96; AC1 = 0.73-0.97) and management (\u03ba = 0.69-0.88; AC1 = 0.71-0.89). Residents showed high agreement for diagnosis (\u03ba = 0.85; AC1 = 0.86) and perfect agreement for management (\u03ba = 1.00; AC1 = 1.00). No adverse events occurred. Patient satisfaction was higher in the physiotherapy group (mean 4.79 vs. 4.19\/5).Conclusion: Experienced physiotherapists demonstrated high agreement with senior physicians in diagnosing and managing MSKDs in the ED. APP appears safe and may improve patient satisfaction without increasing adverse events.<\/jats:p>","DOI":"10.33393\/aop.2026.3586","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:05:44Z","timestamp":1782983144000},"page":"116-129","source":"Crossref","is-referenced-by-count":0,"title":["Frontline agreement in diagnosis and treatment  for musculoskeletal dysfunctions. A prospective,  randomized, controlled study"],"prefix":"10.33393","volume":"16","author":[{"given":"Birol","family":"Zeybeker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8662-6116","authenticated-orcid":false,"given":"Roger","family":"Hilfiker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3214-5442","authenticated-orcid":false,"given":"Amir","family":"Tal-Akabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"18642","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"18818","unstructured":"1. Hostettler S, Kraft E. FMH-\u00c4rztestatistik. Die Schweiz muss mehr \u00c4rztinnen und \u00c4rzte ausbilden, wenn sie nicht weiter vom Ausland abh\u00e4ngig sein will. Das zeigt die Statistik. Was sie auch zeigt: die Medizinerinnen und Mediziner werden \u00e4lter und arbeiten zunehmend in Teilzeit. Problematisch ist, dass es zu wenige Haus\u00e4rztinnen und Haus\u00e4rzte gibt. Schweiz Arzteztg. 2022. https:\/\/www.fmh.ch\/_service\/suche.cfm#q=geringe%20Hausarztdichte"},{"key":"18819","doi-asserted-by":"crossref","unstructured":"2. Veit K. Was beg\u00fcnstigt den Fachkr\u00e4ftemangel? \u2013 Wissenschaft nachgefragt. physiopraxis. Juli 2020;18(07\/08):12\u20133. https:\/\/doi.org\/10.1055\/a-1174-2524","DOI":"10.1055\/a-1174-2524"},{"key":"18820","unstructured":"3. Wunsch C, Buchmann M. Demografischer Wandel versch\u00e4rft Fachkr\u00e4ftemangel. Die Volkswirtschaft; 2019:5. https:\/\/dievolkswirtschaft.ch\/de\/2019\/04\/wunsch-buchmann-05-2019\/?utm_source=chatgpt.com"},{"key":"18821","doi-asserted-by":"crossref","unstructured":"4. Herzog A, Luster M, Keller Lang DI, et al. Emergency depart\u00acment overcrowding: first Swiss application of the Emergency Department Work Index and risk factors for overcrowding. Front Public Health. 2025;13:1691633. https:\/\/doi.org\/10.3389\/fpubh.2025.1691633 https:\/\/pubmed.ncbi.nlm.nih.gov\/41293593","DOI":"10.3389\/fpubh.2025.1691633"},{"key":"18822","unstructured":"5. Vilpert S. Konsultationen in Schweizer Notfallstationen. Obsan Bulletin 2013. Neuch\u00e2tel: Schweizerisches Gesundheitsobser\u00acvatorium. 2013. https:\/\/www.edifix.com\/jobs\/www.obsan.admin.ch\/sites\/default\/files\/publications\/2015\/obsan_bulletin_2013-03_d.pdf. (Accessed May 2025)"},{"key":"18823","doi-asserted-by":"crossref","unstructured":"6. Winteler B, Geese F, Lehmann B, et al. Musculoskeletal phys\u00aciotherapy in the Emergency Department \u2013 evaluation of a new physiotherapy service in a Swiss university hospital. physiosci\u00acence. Juni 2022;18(02):69\u201376. https:\/\/doi.org\/10.1055\/a-1500-1077","DOI":"10.1055\/a-1500-1077"},{"key":"18824","doi-asserted-by":"crossref","unstructured":"7. Hales TR, Bernard BP. Epidemiology of work-related musculo\u00acskeletal disorders. Orthop Clin North Am. 1996;27(4):679-709. https:\/\/doi.org\/10.1016\/S0030-5898(20)32117-9 https:\/\/pubmed.ncbi.nlm.nih.gov\/8823390","DOI":"10.1016\/S0030-5898(20)32117-9"},{"key":"18825","doi-asserted-by":"crossref","unstructured":"8. Dorsett M, Cooper RJ, Taira BR, et al. Bringing value, balance and humanity to the emergency department: the right care top 10 for emergency medicine. Emerg Med J. 1.2020;37(4):240\u20135. https:\/\/doi.org\/10.1136\/emermed-2019-209031 https:\/\/pubmed.ncbi.nlm.nih.gov\/31874920","DOI":"10.1136\/emermed-2019-209031"},{"key":"18826","unstructured":"9. K\u00fcnzi K, J\u00e4ggi J, Dutoit L. Aktueller Stand der schweizerischen Diskussion \u00fcber den Einbezug von hoch ausgebildeten nicht\u00e4rz\u00actlichen Berufsleuten in der medizinischen Grundversorgung: Aktualisierung des Obsan-Arbeitsdokuments 27. Schlussberi\u00accht. Bern: BASS AG; 2013. Available from: https:\/\/www.bag.admin.ch\/dam\/de\/sd-web\/OU8dpfxKqdU2\/2014_bag_2013_schlussbericht_updaten_aktueller_stand_nichtaerzte.pdf?utm_source=chatgpt.com"},{"key":"18827","doi-asserted-by":"crossref","unstructured":"10. Maudsley G, Strivens J. Promoting professional knowledge, experiential learning and critical thinking for medical stu\u00acdents. Med Educ. 2000;34(7):535-544. https:\/\/doi.org\/10.1046\/j.1365-2923.2000.00632.x https:\/\/pubmed.ncbi.nlm.nih.gov\/10886636","DOI":"10.1046\/j.1365-2923.2000.00632.x"},{"key":"18828","unstructured":"11. Physioswiss. Advanced Physiotherapy Practice (APP) 2019 https:\/\/physioswiss.ch\/be\/politik\/advanced-physiotherapy-practice-app\/ (Accessed May 2025)"},{"key":"18829","unstructured":"12. Physioswiss. Positionspapier Swiss Advanced Physiotherapy Practitioner (Swiss APP) 2018 https:\/\/physioswiss.ch\/be\/wp-content\/uploads\/sites\/6\/2018_positionspapier-swiss-app_physioswiss.pdf (Accessed May 2025)"},{"key":"18830","unstructured":"13. World Physiotherapy. Direct access and patient\/client self-referral to physical therapy. 2019. https:\/\/world.physio\/sites\/default\/files\/2020-04\/PS-2019-Direct-access.pdf (Accessed May 2025)"},{"key":"18831","doi-asserted-by":"crossref","unstructured":"14. Ferreira GE, Traeger AC, Maher CG. Review article: a scoping review of physiotherapists in the adult emergency department. Emerg Med Australas. 2019;31(1):43-57. https:\/\/doi.org\/10.1111\/1742-6723.12987 https:\/\/pubmed.ncbi.nlm.nih.gov\/29664184","DOI":"10.1111\/1742-6723.12987"},{"key":"18832","unstructured":"15. Kunz SM. Agreement in diagnosis and treatment management between physiotherapist and physician for patients with mus\u00acculoskeletal disorders: a pilot project [master's thesis]. Bern (CH): Bern University of Applied Sciences (BFH); 2020."},{"key":"18833","doi-asserted-by":"crossref","unstructured":"16. Bird S, Thompson C, Williams KE. Primary contact physiother\u00acapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: an observational study. Journal of Physiotherapy. 2016;62(4):209\u201314. https:\/\/doi.org\/10.1016\/j.jphys.2016.08.005","DOI":"10.1016\/j.jphys.2016.08.005"},{"key":"18834","doi-asserted-by":"crossref","unstructured":"17. de Gruchy A, Granger C, Gorelik A. Physical therapists as pri\u00acmary practitioners in the emergency department: six-month prospective practice analysis. Physical Therapy. 2015;95(9): 1207\u201316. https:\/\/doi.org\/10.2522\/ptj.20130552","DOI":"10.2522\/ptj.20130552"},{"key":"18835","doi-asserted-by":"crossref","unstructured":"18. McClellan CM, Greenwood R, Benger JR. Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department. Emerg Med J. 2006;23(5):384-387. https:\/\/doi.org\/10.1136\/emj.2005.029231 https:\/\/pubmed.ncbi.nlm.nih.gov\/16627842","DOI":"10.1136\/emj.2005.029231"},{"key":"18836","doi-asserted-by":"crossref","unstructured":"19. Sayer JM, Kinsella RM, Cary BA, et al. Advanced musculoskele\u00actal physiotherapists are effective and safe in managing patients with acute low back pain presenting to emergency depart\u00acments. Aust Health Review. 2017;42(3):321\u2013326. https:\/\/doi.org\/10.1071\/AH16211","DOI":"10.1071\/AH16211"},{"key":"18837","doi-asserted-by":"crossref","unstructured":"20. Taylor NF, Norman E, Roddy L, et al. Primary contact physio\u00actherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomized controlled trial. Physiotherapy. 2011;97(2):107- 114. https:\/\/doi.org\/10.1016\/j.physio.2010.08.011 https:\/\/pubmed.ncbi.nlm.nih.gov\/21497244","DOI":"10.1016\/j.physio.2010.08.011"},{"key":"18838","doi-asserted-by":"crossref","unstructured":"21. Richardson B, Shepstone L, Poland F, et al. Randomised con\u00actrolled trial and cost consequences study comparing initial physiotherapy assessment and management with routine practice for selected patients in an accident and emergency department of an acute hospital. Emergency Medicine Journal. 2005;22(2):87\u201392. https:\/\/doi.org\/10.1136\/emj.2003.012294 https:\/\/pubmed.ncbi.nlm.nih.gov\/15662054","DOI":"10.1136\/emj.2003.012294"},{"key":"18839","unstructured":"22. L\u00e4hteenm\u00e4ki ML, Zabal AB, Eckler U, et al. Physiotherapy com\u00acpetencies for autonomous practice: recommendations for educational frameworks. Professional Issues Working Group. Obidos (Portugal): European Network of Physiotherapy in Higher Education (ENPHE); 2022. https:\/\/www.enphe.org\/en\/annals-of-enphe\/physiotherapy-competencies-for-autonmous-practices-recommendations-for-educational-framework (Accessed May 2025)"},{"key":"18840","unstructured":"23. Boissonnault WG, ed. Primary care for the physical thera\u00acpist: examination and triage. 2nd ed. St. Louis, Mo: Elsevier\/ Saunders; 2011. 418 S. https:\/\/shop.elsevier.com\/books\/primary-care-for-the-physical-therapist\/boissonnault\/978-1-4160-6105-2 (Accessed May 2025)"},{"key":"18841","doi-asserted-by":"crossref","unstructured":"24. L\u00fcdtke K, ed. Screening in der Physiotherapie: Das Flaggen- System \u2013 Warnsignale erkennen. 2. Aufl. Stuttgart: Georg Thieme Verlag KG; 2021. https:\/\/eref.thieme.de\/10.1055\/b000000341 (Accessed May 2025)","DOI":"10.1055\/b000000341"},{"key":"18842","doi-asserted-by":"crossref","unstructured":"25. Matifat E, M\u00e9quignon M, Cunningham C, et al. Benefits of musculoskeletal physical therapy in emergency depart\u00acments: a systematic review. Physical Therapy. 1. September 2019;99(9):1150\u201366. https:\/\/doi.org\/10.1093\/ptj\/pzz082","DOI":"10.1093\/ptj\/pzz082"},{"key":"18843","unstructured":"26. K\u00f6hn S. Measuring patient satisfaction in acute care hospitals: nationwide monitoring in Switzerland. 2021;8."},{"key":"18844","doi-asserted-by":"crossref","unstructured":"27. Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33(2):363-374. https:\/\/doi.org\/10.2307\/2529786 https:\/\/pubmed.ncbi.nlm.nih.gov\/884196","DOI":"10.2307\/2529786"},{"key":"18845","doi-asserted-by":"crossref","unstructured":"28. Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85(3):257-268. https:\/\/doi.org\/10.1093\/ptj\/85.3.257 https:\/\/pubmed.ncbi.nlm.nih.gov\/15733050","DOI":"10.1093\/ptj\/85.3.257"},{"key":"18846","doi-asserted-by":"crossref","unstructured":"29. George SZ, Fritz JM, Silfies SP, et al Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(11):CPG1\u201360. https:\/\/doi.org\/10.2519\/jospt.2021.0304","DOI":"10.2519\/jospt.2021.0304"},{"key":"18847","doi-asserted-by":"crossref","unstructured":"30. Lorenz S. Die Pr\u00e4medikationsambulanz: Analyse der Proz\u00acessqualit\u00e4t, Patientenzufriedenheit und Pr\u00e4operativen Angst. Wiesbaden: Springer Fachmedien Wiesbaden; 2023. Available from: Springer Book Page. https:\/\/doi.org\/10.1007\/978-3-658-39259-8","DOI":"10.1007\/978-3-658-39259-8"},{"key":"18848","doi-asserted-by":"crossref","unstructured":"31. Goodwin RW, Hendrick PA. Physiotherapy as a first point of con\u00actact in general practice: a solution to a growing problem? Prim Health Care Res Dev. 2016;17(5):489-502. https:\/\/doi.org\/10.1017\/S1463423616000189 https:\/\/pubmed.ncbi.nlm.nih.gov\/27263326","DOI":"10.1017\/S1463423616000189"},{"key":"18849","doi-asserted-by":"crossref","unstructured":"32. Mallett R, Bakker E, Burton M. Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting? Musculoskeletal Care. 2014;12(4):251-260. https:\/\/doi.org\/10.1002\/msc.1075 https:\/\/pubmed.ncbi.nlm.nih.gov\/24863858","DOI":"10.1002\/msc.1075"},{"key":"18850","doi-asserted-by":"crossref","unstructured":"33. Marks D, Comans T, Bisset L, et al. Substitution of doctors with physiotherapists in the management of common mus\u00acculoskeletal disorders: a systematic review. Physiotherapy. 2017;103(4):341-351. https:\/\/doi.org\/10.1016\/j.physio.2016.11.006 https:\/\/pubmed.ncbi.nlm.nih.gov\/28801031","DOI":"10.1016\/j.physio.2016.11.006"},{"key":"18851","doi-asserted-by":"crossref","unstructured":"34. Brooks G, Dripchak S, Vanbeveren P, et al. Is a prescriptive or an open referral related to physical therapy outcomes in patients with lumbar spine-related problems? J Orthop Sports Phys Ther. 2008;38(3):109-115. https:\/\/doi.org\/10.2519\/jospt.2008.2591 https:\/\/pubmed.ncbi.nlm.nih.gov\/18383644","DOI":"10.2519\/jospt.2008.2591"},{"key":"18852","doi-asserted-by":"crossref","unstructured":"35. Holdsworth LK, Webster VS. Direct access to physiotherapy in primary care: now?\u2014and into the future? Physiotherapy. 2004;90(2):64-72. https:\/\/doi.org\/10.1016\/j.physio.2004.01.005","DOI":"10.1016\/j.physio.2004.01.005"},{"key":"18853","doi-asserted-by":"crossref","unstructured":"36. Ludvigsson ML, Enthoven P. Evaluation of physiotherapists as pri\u00acmary assessors of patients with musculoskeletal disorders seek\u00acing primary health care. Physiotherapy. 2012;98(2):131-137. https:\/\/doi.org\/10.1016\/j.physio.2011.04.354 https:\/\/pubmed.ncbi.nlm.nih.gov\/22507363","DOI":"10.1016\/j.physio.2011.04.354"},{"key":"18854","doi-asserted-by":"crossref","unstructured":"37. Desmeules F, Toliopoulos P, Roy JS, et al. Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic. BMC Musculoskelet Disord. 2013;14(1):162. https:\/\/doi.org\/10.1186\/1471-2474-14-162 https:\/\/pubmed.ncbi.nlm.nih.gov\/23656928","DOI":"10.1186\/1471-2474-14-162"},{"key":"18855","doi-asserted-by":"crossref","unstructured":"38. Downie F, McRitchie C, Monteith W, et al. Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data. Br J Gen Pract. 2019;69(682):e314\u201320. https:\/\/doi.org\/10.3399\/bjgp19X702245 https:\/\/pubmed.ncbi.nlm.nih.gov\/30962224","DOI":"10.3399\/bjgp19X702245"},{"key":"18856","doi-asserted-by":"crossref","unstructured":"39. Leemrijse CJ, Swinkels IC, Veenhof C. Direct access to physi\u00accal therapy in the Netherlands: results from the first year in community-based physical therapy. Physical Therapy. 2008;88(8):936\u201346. https:\/\/doi.org\/10.2522\/ptj.20070308","DOI":"10.2522\/ptj.20070308"},{"key":"18857","doi-asserted-by":"crossref","unstructured":"40. Oakley C, Shacklady C. The clinical effectiveness of the extended-scope physiotherapist role in musculoskeletal triage: a systematic review. Musculoskeletal Care. 2015;13(4):204- 221. https:\/\/doi.org\/10.1002\/msc.1100 https:\/\/pubmed.ncbi.nlm.nih.gov\/25758358","DOI":"10.1002\/msc.1100"},{"key":"18858","doi-asserted-by":"crossref","unstructured":"41. Godoy-Suter MD, Winteler BR, Schmitt KU, et al. The poten\u00actial benefits of physiotherapy in the emergency department: views of patients and healthcare professionals\/Der potenzielle Nutzen der Physiotherapie in der Notaufnahme: Ansichten von Patienten und medizinischem Fachpersonal. International Journal of Health Professions. 2024;11(1):86-98. https:\/\/doi.org\/10.2478\/ijhp-2024-0008","DOI":"10.2478\/ijhp-2024-0008"}],"container-title":["Archives of Physiotherapy"],"original-title":[],"link":[{"URL":"https:\/\/www.archivesofphysiotherapy.com\/index.php\/aop\/article\/download\/3586\/4115","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.archivesofphysiotherapy.com\/index.php\/aop\/article\/download\/3586\/4116","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.archivesofphysiotherapy.com\/index.php\/aop\/article\/download\/3586\/4115","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:07:43Z","timestamp":1782983263000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.archivesofphysiotherapy.com\/index.php\/aop\/article\/view\/3586"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,30]]}},"URL":"https:\/\/doi.org\/10.33393\/aop.2026.3586","relation":{},"ISSN":["2057-0082","2057-0082"],"issn-type":[{"value":"2057-0082","type":"electronic"},{"value":"2057-0082","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,30]]}}}