Igiene e Sanità Pubblica 2025; 98 (5): 301-330
Annamaria Servadio 1, Maria Rita Molinari 5, Loredana Gigli 6, Emanuele Amadio 2, Giovanni Sellitto 2,4, Giovanni Galeoto 2,4
Affiliation
1 Department of Health and Social Professions, Asl Roma 2, 00159 Rome, Italy
2 Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
3 IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, IS, Italy
4 Department of Public Sciences and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
5 Health Directorate, Asl Roma 6, 00047, Rome Italy
6 Department of Health and Social Professions, Asl Roma 3, 00122 Rome, Italy
Abstract:
Background: Emergency departments (EDs) worldwide are increasingly adopting multidisciplinary models of care in which physiotherapists play an evolving and expanding role. International evidence suggests that physiotherapy-led pathways may improve the management of low-acuity presentations such as musculoskeletal and vestibular conditions, which contribute substantially to ED overcrowding. In Italy, however, physiotherapists are not yet structurally integrated into ED teams, and the potential applicability of advanced physiotherapy roles remains unclear.
Objective: The objective of this scoping review is to identify, map, and describe current international models of physiotherapy practice within Emergency Departments, including first-contact roles, advanced practice, direct-access models, and multidisciplinary roles, and to explore their impact on the management of non-urgent conditions such as minor injuries, musculoskeletal disorders, and vestibular presentations.
Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A systematic search of PubMed and Google Scholar was conducted from inception to November 2025, including peer-reviewed studies in English that described, evaluated, or implemented physiotherapy roles in EDs. Eligible populations were ED patients of any age presenting with non-urgent musculoskeletal, traumatic, or vestibular conditions. Data were charted on study design, setting, models of practice, clinical populations, and reported outcomes.
Results: The included studies were primarily conducted in Australia, Canada, and the United Kingdom, and comprised service evaluations, retrospective reviews, quality-of-care studies, pilot projects, validation studies of screening tools, and mixed-methods evaluations of pediatric pathways. Physiotherapy practice in Emergency Departments is mainly organized into First Contact Physiotherapy, Advanced Practice, and Direct Access models, often embedded within specialized pathways for musculoskeletal, vestibular, pediatric, or geriatric care. Overall, physiotherapist-led care is associated with reduced waiting times and ED length of stay, earlier administration of analgesia, improved clinical outcomes (including reduced pain and improved vestibular symptoms), high diagnostic agreement with emergency physicians, lower use of imaging and follow-up services, and high satisfaction among patients, parents, and clinicians. No serious adverse events related to physiotherapy interventions were reported. Most studies were observational, with a limited number of randomized or controlled studies, and no studies were conducted in Italy.
Conclusions: International evidence indicates that physiotherapists can make a meaningful contribution to emergency department care, particularly for low-acuity musculoskeletal and vestibular presentations, through primary contact, advanced practice, and direct-access models. These roles appear safe, effective, and well accepted by patients and clinicians. However, the lack of Italian data, combined with a different regulatory framework and limited autonomy for physiotherapists, currently hinders the translation of these models into the Italian context. Pilot implementations and context-specific evaluations are needed to assess the feasibility and impact of integrating physiotherapists into Italian emergency departments.
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