Demont A, Quentin J, Bourmaud A
Inserm 1123 ECEVE, faculté de médecine, université Paris-Diderot, Paris, France; École universitaire de kinésithérapie, université d'Orléans, Orléans, France.
Pôle Saint-Hélier, centre de médecine physique et réadaptation, Rennes, France.
Rev Epidemiol Sante Publique. 2020 Sep;68(5):306-313. doi: 10.1016/j.respe.2020.08.001. Epub 2020 Sep 3.
Musculoskeletal disorders are increasing in prevalence, principally due to sedentary behaviors. Strong evidence supports an early need for first-line treatment including physiotherapy. New and innovative models in primary and emergency care have been drawn up and put the physiotherapist's skills to work in early and first-line management of patients with musculoskeletal disorders. The objectives of this review were to identify and describe studies assessing models of care integrating direct access to physiotherapy in primary care and in emergency care for patients with musculoskeletal disorders and to provide perspectives on the application of these two models in France.
A literature review was carried out including studies extracted from four scientific databases: PubMed, CINAHL, Embase, and PEDro. The selected articles had to address the clinical effectiveness or efficiency of these models for the provision of care in primary or in emergency care. A narrative literature review method was used. The synthesis deals with the qualitative analysis of the included studies.
Thirty-nine studies were included in this review: 19 on assessment of the direct access to physiotherapy model in primary care and 20 on the direct access to physiotherapy model in emergency departments as concerns patients with musculoskeletal disorders. The studies showed that the different models incorporating direct access to physiotherapy in primary or in emergency care provided better outcomes in terms of quality and access to care while maintaning a similar degree of safety. However, the methodology of the studies included was estimated as being of heterogeneous quality.
The studies dealing with the new models for provision of care integrating direct access to physiotherapy in primary care or emergency care impart two lessons: (1) they are not designed to replace the physician; (2) collaboration between different health professionals aimed at improving patients' access to efficient care is to be encouraged. It would be worthwhile to focus upon dissemination factors that would enhance the efficiency of these innovative models in other countries, as in France.
肌肉骨骼疾病的患病率正在上升，主要原因是久坐行为。有力证据表明，早期就需要包括物理治疗在内的一线治疗。已经制定了初级和急诊护理中的新型创新模式，并将物理治疗师的技能应用于肌肉骨骼疾病患者的早期和一线管理。本综述的目的是识别和描述评估在初级护理和急诊护理中为肌肉骨骼疾病患者提供直接物理治疗的护理模式的研究，并就这两种模式在法国的应用提供观点。
进行了一项文献综述，包括从四个科学数据库（PubMed、CINAHL、Embase和PEDro）中提取的研究。所选文章必须涉及这些模式在初级或急诊护理中提供护理的临床有效性或效率。采用叙述性文献综述方法。综合分析涉及对纳入研究的定性分析。
本综述纳入了39项研究：19项评估初级护理中直接物理治疗模式，20项评估急诊科针对肌肉骨骼疾病患者的直接物理治疗模式。研究表明，在初级或急诊护理中纳入直接物理治疗的不同模式在护理质量和可及性方面提供了更好的结果，同时保持了相似的安全程度。然而，纳入研究的方法学质量估计参差不齐。
涉及在初级护理或急诊护理中提供直接物理治疗的新型护理模式的研究有两点启示：（1）它们并非旨在取代医生；（2）应鼓励不同卫生专业人员之间的合作，以改善患者获得高效护理的机会。值得关注传播因素，以提高这些创新模式在其他国家（如法国）的效率。
