Physiotherapy in Emergency Medicine: organizational integration and evaluation of a new acute-care model. A retrospective observational study at ASL Roma 2.

چکیده اصلی

BACKGROUND: In Emergency Medicine units, physiotherapy must address motor and respiratory needs in complex patients, often with limited professional resources that are not exclusively dedicated to the unit. Describing service volume, coverage and response capacity is relevant to physiotherapy planning and resource governance. OBJECTIVE: To describe the volume, coverage, timeliness and response capacity of physiotherapy activity delivered by a single professional resource assigned to the Emergency Medicine unit, while secondarily characterising patients, interventions, pathways and outcomes and, in a selected subsample, pre-post changes in functional and symptom-related outcomes. METHODS: Retrospective observational study based on the clinical registry of the Emergency Medicine unit at Sant'Eugenio Hospital in Rome. A total of 335 physiotherapy episodes were analysed: 197 in 2025 and 138 in the first half of 2026, corresponding respectively to 684 and 377 hospital admissions. The service was provided by a single physiotherapist, present six hours per day from Monday to Saturday, not exclusively dedicated to the unit, with no Sunday or public-holiday coverage. All requests for functional assessment and physiotherapy management submitted by the unit physicians were assessed. In a selected subsample of 162 episodes, T0-T1 changes in the Barthel Index, Trunk Control Test, NRS and Borg scale were also explored, together with associations with timeliness and treatment days. RESULTS: The proportion of hospital admissions receiving physiotherapy assessment increased from 28.8% in 2025 to 36.6% in the first half of 2026 (difference 7.8 percentage points; p=0.009). Mean monthly physiotherapy episodes increased from 16.4 to 23.0, while physiotherapy episodes per bed/month increased from 1.09 to 1.28. Response capacity to received requests was 100% in both periods. The population had a median age of 77 years; 58.5% of episodes fell within respiratory clinical macro-areas. Barthel and Trunk scores were associated with final discharge destination, while no overall associations emerged between type of physiotherapy intervention and outcome. In the subsample with serial assessments, all outcomes showed a significant T0-T1 change (p<0.001); assessment within ≤24 hours was not associated with greater improvement, whereas treatment days were positively correlated with improvement in Barthel (ρ=0.882), Trunk (ρ=0.443), NRS (ρ=0.673) and Borg (ρ=0.382), all p<0.001. CONCLUSIONS: A single shared physiotherapy resource, responding to demand from the clinical unit, ensured that all medical requests were addressed and achieved increasing service penetration despite the absence of Sunday and public-holiday coverage. The findings support the organisational value of a structured physiotherapy presence in Emergency Medicine. In the subsample with serial measures, functional and symptom-related improvement was also observed, with a dose-response relationship between treatment days and magnitude of change. These clinical analyses remain exploratory and do not allow causal inference.

متن کامل اصلی