Diagnostic concordance between physiotherapist and emergency physicians for patients with a musculoskeletal disorder in the emergency department

Question What is the level of diagnostic concordance between physicians and physiotherapists for patients consulting in an emergency department (ED) with musculoskeletal disorders (MSKDs)? Design Secondary analysis of data obtained through a pragmatic randomized controlled trial, physiotherapist (PT) and emergency physicians (EPs) unblinded, per-protocol analysis. Participants 78 participants aged 18 to 80 years presenting with a minor MSKD were recruited and data from the 40 participants randomized in the intervention group were used (mean age 36.6 yrs (SD: 17.3, IQR: 22.0; 46.8); women: 55%). Outcome measures Diagnostic concordance was established using the International Classification of Diseases 11 (ICD-11) and examined between EP and PT using raw agreement and Gwet’s first-order agreement coefficient (AC1). Results Forty participants were recruited and 36 were assessed by the PT and EP (36.8 ± 18.2 years old; 55.6% women). Overall raw agreement was 86.1% and an almost perfect diagnostic concordance was observed between PT and EP (Gwet’s AC1: 0.84, 95% CI: 0.69 – 0.98). The most common reason for disagreement was suspected bone fracture or contusion in comparison with ligament or meniscus disorder. Conclusion Results from this study indicate that overall diagnostic concordance between PT and EP in the ED for patients consulting with MSKDs is almost perfect. These results tend to support the safety of such models of care. However, more studies are needed to confirm these results as the EP wasn’t always independent and the classification used was imprecise. Registration #[NCT04009369][1] ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT04009369 ### Funding Statement Funding for this project was provided by the CHU de Québec-Université Laval, subsidies from LJH and KP and a research grant awarded by the multidisciplinary council of the CHU de Québec-Université Laval in association with the Fondation du CHU de Québec. RG received scholarships from the Canadian Institutes of Health Research, the CIRRIS, the Ordre professionnel de la physiothérapie du Québec and the Department of Rehabilitation funds of the Faculty of Medicine at Université Laval. KP is a Fonds de recherche du Québec-Santé (FRSQ) Junior 1 Research Scholar. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The CHU de Québec-Université Laval Ethics Committee approved this study. All participants gave written informed consent before data collection began. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data that support the findings of this study are available from the corresponding author, LJH, upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04009369&atom=%2Fmedrxiv%2Fearly%2F2020%2F11%2F03%2F2020.10.28.20221762.atom