Earlier this year, the Organization for Musculoskeletal Therapy of France (OMT-France) in collaboration with the Preuve et Evidence en Kinésithérapie Association de Bretagne (PEKAB) association produced in French language an open-access triage guide (https://www.omt-france.fr/le-guide-du-triage-en-kinesitherapie-musculo-squelettique/) for physiotherapists assessing patients with neuro-musculoskeletal conditions. The aims of this first screening guide were to introduce the notions of triage and to provide information on common red flags organized by systems. An appropriate triage makes it possible to redirect patients either directly to the emergency room (ER) or to their attending physician or to be able to safely initiate physiotherapy treatment. This guide will be regularly updated in order to offer a document based on current scientific data. The information that will emerge from the latest scientific studies, as well as new recommendations in the field of triage, will therefore be integrated and updated.
Direct access refers to the circumstances where physiotherapy services are available to patients/clients without the requirement of a referral from a healthcare provider such as a physician [1]. Triage in physiotherapy is not a skill reserved only for those physiotherapists who practice direct access and who need to ensure treating their patients safely but also a necessary skill in cases where a patient’s condition changes, whether during the physiotherapy treatment or simply between the time the physician was consulted and the time the physiotherapist initiates treatment.
OMT-France joined the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) in 2020 as a Member organization. Belgium, Switzerland and Canada are the only three other French speaking countries that are Member Organizations of IFOMPT. The publication of this open-access triage guide could lead to more French-speaking countries including Luxembourg and Monaco in Europe, the African countries including Algeria, Benin, Burkina Faso, Burundi, Cameroon, Chad, Comoros, Côte d’Ivoire, Democratic Republic of Congo, Djibouti, Guinea, Haiti, Madagascar, Mali, Morocco, Niger, Rwanda, Senegal, Seychelles, Togo, Tunisia, Vanuatu, and those from America and Oceania and adoption of educational standards for physiotherapists that include triage in entry-level or post-professional programs. Such steps could lead to more autonomy of the physiotherapy profession but also the potential for more physiotherapists being able to offload the medical system in ERs and outpatient clinics by allowing them to make decision and evaluate, treat and educate patients with neuromusculoskeletal conditions [2] without requiring the patients to consult a medical provider first [3].
There is evidence that consulting a physiotherapist first results in significant cost savings [4,5], improves clinical outcomes in ERs [6], and decreases opioid prescriptions, ER visits, and imaging [7]. In the global burden of disease, low back pain, neck pain, and other musculoskeletal conditions rank in the top 4 of years lived with disability in 25- to 64-year-old patients in both developed and developing countries [8]. Many patients suffer chronic pain and physical disability related to musculoskeletal conditions, and general medical practitioners are currently inadequately prepared and trained to deal with this challenge [9,10].
Although safety, patient satisfaction [11], quality of care, and cost-effectiveness of MSK physical therapists [3–5,12] have been demonstrated in extended roles within primary care clinics, implementation of non-physician-led primary care programs and health care policies in many countries have not been updated to reflect these superior cost-saving measures. It is time to further define the role of physiotherapists within the health care system around the world, both in developed and developing nations.
The initiative of OMT-France to publish this open-access physiotherapists’ guide of triage of patients with neuromusculoskeletal conditions is one more step toward patients’ direct access for physiotherapy care and the ability for skilled physiotherapists to assess and manage patients as a novel point of entry in the healthcare system to unload the medical providers and decrease cost of care.
Funding Statement
The authors reported there is no funding associated with the work featured in this article.
Disclosure statement
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