What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol.

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Nonetheless, APP has been shown as a means of mitigating against emergency department (ED) crowding and reducing pressure on EDs. This protocol outlines the methods in conducting a scoping review to identify the extent of APP roles in urgent care and ED settings, their expertise levels, the profile of patients they treat and the components of care they provide. Methods This scoping review will be conducted in line with the Joanna Briggs Institute framework for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting of this review. This review will include published studies of any design that are focussed on APP assessment and/ or subsequent treatment in the ED or urgent care setting among adults. The electronic databases: Medline (Ovid), Pubmed, CINAHL Complete, EMBASE, Epistemonikos, Central Register of Controlled Trials in the Cochrane Library and Scopus, trial registries and grey literature databases will be searched. The reference list of included sources of evidence in the review will be searched for additional sources. The methodological quality of the studies will not be formally explored. Relevant data will be extracted from each article using a predefined data extraction form by two independent reviewers. Data synthesis will be derived from the ‘PCC’ framework (population, concept, and context). Conclusions This scoping review will serve to characterise the roles, responsibilities, levels of expertise and the specific components of care that APP offers in urgent and emergency care settings. 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HRB Open Res 2025, 8 :116 ( https://doi.org/10.12688/hrbopenres.14245.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] Christina Hayes https://orcid.org/0000-0002-2218-3667 1 , Mairead Conneely https://orcid.org/0000-0002-9233-2007 1 , Rosa McNamara https://orcid.org/0000-0002-7803-0483 2 , [...] Rosie Quinn 3 , Helen French https://orcid.org/0000-0002-0300-4395 4 , François Desmeules 5,6 , Ruth Kilcawley 7 , Karen McCreesh https://orcid.org/0000-0003-3702-7330 1 , Rose Galvin https://orcid.org/0000-0002-8171-224X 1 Christina Hayes https://orcid.org/0000-0002-2218-3667 1 , Mairead Conneely https://orcid.org/0000-0002-9233-2007 1 , [...] Rosa McNamara https://orcid.org/0000-0002-7803-0483 2 , Rosie Quinn 3 , Helen French https://orcid.org/0000-0002-0300-4395 4 , François Desmeules 5,6 , Ruth Kilcawley 7 , Karen McCreesh https://orcid.org/0000-0003-3702-7330 1 , Rose Galvin https://orcid.org/0000-0002-8171-224X 1 PUBLISHED 29 Oct 2025 Author details Author details 1 School of Allied Health, Ageing Research Centre, Health Research Institute,, University of Limerick Faculty of Education and Health Sciences, Limerick, County Limerick, Ireland 2 Clinical Lead, National Emergency Medicine Programme, St Vincent's Hospital, Dublin, Ireland 3 Our Lady of Lourdes Hospital, Drogheda, County Dublin, Ireland 4 Royal College of Surgeons in Ireland Faculty of Medicine and Health Sciences, Dublin, Leinster, Ireland 5 5School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada 6 Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal Affiliated Research Center, Montreal, QC, Canada 7 National Health & Social Care Professions Office, Health Service Executive, St Mary's Campus, County Dublin, Ireland Christina Hayes Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Mairead Conneely Roles: Data Curation, Formal Analysis, Methodology, Software, Writing – Review & Editing Rosa McNamara Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Rosie Quinn Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Helen French Roles: Conceptualization, Methodology, Writing – Review & Editing François Desmeules Roles: Data Curation, Formal Analysis, Methodology, Writing – Review & Editing Ruth Kilcawley Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Karen McCreesh Roles: Methodology, Writing – Review & Editing Rose Galvin Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction The Advanced Practice Physiotherapy (APP)bmodel of care is implemented internationally, with notable variations in its application across different healthcare systems. Nonetheless, APP has been shown as a means of mitigating against emergency department (ED) crowding and reducing pressure on EDs. This protocol outlines the methods in conducting a scoping review to identify the extent of APP roles in urgent care and ED settings, their expertise levels, the profile of patients they treat and the components of care they provide. Methods This scoping review will be conducted in line with the Joanna Briggs Institute framework for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting of this review. This review will include published studies of any design that are focussed on APP assessment and/ or subsequent treatment in the ED or urgent care setting among adults. The electronic databases: Medline (Ovid), Pubmed, CINAHL Complete, EMBASE, Epistemonikos, Central Register of Controlled Trials in the Cochrane Library and Scopus, trial registries and grey literature databases will be searched. The reference list of included sources of evidence in the review will be searched for additional sources. The methodological quality of the studies will not be formally explored. Relevant data will be extracted from each article using a predefined data extraction form by two independent reviewers. Data synthesis will be derived from the ‘PCC’ framework (population, concept, and context). Conclusions This scoping review will serve to characterise the roles, responsibilities, levels of expertise and the specific components of care that APP offers in urgent and emergency care settings. READ ALL READ LESS Keywords Advanced Practice Physiotherapy, APP, extended-scope physiotherapy, extended-scope, advanced practice, primary contact physiotherapy, first-contact physiotherapy, extended scope of practice. Corresponding Author(s) Christina Hayes ( [email protected] ) Close Corresponding author: Christina Hayes Competing interests: No competing interests were disclosed. Grant information: This research is funded by an unrestricted grant from the National Health and Social Care Professions Office (2025-2026). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Hayes C et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Hayes C, Conneely M, McNamara R et al. What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] . HRB Open Res 2025, 8 :116 ( https://doi.org/10.12688/hrbopenres.14245.1 ) First published: 29 Oct 2025, 8 :116 ( https://doi.org/10.12688/hrbopenres.14245.1 ) Latest published: 29 Oct 2025, 8 :116 ( https://doi.org/10.12688/hrbopenres.14245.1 ) Introduction Emergency Departments (ED) are under increasing pressure internationally 1 , 2 . In Ireland, 1.29 million ED presentations were reported in 2021 3 , with an increase to 1.36 million in 2023 4 , where attendees spent an average of 12 hours in the ED 5 . Global efforts have been made to mitigate against ED overcrowding and improve healthcare efficiency, costs and patient safety 6 . One such method of reform has been the implementation of advanced practice physiotherapy (APP) within the ED setting internationally 7 – 9 . These new models of care in which allied health professionals, including physiotherapists, have emerged as key health providers in the ED, especially given that more than 25% of all ED presentations are people with musculoskeletal disorders 7 . An international consensus regarding a common understanding of the definition of APP is lacking 10 . The World Physiotherapy organisation described APP as a higher level of physiotherapy practice requiring advanced clinical skills, knowledge and autonomy to improve patient outcomes and provide clinical leadership, typically practiced by a small recognised group of experts in the field 10 . Moreover, in certain jurisdictions, APPs face restrictions on the services they are permitted to offer and are not acknowledged as salaried clinical grades 11 . APP is still in its early stages of development, with variability in its implementation in the ED and urgent care setting depending on the country and professional regulations. APP practitioners’ scope of practice may also vary within the same jurisdiction 7 . For instance, common APP practices in the ED may include the autonomous care of patients. This may involve making diagnoses, requesting medical imaging, prescription of medications and independent discharge planning for patients in the ED 7 , 12 – 14 . This contrasts to usual physiotherapy practice wherein patients are typically referred after a physician’s initial assessment and initiation of treatment 7 . Ireland, like many other jurisdictions, lacks formal recognition or salaried clinical grading for APP. APP has however, demonstrated reduced length of stay 15 , reduced wait time 8 , 15 and high levels of satisfaction in the ED 16 . Furthermore, APP is seen as a model of care with the potential to address some of the most pressing healthcare challenges internationally including lack of access to primary care services, escalating wait times for patients in urgent care settings and a shortage of healthcare professionals due to burnout and stress 17 , 18 . The implementation of models of care that maximise the scope of practice of healthcare professionals, including physiotherapists, have a positive impact at the patient, community and healthcare system levels 17 . Evidence examining the effectiveness of physiotherapy in the ED has previously been synthesised 7 , 12 . A previous scoping review of 27 studies that examined the evidence in relation to physiotherapists’ roles in the ED reported a lack of robust research to inform policy 12 . Furthermore, this scoping review explored the role of physiotherapists as a whole, not specific to APP practitioners 12 . Another systematic review by Desmeules and colleagues conducted a systematic review that explored physiotherapist care for patients with musculoskeletal disorders in the ED 7 . Results from this review demonstrated that physiotherapy roles vary depending on the setting and legalisation and reported that a limited number of high quality studies were identified for inclusion 7 . Given that both reviews explored the role of physiotherapists as a whole in the ED, not specific to APP practitioner roles, and the recent global shift towards APP care in the ED, an update of the available evidence for APP roles in the ED is warranted. A scoping review provides explicit methods to comprehensively summarise evidence consisting of variable study designs with the objective of informing policy, practice and inform future research 19 . The overall aim of this scoping review is to explore the role of APP practitioners in urgent care and emergency department settings. Specifically, this study will aim to: Characterise the role, responsibilities, levels of expertise, and components of care that APP offers; and Describe profile of patients that are treated by APP practitioners in urgent and emergency care settings. This information will be used to inform a foundational concept of APP in urgent and emergency care settings and inform the future implementation of APP policy, practice and research. Methods This scoping review will be conducted in line with the Joanna Briggs Institute (JBI) methodology for scoping reviews 20 . The scoping review framework proposed by Arksey and O’Malley will be employed 21 . The report will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) 22 . This protocol is reported in line with the PRISMA-P checklist 23 , and registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/W4FXH . Ethics Formal ethical approval is not required for this review as all data included are anonymous secondary data. Eligibility criteria The ‘PCC’ mnemonic (population, concept, and context) derived by Peters and colleagues was adopted to guide the eligibility criteria for this scoping review 20 . Population Adults (aged ≥18 years) who present to the ED or urgent care unit (e.g. local injury unit). Concept The intervention of interest is APP assessment and/or treatment in the ED urgent care setting. The assessment/intervention may be conducted independently or as part of a multidisciplinary (MDT) plan of care. The following definition of APP that was derived from the findings of international focus groups on the global perspectives of APP along with the World Physiotherapy definition 10 will be used: “Expert physiotherapists who employ a higher level of competencies and expertise with additional responsibilities and autonomy to manage complex and challenging health needs of individuals, families and populations within or beyond their scope of practice. Advanced practice physiotherapists demonstrate competencies as expert clinician, communicator, collaborator, leader, health advocate, scholar, and professional” 17 . Context Published studies of any design that are focussed on APP assessment and/ or subsequent treatment in the ED or urgent care setting will be considered eligible. There will be no date or language restrictions applied to the database search. Inclusion criteria Review articles including systematic reviews, scoping reviews, and rapid reviews; quantitative studies (observational and experimental); qualitative and mixed method studies; clinical care guidelines; and grey literature. Grey literature including studies, reports and published articles that focus on APP assessment and/or subsequent treatment among adults in the ED or urgent care setting. Exclusion criteria Articles in which APP is initiated on a hospital ward and not in the ED; Conference abstracts; Primary care based studies. Search strategy The search strategy for this Scoping review will be developed in collaboration with an information specialist at the University of Limerick (UL). An initial limited search of the CINAHL via EBSCO and OVID MEDLINE databases will be conducted to identify articles on the topic using the search strategy outlined in the ‘Extended data’. A logic grid that uses Boolean operators will structure searches. The text words contained in the titles and abstracts of relevant articles, and the index terms/ key words used to describe the articles will inform subject headings for a full search strategy with the input of a specialist health sciences librarian at UL. A comprehensive search will be completed by MC in the following electronic databases: Medline (Ovid), Pubmed, EMBASE, CINAHL Complete, Epistemonikos, Central Register of Controlled Trials in the Cochrane Library and Scopus. Trial registries including the WHO International Clinical Trials Registry Platform (ICTRP): www.who.int/ictrp/en/ will be searched. A grey literature search will be conducted in the following databases: grey literature sources ( DART-Europe E-theses portal , Open Grey , and Trip Medical database ). The reference list of included sources of evidence in the review will be searched for additional sources via backward and forward citation searching by CH and MC. Study selection Study selection will be completed using a two-step process. Firstly, studies will be downloaded to Endnote, and duplicates removed. The screening process will be carried out using Rayyan screening software. Titles and abstracts will be screened by two independent review authors (CH and MC). Step 2 will involve two independent review authors (CH and MC) screening full-text studies according to the inclusion criteria, which will be outlined in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram. Any inconsistencies in the inclusion process will be resolved via consensus or third author consultation (RG). Charting the data An adapted standardised data charting form developed by the JBI methodology guidance for scoping reviews will be used to guide the data extraction process ( Table 1 ) 20 . Authors of papers will be contacted to request missing or additional data, where required. The data charting form will be piloted on two studies by two independent authors (CH and MC) to ensure that all necessary data will be captured appropriately. The draft data charting form ( Table 1 ) may be refined at review stage as required. Data will be independently charted by one researcher (CH) and cross-checked against original articles by a second researcher (MC) to ensure the validity of extracted data. Table 1. Adapted data charting form from Joanna Briggs Institute (JBI) methodology for scoping reviews 20 . Scoping Review Details Scoping Review title and publication type: Review objective/s: Review question/s: Inclusion/Exclusion Criteria Population Concept Context (e.g. Emergency Department or local injury unit) Types of evidence source Evidence source Details and Characteristics Citation details (e.g. author/s, date, title, journal, volume, issue, pages) Country Context Participants (details e.g. age/sex and number) Details/Results extracted from source of evidence (in relation to the concept of the scoping review) Roles of APP Training levels of physiotherapists Outcomes of interest evaluated in included studies Assessment of the risk of bias or methodological quality of included studies is not relevant as the aim of this scoping review is to describe the current APP practices in the ED or urgent care setting 20 . Data analysis and presentation Data synthesis will be derived from the ‘PCC’ framework (population, concept, and context) by Peters and colleagues 20 . This will include information on the profile of patients that APP practitioners are treating, intervention components, APP roles and responsibilities and outcomes of interest outlined in included studies. Quantitative data analysis including descriptive analysis, such as, year, country, setting, participant characteristics and outcomes of interest will be conducted using SPSS Version 24 software and presented in a tabular format. Qualitative data will be presented narratively, featuring a summary of the findings in included studies. Basic coding of the qualitative findings will be conducted by two independent reviewers (CH and RG) using NVivo software to identify and categorise the described features of APP according to the population, concept, and context. Study status This protocol was registered prospectively on the Open Science Framework. Discussion This scoping review protocol describes a systematic approach to investigate the role of APP in urgent care and ED settings. It aims to delineate the extent of their responsibilities, levels of expertise, patient demographics and the specific components of care APP offers. Previous evidence suggests that care provided by physiotherapists in the ED may contribute to shorter waiting times among patients with lower urgency 12 . However, findings from randomised controlled trials report no notable differences in the effectiveness or costs associated with care delivered by physiotherapists in the ED in comparison to other ED staff 12 . Given the heterogeneity of APP roles internationally, this scoping review will be used to inform a foundational concept of APP in urgent care and ED settings and enable the future examination of APP pathways, practice and policy. Dissemination The review will abide by the (PRISMA-ScR) 22 standardised reporting guidelines and will be published in a peer-reviewed journal and disseminated through discussion with the National Emergency Medicine Programme in Ireland. Scientific outputs will be disseminated in the form of presentations at relevant physiotherapy and emergency medicine conferences. Data availability Underlying data No data are associated with this article. Extended data Open Science Framework: What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. https://doi.org/10.17605/OSF.IO/W4FXH 24 . This Project contains the following extended data: PRISMA-P checklist Database search terms Reporting guidelines Open Science Framework: PRISMA-P checklist 23 for What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. https://doi.org/10.17605/OSF.IO/W4FXH 24 . Data are available under the terms of the CC0 open licence. Faculty Opinions recommended References 1. Di Somma S, Paladino L, Vaughan L, et al. : Overcrowding in emergency department: an international issue. Intern Emerg Med. 2015; 10 (2): 171–5. PubMed Abstract | Publisher Full Text 2. National Center for Health Statistics: National Hospital Ambulatory Medical Care Survey: 2021 Emergency Department Summary Tables. Dublin, Ireland, 2021. Reference Source 3. Health Information and Quality Authority: Overview report monitoring programme against the national standards in emergency departments in 2022. Dublin, Ireland, 2022. 4. Health Service Executive, Annual Report and Financial Statements 2023: Reforming our system to deliver better care. Dublin, Ireland, 2023. Reference Source 5. Health Service Executive: Urgent and Emergency Care Weekly Performance Update 2024–2025. Dublin, Ireland, 2025. 6. Sartini M, Carbone A, Demartini A, editors., et al. : Overcrowding in emergency department: causes, consequences, and solutions—a narrative review. Healthcare (Basel). MDPI, 2022; 10 (9): 1625. PubMed Abstract | Publisher Full Text | Free Full Text 7. Matifat E, Méquignon M, Cunningham C, et al. : Benefits of musculoskeletal physical therapy in emergency departments: a systematic review. Phys Ther. 2019; 99 (9): 1150–66. PubMed Abstract | Publisher Full Text 8. McClellan CM, Cramp F, Powell J, et al. : A randomised trial comparing the clinical effectiveness of different emergency department healthcare professionals in soft tissue injury management. BMJ Open. 2012; 2 (6): e001092. PubMed Abstract | Publisher Full Text | Free Full Text 9. Sutton M, Govier A, Prince S, et al. : Primary-contact physiotherapists manage a minor trauma caseload in the emergency department without misdiagnoses or adverse events: an observational study. J Physiother. 2015; 61 (2): 77–80. PubMed Abstract | Publisher Full Text 10. World Physiotherapy: Policy statement: Advanced physiotherapy practice. London, UK, 2023. Reference Source 11. O'Mir M: Advanced practice physiotherapy in Ireland. 2021. 12. Ferreira GE, Traeger AC, Maher CG: Review article: a scoping review of physiotherapists in the adult emergency department. Emerg Med Australas. 2019; 31 (1): 43–57. PubMed Abstract | Publisher Full Text 13. Kersten P, McPherson K, Lattimer V, et al. : Physiotherapy extended scope of practice–who is doing what and why? Physiotherapy. 2007; 93 (4): 235–42. Publisher Full Text 14. Desmeules F, Roy J-S, MacDermid JC, et al. : Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord. 2012; 13 (1): 107. PubMed Abstract | Publisher Full Text | Free Full Text 15. Howland D, Cunniffe G, Morris S, et al. : An evaluation of the effectiveness of an advanced practice physiotherapist in the emergency department setting in Ireland. Ir J Med Sci. 2023; 193 (3): 1533–8. PubMed Abstract | Publisher Full Text 16. Goodman D, Harvey D, Cavanagh T, et al. : Implementation of an expanded-scope-of-practice physiotherapist role in a regional hospital emergency department. Rural Remote Health. 2018; 18 (2): 4212. PubMed Abstract | Publisher Full Text 17. Tawiah AK, Wieler M, Miller J, et al. : What is the global perspective on advanced practice physiotherapy: A qualitative study across five countries. PLoS One. 2025; 20 (4): e0320842. PubMed Abstract | Publisher Full Text | Free Full Text 18. Disser NP, De Micheli AJ, Schonk MM, et al. : Musculoskeletal consequences of COVID-19. J Bone Joint Surg Am. 2020; 102 (14): 1197–204. PubMed Abstract | Publisher Full Text | Free Full Text 19. Daudt HM, Van Mossel C, Scott SJ: Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol. 2013; 13 : 48. PubMed Abstract | Publisher Full Text | Free Full Text 20. Peters MD, Marnie C, Tricco AC, et al. : Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18 (10): 2119–26. PubMed Abstract | Publisher Full Text 21. Arksey H, O'malley L: Scoping studies: towards a methodological framework. Int J Soc Res. 2005; 8 (1): 19–32. Publisher Full Text 22. Tricco AC, Lillie E, Zarin W, et al. : PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169 (7): 467–73. PubMed Abstract | Publisher Full Text 23. Moher D, Shamseer L, Clarke M, et al. : Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4 (1): 1. PubMed Abstract | Publisher Full Text | Free Full Text 24. Hayes C: What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. Open Science Framework, 2025. http://www.doi.org/10.17605/OSF.IO/W4FXH Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 29 Oct 2025 ADD YOUR COMMENT Comment Author details Author details 1 School of Allied Health, Ageing Research Centre, Health Research Institute,, University of Limerick Faculty of Education and Health Sciences, Limerick, County Limerick, Ireland 2 Clinical Lead, National Emergency Medicine Programme, St Vincent's Hospital, Dublin, Ireland 3 Our Lady of Lourdes Hospital, Drogheda, County Dublin, Ireland 4 Royal College of Surgeons in Ireland Faculty of Medicine and Health Sciences, Dublin, Leinster, Ireland 5 5School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada 6 Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal Affiliated Research Center, Montreal, QC, Canada 7 National Health & Social Care Professions Office, Health Service Executive, St Mary's Campus, County Dublin, Ireland Christina Hayes Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Mairead Conneely Roles: Data Curation, Formal Analysis, Methodology, Software, Writing – Review & Editing Rosa McNamara Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Rosie Quinn Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Helen French Roles: Conceptualization, Methodology, Writing – Review & Editing François Desmeules Roles: Data Curation, Formal Analysis, Methodology, Writing – Review & Editing Ruth Kilcawley Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Karen McCreesh Roles: Methodology, Writing – Review & Editing Rose Galvin Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This research is funded by an unrestricted grant from the National Health and Social Care Professions Office (2025-2026). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 29 Oct 2025, 8:116 https://doi.org/10.12688/hrbopenres.14245.1 Copyright © 2025 Hayes C et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Hayes C, Conneely M, McNamara R et al. What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] . HRB Open Res 2025, 8 :116 ( https://doi.org/10.12688/hrbopenres.14245.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 29 Oct 2025 Views 0 Cite How to cite this report: Maddigan K. Reviewer Report For: What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] . HRB Open Res 2025, 8 :116 ( https://doi.org/10.21956/hrbopenres.15667.r51132 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-116/v1#referee-response-51132 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Nov 2025 Kaitlyn Maddigan , Western University, London, Ontario, Canada Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15667.r51132 I thank the authors for the opportunity to review their paper. This article is a protocol for a scoping review. The study aims to characterize the role, responsibilities, levels of expertise, and components of care that APP offers; and ... Continue reading READ ALL I thank the authors for the opportunity to review their paper. This article is a protocol for a scoping review. The study aims to characterize the role, responsibilities, levels of expertise, and components of care that APP offers; and describe the profile of patients that are treated by APP practitioners in urgent and emergency care settings. This study is very interesting and undeniably useful regarding the current state of emergency departments internationally and the potential implications of widespread implementation of APP in these settings. The methodology used is appropriate, although the analysis methods lacks precision. Overall, the protocol is written well. Below are some specific comments to take into consideration: 1) in the introduction, on the final line of the third paragraph you have written: This contrasts to usual physiotherapy practice wherein patients are typically referred after a physician’s initial assessment and initiation of treatment. - this is not true for all jurisdictions internationally; for example physiotherapists in Canada are primary healthcare practitioners, patients do not require a physician assessment or referral to see a physiotherapist for assessment and diagnosis. 2) in the introduction, in the 5th paragraph you have written: Another systematic review by Desmeules and colleagues conducted a systematic review that explored physiotherapist care for patients with musculoskeletal disorders in the ED. - these is an typo here 'systematic review' has been included twice in this sentence. 3) You have described in your objectives that you aim to characterize 'the level of expertise' of the APPs but you have not adequately described what this means or how you plan to do this in the methods. Of all the constructs that you aim to characterize it is the only one with some level of ambiguity. Given that you are referring to 'a level', it could imply that there may be some way to measure this? Will characterizing this be based on the complexity of the cases the APPs handle or some other measurement tool? I think this requires further description/definition to help the reader understand what exactly will contribute to this characterization. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: My area of research centres around investigating the optimal educational pathway to APP for the physiotherapist, both internationally and in a Canadian context. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Maddigan K. Reviewer Report For: What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] . HRB Open Res 2025, 8 :116 ( https://doi.org/10.21956/hrbopenres.15667.r51132 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-116/v1#referee-response-51132 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Vella SP. Reviewer Report For: What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] . HRB Open Res 2025, 8 :116 ( https://doi.org/10.21956/hrbopenres.15667.r51135 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-116/v1#referee-response-51135 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 04 Nov 2025 Simon P Vella , The University of Sydney, Sydney, Australia Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15667.r51135 Summary Thank you for the opportunity to review this exciting project. This scoping review protocol aims to explore the role of advanced physiotherapy practice for adults in urgent care and emergency departments, regardless ... Continue reading READ ALL Summary Thank you for the opportunity to review this exciting project. This scoping review protocol aims to explore the role of advanced physiotherapy practice for adults in urgent care and emergency departments, regardless of their complaint. The protocol will use appropriate methodology, such as the JBI framework and PRISMA-ext for Scoping reviews, to answer this important research question. The protocol is well written, in which I only have a few comments: Line 1 abstract: The Advanced Practice Physiotherapy (APP)bmodel of care is implemented internationally, with notable variations in its application across different healthcare systems. Grammar – ‘bmodel of care’, remove b. Should read ‘model of care’ Introduction: Paragraph 1: Global efforts have been made to mitigate against ED overcrowding and improve healthcare efficiency, costs and patient safety 6 . Could this be written more simply – Global efforts have been made to reduce ED overcrowding and improve healthcare efficiency, costs and patient safety. Comment: Is emergency department and urgent care setting referring to one (i.e. the same) setting or is this referring to two different settings? That is, Emergency department is one setting and urgent care is another setting. For example, in Australia, we have the emergency department which is tied to a hospital. This is one service. We also have urgent care services (i.e. Urgent care setting) which are community based pre-hospital services. This is a different service to the ED. Therefore, the role of the APP in Australia might differ between these two settings as one is a community setting and the other is in the emergency health care setting. It might be appropriate to define ‘ urgent care and emergency department setting’ in the introduction to provide the reader context of the setting in Ireland, as this may be different to other countries, like Australia. Thanks again for the opportunity to review the protocol and I look forward to reading the completed project. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Emergency health services, emergency department, back pain, allied health care I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Vella SP. Reviewer Report For: What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] . HRB Open Res 2025, 8 :116 ( https://doi.org/10.21956/hrbopenres.15667.r51135 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-116/v1#referee-response-51135 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 29 Oct 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 29 Oct 25 read read Simon P Vella , The University of Sydney, Sydney, Australia Kaitlyn Maddigan , Western University, London, Canada Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Maddigan K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Nov 2025 | for Version 1 Kaitlyn Maddigan , Western University, London, Ontario, Canada 0 Views copyright © 2025 Maddigan K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I thank the authors for the opportunity to review their paper. This article is a protocol for a scoping review. The study aims to characterize the role, responsibilities, levels of expertise, and components of care that APP offers; and describe the profile of patients that are treated by APP practitioners in urgent and emergency care settings. This study is very interesting and undeniably useful regarding the current state of emergency departments internationally and the potential implications of widespread implementation of APP in these settings. The methodology used is appropriate, although the analysis methods lacks precision. Overall, the protocol is written well. Below are some specific comments to take into consideration: 1) in the introduction, on the final line of the third paragraph you have written: This contrasts to usual physiotherapy practice wherein patients are typically referred after a physician’s initial assessment and initiation of treatment. - this is not true for all jurisdictions internationally; for example physiotherapists in Canada are primary healthcare practitioners, patients do not require a physician assessment or referral to see a physiotherapist for assessment and diagnosis. 2) in the introduction, in the 5th paragraph you have written: Another systematic review by Desmeules and colleagues conducted a systematic review that explored physiotherapist care for patients with musculoskeletal disorders in the ED. - these is an typo here 'systematic review' has been included twice in this sentence. 3) You have described in your objectives that you aim to characterize 'the level of expertise' of the APPs but you have not adequately described what this means or how you plan to do this in the methods. Of all the constructs that you aim to characterize it is the only one with some level of ambiguity. Given that you are referring to 'a level', it could imply that there may be some way to measure this? Will characterizing this be based on the complexity of the cases the APPs handle or some other measurement tool? I think this requires further description/definition to help the reader understand what exactly will contribute to this characterization. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise My area of research centres around investigating the optimal educational pathway to APP for the physiotherapist, both internationally and in a Canadian context. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Maddigan K. Peer Review Report For: What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] . HRB Open Res 2025, 8 :116 ( https://doi.org/10.21956/hrbopenres.15667.r51132) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-116/v1#referee-response-51132 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Vella S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Nov 2025 | for Version 1 Simon P Vella , The University of Sydney, Sydney, Australia 0 Views copyright © 2025 Vella S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Summary Thank you for the opportunity to review this exciting project. This scoping review protocol aims to explore the role of advanced physiotherapy practice for adults in urgent care and emergency departments, regardless of their complaint. The protocol will use appropriate methodology, such as the JBI framework and PRISMA-ext for Scoping reviews, to answer this important research question. The protocol is well written, in which I only have a few comments: Line 1 abstract: The Advanced Practice Physiotherapy (APP)bmodel of care is implemented internationally, with notable variations in its application across different healthcare systems. Grammar – ‘bmodel of care’, remove b. Should read ‘model of care’ Introduction: Paragraph 1: Global efforts have been made to mitigate against ED overcrowding and improve healthcare efficiency, costs and patient safety 6 . Could this be written more simply – Global efforts have been made to reduce ED overcrowding and improve healthcare efficiency, costs and patient safety. Comment: Is emergency department and urgent care setting referring to one (i.e. the same) setting or is this referring to two different settings? That is, Emergency department is one setting and urgent care is another setting. For example, in Australia, we have the emergency department which is tied to a hospital. This is one service. We also have urgent care services (i.e. Urgent care setting) which are community based pre-hospital services. This is a different service to the ED. Therefore, the role of the APP in Australia might differ between these two settings as one is a community setting and the other is in the emergency health care setting. It might be appropriate to define ‘ urgent care and emergency department setting’ in the introduction to provide the reader context of the setting in Ireland, as this may be different to other countries, like Australia. Thanks again for the opportunity to review the protocol and I look forward to reading the completed project. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Emergency health services, emergency department, back pain, allied health care I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Vella SP. Peer Review Report For: What is the role of advanced physiotherapy practice for adults in urgent care and emergency department settings? A scoping review protocol. [version 1; peer review: 2 approved] . HRB Open Res 2025, 8 :116 ( https://doi.org/10.21956/hrbopenres.15667.r51135) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-116/v1#referee-response-51135 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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