Physical and occupational therapist evaluations for fall prevention in the emergency department: A geriatric ED guidelines 2.0 systematic review

Lauren T. Southerland, Department of Emergency Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Pedro K. Curiati, Geriatric Emergency Department Research Group (ProAGE), Hospital Sírio-Libanês, São Paulo, Brazil.
Richard D. Shih, Department of Emergency Medicine, Florida Atlantic University Schmidt College of Medicine, Boca Raton, Florida, USA.
Alexander X. Lo, Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois, USA.
Kristie Harper, Curtin University, Perth, WA, Australia.
Ian Tarnovsky, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Alexis Brengartner, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Luna Ragsdale, Department of Emergency Medicine, Duke University, Durham, North Carolina, USA.
Neha Raukar, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Suzanne Ryer, Advocate Health - MidwestFollow
Katherine M. Hunold, Department of Emergency Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Fabrice Mowbray, College of Nursing, Michigan State University, East Lansing, Michigan, USA.
Charles L. Maddow, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Christopher R. Carpenter, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Shan W. Liu, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Abstract

Background: Older adults are at high risk for severe injuries and death from falls. Physical therapist (PT) and occupational therapist (OT) evaluations have been introduced into Emergency Department (ED) care to assist with fall risk evaluation and fall prevention care. An evaluation of current evidence was undertaken to inform the Geriatric ED Guidelines 2.0.

Methods: Systematic review of physical and/or occupational therapy evaluation for fall prevention in the ED. The intervention was evaluation by a rehabilitation therapist (PT, OT, or both) for fall prevention, fall assessment, or mitigation of fall risk factors. Studies that did not perform the evaluation during the ED or ED Observation Unit visit were excluded, such as referrals for home consultation. The published literature was searched using strategies created by a medical librarian and was implemented in Embase and PubMed in March 2025. Covidence was used for article collation and review. Risk of bias was assessed using the Cochrane Risk of Bias v2 and the Ottawa-Newcastle scale.

Results: The search resulted in 387 articles with 52 duplicates, for 335 unique citations. Ten articles on 6 datasets were included (4 abstracts and 6 published manuscripts). One article was at high risk of bias as very few intervention patients received therapist evaluation. The remaining 5 datasets had varied co-interventions in addition to PT and/or OT evaluations. PT or OT evaluation in the ED was associated with reduced ED revisits at 1, 2, and 6 months. Evaluations in the ED were not associated with increased hospital admission rates or ED length of stay. A meta-analysis was infeasible due to varied outcome timeframes.

Conclusions: PT and/or OT evaluations for fall prevention were associated with reduced subsequent ED revisits for older adults. However, the impact of co-interventions and heterogeneity limits strong conclusions.

Document Type

Article

PubMed ID

41354970

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