The role of the physiotherapist in the assessment and management of blunt mechanism chest wall injury: A systematic integrative review and narrative synthesis

Background: Blunt mechanism chest wall injury (CWI) is a common traumatic presentation to acute hospitals globally and it is associated with high levels of mortality and morbidity. The role of the physiotherapist in the management of this injured population needs clearer definition. Aim: To synthesise existing evidence relating to the ‘work’ of physiotherapists in the assessment, management and evaluation of patients with blunt mechanism CWI. Design: A systematic integrative review of relevant literature with a narrative synthesis. Data sources: Embase (Ovid), MEDLINE (Ovid), CINAHL Plus with Full Text (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), PEDro (Physiotherapy Evidence Database), AMED (Ovid). Further searches for grey literature and hand searches were applied. Databases were searched from their inception to December 2024. Analysis and data integration was undertaken through narrative synthesis following a process of thematic coding. Results: From 7433 identified papers, 92 were included in the final evidence synthesis. Fifty were full published empirical studies, 14 were evidence reviews, 19 were conference abstracts, three were case presentations and six were opinion pieces. Analysis identified the broad scope of clinical care provided by physiotherapists covering (i) initial assessment and emergency care; (ii) acute care priorities and care planning; (iii) patient education and optimising patient self-management; and (iv) post-acute care and follow-up. Conclusion: There is a need for a more standardised approach to the care provided to this patient group. Clinicians need to acquire and develop formal competencies and capacities and knowledge in a more structured approach.