Musculoskeletal Triage in Physiotherapy: A Model Proposal to Strengthen Clinical Management, Decision-Making, and Professional Education

Abstract

Introduction

Physiotherapy triage is an essential process for determining whether a patient is an appropriate candidate for rehabilitation, identifying serious pathologies or comorbidities, and guiding the most suitable clinical approach according to the patient's presentation. However, its application has been largely restricted to emergency settings, limiting its potential as a structured tool for clinical management and clinical reasoning. The American Physical Therapy Association (APTA), through the Treatment-Based Classification (TBC) model, has demonstrated that continuous triage systems can optimize clinical decision-making and improve healthcare efficiency.

This gap represents an opportunity to redefine musculoskeletal physiotherapy practice. The integration of a structured triage system may contribute to standardizing clinical processes while promoting the development of more critical, autonomous, and evidence-based healthcare professionals.

Objective

To identify and analyze the available evidence regarding the theoretical foundations and applied models of musculoskeletal triage in physiotherapy, with the aim of strengthening academic training, optimizing clinical management, and improving quality of care.

Methodology

A systematic review was conducted following the PRISMA 2020 guidelines. Searches were performed in PubMed, Scopus, PEDro, ScienceDirect, and Google Scholar, including articles published in English and Spanish between 2010 and 2025. The search terms included “musculoskeletal triage,” “clinical screening,” “physiotherapy,” and “education.” Studies addressing musculoskeletal triage models, clinical assessment tools, screening processes, or educational strategies were included. Studies focused exclusively on emergency services or non-musculoskeletal areas were excluded. Methodological quality was assessed using the AMSTAR 2, PEDro, and STROBE tools according to study design. Of the 130 records identified, 28 met the inclusion criteria and were analyzed qualitatively.

Results

The reviewed studies revealed that physiotherapy triage remains primarily focused on the identification of red flags and referral for medical evaluation, with limited integration of tools designed to support longitudinal monitoring and clinical reasoning. No widely accepted standardized musculoskeletal triage model for physiotherapy practice was identified. Nevertheless, several authors highlighted the importance of classifying patients according to the severity, irritability, nature, stage, and stability of their condition to optimize clinical decision-making. The Severity, Irritability, Nature, Stage and Stability (SINSS) model emerged as the most consistent conceptual framework for musculoskeletal assessment. Based on these findings, a musculoskeletal triage model was developed using objective clinical criteria and patient classification according to the stage of condition progression, accompanied by a standardized physiotherapy decision-making pathway.

Conclusions

The lack of systematic musculoskeletal triage models applicable to physiotherapy practice represents a limitation for clinical decision-making, healthcare management, and professional education. The proposed model redefines triage as a continuous process of assessment, classification, and follow-up aimed at optimizing clinical reasoning, promoting standardized care, and strengthening evidence-based education in musculoskeletal physiotherapy.