Physiotherapist-led care for musculoskeletal conditions in the emergency department (RESHAP-ED): a randomised controlled trial with economic evaluation

Résumé fourni par la source

BACKGROUND: Long stays in the emergency department compromise patient safety and health system performance. Physiotherapist-led models of care may improve care and emergency department performance, but their effects have not been rigorously evaluated in randomised trials. We compared the effectiveness, safety, and cost-effectiveness of physiotherapist-led care with usual care for patients presenting to the emergency department with musculoskeletal conditions. METHODS: RESHAP-ED was an open-label, pragmatic, randomised trial that recruited adults aged 18 years and older at five emergency departments in New South Wales, Australia, with uncomplicated musculoskeletal conditions (eg, soft tissue conditions, neck and back pain, and fractures or dislocations not requiring orthopaedic review or surgery). Participants were randomly assigned (1:1), using statistician-generated randomly permuted blocks, to either physiotherapist-led care (intervention) or usual physician-led or nurse practitioner-led care (control). The primary outcome was length of stay in the emergency department, calculated as time from arrival to discharge, analysed in the intention-to-treat population using a linear mixed-effects model. The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12623000782639) and is completed. FINDINGS: Between Nov 22, 2023 and March 29, 2025, 4219 patients were screened, 2728 were deemed ineligible for inclusion, and 1491 participants were randomly assigned (746 assigned to the physiotherapy-led intervention group and 745 assigned to the physician-led or nurse-led practitioner control group). Following the exclusion of 16 participants after randomisation, 1475 were included in the analysis (737 in the intervention group and 738 in the control group). The mean age of participants was 40·1 years (SD 16·5). 719 (48·7%) participants were male, 755 (51·2%) were female, and one (0·1%) participant had unreported sex data. Follow-up for the primary outcome was 100% complete. The mean length of stay in the emergency department was 2·4 h in the intervention group and 3·4 h in the control group (-1·0 h [95% CI -1·2 to -0·8]). Adverse events were reported by 39 (6·6%) of 591 participants in the intervention group versus 33 (5·9%) of 555 in the control group (p=0·72). The intervention group had lower costs (-$35·1 [95% CI -69·0 to -1·7]) and a high probability (98·1%) of being cost-effective. INTERPRETATION: A physiotherapist-led model of care in the emergency department reduced length of stay among patients presenting with uncomplicated musculoskeletal conditions, without compromising health outcomes or safety, and was cost-effective. FUNDING: Medical Research Future Fund.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.