Direct‐access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial

Abstract

Objectives The objective was to evaluate the effects of direct‐access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. Methods We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two‐way analyses of variance, log‐linear analysis, and chi‐square tests. Results Seventy‐eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over‐the‐counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow‐up for imaging tests, other professionals consulted, and hospitalization rates. Conclusion Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge.

Health-Related Quality of Life of Patients Presenting to the Emergency Department with a Musculoskeletal Disorder

“…Cross-sectional data were acquired during the baseline assessment performed as part of a single center randomized controlled trial conducted between September 2018 and March 2019 in an Academic ED in Quebec City (Canada). 50 In this trial, management by a physiotherapist in the ED compared to usual care resulted in a decrease in the level of pain and pain interference on function for up to 3 months post-initial consultation, as well as a reduction in the number of recommended imaging studies, the amount of prescription and non-prescription medication used, and repeat visits to the ED for the same condition. 50 The study was approved by the Research Ethics Committee of the CHU de Québec – Université Laval and registered at the US National Institutes of Health #NCT04009369.…”

“… 50 In this trial, management by a physiotherapist in the ED compared to usual care resulted in a decrease in the level of pain and pain interference on function for up to 3 months post-initial consultation, as well as a reduction in the number of recommended imaging studies, the amount of prescription and non-prescription medication used, and repeat visits to the ED for the same condition. 50 The study was approved by the Research Ethics Committee of the CHU de Québec – Université Laval and registered at the US National Institutes of Health #NCT04009369. Patients presenting to the ED were recruited if they had a potential peripheral or vertebral minor MSKD (eg, sprain, strain, tendinitis, low back pain, neck pain) and if given a triage score of 3 (urgent), 4 (less urgent) or 5 (non urgent) based on the Canadian Emergency Department Triage and Acuity Scale classification.…”

Direct Access to Physical Therapy: Should Italy Move Forward?

“…Emerging evidence from recent studies emphasizes the potential role of DAPT in reducing costs associated with the care pathway: fewer visits, fewer exams, and a more active approach that may allow patients with MSD to achieve an earlier and better functional recovery [ 4 , 12 ]. Moreover, two recent randomized controlled trials have reported DAPT as an effective strategy even for patients with acute musculoskeletal pain in the emergency department [ 13 ] and a quick and safe adjunct to usual general practitioner-led primary care [ 14 ].…”

“…These promising results of DAPT increased the interest in the topic leading to several novel publications [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Ohja et al were the first to provide preliminary evidence that DAPT was associated with better outcomes and fewer costs than a referred pathway [ 21 ].…”

Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation

“…However, several studies have reported that primary contact physiotherapist management can reduce the use of services and resources during the ED stay. [8,[26][27][28][29]55] This research project will fill an important need in the literature by providing an in-depth analysis of the costs and efficiency of the considered models of care . Indeed, this project will help identify the most efficient ED model of care.…”