Aims:
The management of patients presenting to emergency departments (Eds) with a musculoskeletal condition is traditionally done by physicians or nurse practitioners and can be very time-consuming. The primary objective of RESHAP-ED is to investigate whether a primary-contact physiotherapy pathway when compared to physician/nursing pathway reduces time spent in EDs. We also investigate health outcomes (pain intensity, quality of life and satisfaction with care), cost-effectiveness, and acceptability.
Methods:
RESHAPE-ED (ACTRN1263000782639) is a multi-centre trial conducted in Royal Prince Alfred, Sutherland, Ryde, Gosford, Wyong and Grafton Hospitals. Patients with simple musculoskeletal conditions will be recruited for this trial. The primary outcome is ED length of stay. Secondary outcomes will include acceptability, feasibility, and cost-effectiveness of primary-contact physiotherapy, and explore patient’s experience. Analyses of the primary and secondary outcomes will be conducted following the intention-to-treat principles. The adjusted mean difference in ED length of stay will be calculated using linear regression adjusted for hospital using a random effect model.
Results:
Recruitment at Royal Prince Alfred Hospital commenced in November 2023. As of now, 1100 participants have been screened, with 570 enrolled. Other sites will commence recruitment in July–August 2024. We achieved a remarkable response rate for our primary outcome (99.5%), and a reported response rate of 77.0% for our secondary outcomes. So far, we have completed qualitative interviews with 12 clinicians and 7 patients.
Conclusions:
This will be the first large, high-quality randomized trial investigating patient flow, scalability, and cost-effectiveness of primary-contact physiotherapy in EDs. As a pragmatic trial, the intervention will be conducted in real-world ED settings, allowing for immediate application of results in routine practice. This could enhance access to appropriate care within EDs.