Effect and Cost of a Physiotherapy-led Care Model in Emergency Departments for Patients With Minor Musculoskeletal Injuries

Official title

Effect and Cost-effectiveness of a Physiotherapy-led Care Model for Patients Referred to an Emergency Department Due to Musculoskeletal Injuries: A Multicentre Quasi-randomized Clinical Trial

Overview

Both in Denmark and internationally, emergency departments have been overwhelmed for several years by a growing number of patients, combined with a shortage of doctors and nurses. This problem is expected to continue because the number of elderly people with multiple health problems is increasing. To keep providing good quality care in emergency departments, we need to consider new ways of organizing treatment. In Canada, Australia, and the UK, some hospitals have tried a model where specially trained physiotherapists examine and treat patients who come in with muscle and joint injuries and pain. Since these patients make up about 25% of all those referred to emergency departments, this model could help take some pressure off doctors and nurses. That way, doctors and nurses can spend more time caring for seriously ill patients who need urgent help. Several studies on these physiotherapist-led models show benefits for both patients and the healthcare system. Patients report being more satisfied and better informed about their injury and treatment. They wait less, have fewer unnecessary tests, and need fewer repeat visits to the emergency department. However, similar studies have never been done in Scandinavia, even though some Danish emergency departments have tested similar models. Healthcare systems and the education of physiotherapists differ between Scandinavian countries and the countries mentioned above. So, we don't know if we would see the same benefits here. Also, there has been no research on whether this model is cost-effective, which is important for decision-makers when planning future healthcare budgets. With this research project, we want to test a model in Danish hospitals where specially trained physiotherapists take care of examining, treating, and discharging patients with muscle and joint pain and injuries. We will look at how this model affects patient experiences (like pain and satisfaction) and clinical outcomes (like repeat emergency visits and use of imaging tests), compared to the usual practice where doctors handle these patients. We will also study whether the model is cost-effective, meaning whether the benefits of using this approach are worth the costs, or even greater than the costs. The study will be conducted at 4-5 hospitals, where a total of 800 patients with minor musculoskeletal injuries will be included in connection with their visit at the emergency department. Patients will receive questionnaires at 1, 4, 12 and 26 weeks after injury regarding patient reported outcomes. Register data will be retrieved at 26 weeks regarding the patients' health care use during follow-up.

Interventions

• Other Advanced practice physiotherapy
  Physiotherapists undergoing post-graduate education as advanced practice physiotherapists will independently diagnose, manage and discharge patients.
• Other Usual Care
  Nurses and physicians in the emergency department will diagnose, manage and discharge patients as usual

Primary outcome measures

• Brief pain inventory short form [Time frame: From baseline (time of injury) to 12 weeks follow-up]
• Euroqol 5 Dimensions 5 Levels [Time frame: From baseline to 26 weeks]

Secondary outcome measures (6)

• Visit-specific satisfaction questionnaire [Time frame: Is collected at week 1 after baseline]
• PROMIS short form physical function [Time frame: From baseline to 12 weeks after.]
• PROMIS short form upper extremety [Time frame: From baseline to 12 weeks]
• Work Productivity and Activity Impairment [Time frame: From baseline to 12 weeks]
• Return-visits to emergency department [Time frame: From baseline to 12 week follow-up]
• Health care use in primary care [Time frame: From baseline to 26 week follow-up]

Eligibility criteria

Inclusion criteria

• Musculoskeletal pain and injury to the upper or lower extremities
• Triaged non-urgent (blue) in the emergency department
• Speaks and understands Danish

Exclusion criteria

• High velocity trauma
• Cognitively unable to participate
• Non-malignant conditions (cancer, inflammation, infection)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

Denmark · 1 center

• Aarhus University Hospital — Aarhus N

Identifiers

NCT: NCT07137754 · Journal no. 1-10-72-137-24 · 4285-00270B

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗