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

Aarhus University Hospital

Status: Enrolling

Conditions: Musculoskeletal Disorders; Emergency Care; Physiotherapy

Treatments: Other: Usual Care; Other: Advanced practice physiotherapy

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT07137754

4285-00270B (Other Grant/Funding Number)

Journal no. 1-10-72-137-24

Details and patient eligibility

About

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.

Enrollment: 800 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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)

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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800 participants in 2 patient groups

Advanced practice physiotherapy

Experimental group

Description:

Advanced practice physiotherapists will independently diagnose, manage and discharge patients

Treatment:

Other: Advanced practice physiotherapy

Usual care

Active Comparator group

Description:

Nurses and physicians in the emergency department will diagnose, manage and discharge patients as per usual care

Treatment:

Other: Usual Care