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

Context In several countries, physiotherapists (PT) have been integrated within emergency departments (EDs) to help manage patients with musculoskeletal disorders (MSKDs). Still, research on the effects of such initiatives is scarce. Objectives To evaluate the effects of direct access PT on MSKD patients consulting the ED in terms of clinical outcomes and use of health care resources. Design, Setting, Participants Randomized controlled trial, academic ED in Quebec City (Canada), participants 18-80 years presenting with a minor MSKD. Intervention Direct access PT at the ED Control Emergency Physicians lead management (EP). Main Outcome Measure Clinical outcomes (pain, interference of pain on function) and use of resources (ED return visit, interventions, diagnostic tests, consultations) were compared between groups at ED discharge and after 1 and 3 months using two-way ANOVAs, log-linear analysis and χ2 tests. Results Seventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). Participants in the PT group (n=40) had statistically lower levels of pain and pain interference at 1- and 3-months. They were recommended fewer imaging tests (38% vs. 78%; p<.0001) and prescription medication (43% vs. 67%; p=.030) at ED discharge, had used less prescription medication (32% vs. 72%; p=.002) and had revisited significantly less often the ED (0% vs. 21%; p=.007) at 1-month than those in the EP group (n=38). At 3 months, the PT group had used less over-the-counter medication (19% vs. 43%; p=.034). 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. The results of this study support the implementation of such models of care for the management of this population. Trial Registration This trial is registered at the US National Institutes of Health ([ClinicalTrials.gov][1]) #[NCT04009369][2] Ethical approval This trial was approved by the Research Ethics Committee of the CHU de Québec - Université Laval #MP-20-2019-4307 ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT04009369 ### Funding Statement Funding for this project was provided by the CHU de Québec-Université Laval, subsidies from LJH and KP and a research grant awarded by the multidisciplinary council of the CHU de Québec − Université Laval in association with the Fondation du CHU de Québec. RG received scholarships from the Canadian Institutes of Health Research, the CIRRIS, the Ordre professionnel de la physiothérapie du Québec and the Department of Rehabilitation funds of the Faculty of Medicine at Université Laval. KP is a Fonds de recherche du Québec-Santé (FRSQ) Junior 1 Research Scholar. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This trial was approved by the Research Ethics Committee of the CHU de Québec - Université Laval #MP-20-2019-4307 All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][1]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data that support the findings of this study are available from the corresponding author, LJH, upon reasonable request. [1]: http://ClinicalTrials.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04009369&atom=%2Fmedrxiv%2Fearly%2F2020%2F10%2F29%2F2020.10.28.20221531.atom