Impacts of Physiotherapy Services in a Quebec Emergency Department
Condition: Musculoskeletal Pain; Musculoskeletal Diseases; Musculoskeletal Injury
MeSH terms: Musculoskeletal Pain; Musculoskeletal Diseases; Emergencies
Study type: Interventional

Summary: 
      Emergency departments (ED) in several countries integrated physiotherapists in order to
      reduce wait times for patients with musculoskeletal disorders (MSKD). These initiatives have
      indeed reduced wait times, length of stay, time waited before seeing a professional and the
      prescription of unnecessary consultations and diagnostic tests. In Canada, such initiatives
      are marginal and their effects have not been studied.

      The objectives of the project are to evaluate the effects of physiotherapy management of
      patients with MSKD in ED compared to usual practice on clinical course of patients, use of
      services and resources, and waiting time and length of stay in ED. The hypothesis is that
      patients presenting with a MSKD to the ED with direct access to a physiotherapist will have
      better clinical outcomes and that use of services, waiting time, and length of stay are going
      to be inferior to those of the EP group.
    

Detailed description: 
      Background and rationale: Emergency departments (ED) in several countries integrated
      physiotherapists, which led, for patients with musculoskeletal disorders (MSKD), to a
      reduction in wait times, length of stay, time waited before seeing a professional and the
      prescription of unnecessary consultations and diagnostic tests. Furthermore, early access to
      physiotherapy is associated with a decrease in pain and psychological symptoms and decreased
      risks of developing persistent pain. In Canada, such initiatives are still marginal and their
      effects have not been studied.

      Objectives: Evaluate the effects of direct access physiotherapy management of patients with
      MSKD in the ED compared to the usual management by the emergency physician on clinical course
      of patients (pain, quality of life and disability) and use of services and resources at one
      and three months, and waiting time and length of stay in the ED.

      Methods: A randomized controlled trial is currently in progress at the Centre hospitalier de
      l'Université Laval (CHUL). Two groups of 50 participants each are recruited over a six months
      period: one group with direct access to a physiotherapist (PT) in the ED and one control
      group with the usual access care to the emergency physician. Data is extracted from the
      patients' medical record, administrative data from the ED, self-administered forms given to
      the patients during their ED stay and either electronic or phone follow-ups (1 and 3 months).
      Data will be analysed using descriptive (demographic and clinical profiles) and inferential
      statistics (repeated ANOVA between groups across time points and Student T tests for
      independent samples).

      Importance of potential findings for MSK health: ED overcrowding causes prolonged lengths of
      stay, increased rates of patient leaving without being seen, increased medical errors,
      increased mortality among ambulatory and non-ambulatory patients and decreased patient
      satisfaction. This project will measure the effects of integrating PTs into the ED in a
      Canadian hospital setting and help identify ways to improve the current services offered to
      patients with a MSKD presenting to the ED. Direct access to PT may improve musculoskeletal
      health outcomes and support positive patient experience.
    

Intervention name(s): Direct access to a PT
Intervention type(s): Other
Intervention description(s): Direct access to a PT in the ED immediately after triage and prior to physician assessment.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Health care access; Health services; Professional practices