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.