Objective
To evaluate if direct physiotherapy assessment and management of patients
presenting to emergency departments with musculoskeletal injuries (primary
contact physiotherapy) results in reduced length of stay without any increase in
adverse effects compared with secondary contact physiotherapy, where patients
are seen by a physiotherapist after initial assessment by a doctor.
Design
Prospective non-randomised controlled trial.
Setting
Three metropolitan emergency departments.
Participants
Adults (n=315) presenting to emergency departments with peripheral
musculoskeletal injuries were allocated to primary or secondary contact
physiotherapy; 306 participants completed the study. Patients with serious
pathology, open fractures and spinal pain were excluded.
Intervention
A single episode of physiotherapy.
Main outcome measures
Primary outcome measures were patient length of stay, waiting time and
treatment time. Secondary outcome measures were re-presentations to the
emergency department, imaging referrals, patient satisfaction and emergency
department staff acceptance.
Results
Primary contact physiotherapy resulted in a reduction in length of stay of
59.5minutes [95% confidence interval (CI) 38.4 to 80.6] compared with secondary
contact physiotherapy, with a reduced waiting time of 25.0minutes (95%CI 12.1 to
38.0) and a reduced treatment time of 34.9minutes (95%CI 16.2 to 53.6). There
were no differences between the groups in imaging referrals or re-presentations.
Patients strongly agreed (≥82%) that they were satisfied with their management,
and 96% of emergency department staff agreed that primary contact
physiotherapists had appropriate skills and knowledge to provide emergency
care.
Conclusion
Experienced musculoskeletal physiotherapists working in emergency departments
can be the first point of contact for patients with simple, semi-urgent and
non-urgent peripheral musculoskeletal injuries, resulting in decreased waiting
times and length of stay for patients without any adverse
effects.
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