Physiotherapy Clinical Trial
Official title:
Advanced Practice Physiotherapy Care in Emergency Departments for Patients With Musculoskeletal Disorders: A Pragmatic Cluster Randomized Controlled Trial and Cost Analysis
Overcrowding in emergency departments (ED) is a major concern worldwide. Recent reports show that Canada has among the longest ED waiting times and limited access to care has been associated with poorer outcomes for many patients. Patients suffering from musculoskeletal disorders (MSKD) represent at least 25% of all ED visits and this number is expected to increase with the aging population. New collaborative models of care have been emerging in various settings, such as EDs, and physiotherapists (PT) have been identified as expert clinicians to care for patients with MSKD. These advanced practice physiotherapy (APP) models of care often allow for a more extended scope of practice for PTs in which they have direct access to patients without a physician referral, triage patients and sometimes prescribe medical imaging or medication. ED APP has emerged as a promising new ED model of care, but evidence of the efficacy and safety of such models is still limited. Only a few RCTs have been conducted and no studies have assessed the efficacy or cost-utility of physiotherapy models of care for patients with MSKD in Canadian EDs. Evaluation of the benefits of such models is highly context-dependent and systematic evaluation of these models is warranted to support further implementation in Canada. The aim of this multicenter stepped-wedge cluster RCT and cost analysis is to compare the effectiveness of a direct access APP model of care compared to usual physician ED care for persons presenting to an ED with a MSKD, in terms of pain, function, health care resources utilization and costs. Evidence-based development of new APP models of care in EDs could help improve access and quality of care for Canadians, thus relieving some of the pressure on our healthcare system by providing new innovative pathways of access to care for these patients.
Background: Overcrowding in emergency departments (ED) is a major concern and reports show that Canada has among the longest ED wait and length of stay times. Patients suffering from musculoskeletal disorders (MSKD) represent at least 25% of all ED visits and this number is expected to increase with the aging population. Physiotherapists (PT) have been identified as expert clinicians to care for patients with MSKD and new collaborative models of care involving PTs have been emerging in ED. Traditionally, PTs provide care in EDs only after physicians have assessed patients and made a referral for physiotherapy. More autonomous PT involvement in ED models of care allows for efficient collaborative practice with physicians and other professionals and can benefit ED performance, patient outcomes, as well as healthcare resource utilization. These advanced practice physiotherapy (APP) models of care often allow for a more extended scope of practice for PTs in which they have direct access to patients without a physician referral, triage patients and sometimes prescribe medical imaging or medication. ED APP has emerged as a promising new ED model of care, but evidence of the effectiveness of such models is limited. Only a few RCTs have been conducted and no studies have assessed the efficacy or cost-utility of APP models of care in Canadian EDs. Evaluation of the benefits of such models is highly context-dependent and systematic evaluation of these models is warranted to further support implementation in Canada. Objectives: To compare the effectiveness of a direct access APP model of care compared to usual physician ED care for persons presenting to an ED with a MSKD, in terms patient-related outcomes, health care resources utilization and costs. Methods: This trial is a multicenter stepped-wedge cluster RCT with a cost analysis. Six EDs (clusters) will be randomized to a treatment sequence where patients will either be managed by an ED PT or receive usual ED physician care without the intervention of a PT. Seven hundred and forty four patients with a MSKD will be recruited. Main outcome measures will be the Brief Pain Inventory as well as the EQ-5D-5L for economic outcomes. Secondary measures will include validated self-reported disability questionnaires and other healthcare utilization outcomes such as prescription of imaging tests and medication. Adverse events and re-visits to ED will also be monitored. Outcomes will be collected at inclusion, at ED discharge and at 4, 12 and 26 weeks following the ED visit. Health care costs will be measured from the perspective of the public system using Time-Driven Activity Based Costing. Per-protocol and intention-to-treat analyses will be performed using linear mixed-models with a random effect for cluster and fixed effect for time. The diverse and complementary research team assembled has the required methodological expertise to successfully complete this trial and several knowledge users have been involved which assures the feasibility and maximizes the impacts of this project. Discussion: MSKD not only represent a significant economic burden in Canada, but also have a significant impact on our health care system and the quality of life of Canadians. By providing an innovative pathway of access to care, APP care could help relieve pressure on Canadian ED and help provide efficient care for Canadians with MSKD. ;
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT06338254 -
Efficacy of Percussion Massage Therapy Applied to the Lower Extremity on Pain, Edema in Pregnant Women
|
N/A | |
Completed |
NCT04894929 -
Comprehensive Geriatric Assessment in the Monitoring of Functional Improvement
|
N/A | |
Completed |
NCT05875480 -
The Effectiveness of Telerehabilitation After Arthroscopic Meniscus Repair
|
N/A | |
Not yet recruiting |
NCT03992235 -
Importance of Exercise Educational Materials in Chest Physiotherapy
|
N/A | |
Completed |
NCT04114175 -
Spinal Stabilization Exercises in Individuals With Transtibial Amputatıon
|
N/A | |
Recruiting |
NCT03309540 -
Effect of Physiotherapeutic Interventions on Quality of Life in Patients With Chronic Low Back Pain. (Study 2)
|
N/A | |
Recruiting |
NCT06042465 -
Investigation on Efficacy Between TCM Treatment Using Acupuncture and Tui-na With Physiotherapy on Patellofemoral Pain Syndrome
|
N/A | |
Recruiting |
NCT04568564 -
Telerehabilitation in Lung Surgery Patients
|
N/A | |
Completed |
NCT04215497 -
Effect of PSSE on Spine Reposition Sensation in Scoliosis
|
N/A | |
Completed |
NCT03520816 -
The Effect of Early Physiotherapy on Biochemical Parameters in Major Burn Patients: A Burn Center's Experience
|
N/A | |
Completed |
NCT03505918 -
Supervised Physical Therapy Versus Unsupervised Home Exercise After Surgery for Lumbar Disc Herniation
|
N/A | |
Completed |
NCT04418687 -
Use of the Orthoglide for Improved Patient Outcome Following Total Knee Replacement
|
N/A | |
Completed |
NCT04179292 -
The Effect of Physiotherapy Program in Scleroderma Patients
|
N/A | |
Completed |
NCT04317937 -
The Effects Of Jaw Sensorimotor System In The Treatment Of Neck Pain And Dysfunction
|
N/A | |
Recruiting |
NCT04445350 -
Motor Learning in Knee Osteoarthritis
|
N/A | |
Completed |
NCT04943640 -
The Additional Effect of Different Taping Applications in Patients With Lumbar Radiculopathy
|
N/A | |
Completed |
NCT03726541 -
Hemodynamic Effects of Physiotherapy in the Early Postoperative Period
|
N/A | |
Not yet recruiting |
NCT05821335 -
Leap Motion Based Gamefication Exercises in the Individuals With Systemic Sclerosis
|
N/A | |
Recruiting |
NCT05859412 -
Mechanisms of Neurodynamic Treatments
|
N/A | |
Not yet recruiting |
NCT05829096 -
The COMBINED Study to Integrate Health Behaviour Change for People With a Rotator Cuff Disorder
|
N/A |