RESHAP-ED: comparing primary-contact physiotherapy with standard care for musculoskeletal conditions in emergency departments.

This is a pragmatic multicentre, two-arm, parallel randomised controlled trial with nested process and economic evaluations. The intervention group in this trial will be the primary-contact physiotherapist in the Hospital Emergency Department. The primary-contact physiotherapist will nominate themselves as the care provider in the Cerner FirstNet® system to indicate they are seeing the patient and then see the patient immediately. This process of recording who provides initial care in Cerner® is usual practice in emergency departments. The physiotherapy intervention will consist of a senior level 4 physiotherapist individually assessing and managing the patient as primary contact in the Hospital Emergency Department. After their initial assessment, the primary-contact physiotherapist will choose the best course of management with consultation with the patient. Care for the low back pain cases will be provided according to recommendations from the Australian Low Back Pain Clinical Care Standard, and other musculoskeletal conditions will be managed via best practice as recommended by the Emergency Care Institute. The primary-contact physiotherapist may consult a medical/nurse practitioner (collaborative model of care) or autonomously manage eligible patients. In the autonomous model of care, the physiotherapist is responsible for selecting eligible patients from the triage list, assessment, management, diagnosis, and discharge with no involvement of a medical/nurse practitioner. In the collaborative model of care, after selecting and assessing the patient, the primary-contact physiotherapist shares discharge and management decision making with a medical/nurse practitioner. All patients will be provided a discharge plan, including timely follow-up in the outpatient setting. Outpatient care will be provided by existing outpatient services such as outpatient physiotherapy, specialist clinics if required, virtual hospitals, and GP clinics. About 40 patients allocated to the primary-contact physiotherapy group will be invited to participate in a 30-45 minute audio-recorded semi-structured qualitative interview by their treating primary-contact physiotherapist during the emergency department visit. We will report data from the first 40 patients who agree to participate. This semi-structure interview will be conducted by a member of the research team. About 40 clinicians will also be invited to participate in a 30-45 minute audio-recorded semi-structured qualitative interview. Adherence to the intervention will be monitored using data from the electronic medical record. Every patient enrolled in this study will be followed for a period of 42 days. We expect the total duration of this study to be four years. The Australian Low Back Pain Clinical Care Standard (2022) can be accessed at: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/low-back-pain-clinical-care-standard-2022. Emergency Care Institute guidelines for other musculoskeletal conditions can be accessed at: https://aci.health.nsw.gov.au/networks/eci