Emergency Care, Musculoskeletal Disorders, Physiotherapy
Conditions
Brief summary
Both in Denmark and internationally, emergency departments have been overwhelmed for several years by a growing number of patients, combined with a shortage of doctors and nurses. This problem is expected to continue because the number of elderly people with multiple health problems is increasing. To keep providing good quality care in emergency departments, we need to consider new ways of organizing treatment. In Canada, Australia, and the UK, some hospitals have tried a model where specially trained physiotherapists examine and treat patients who come in with muscle and joint injuries and pain. Since these patients make up about 25% of all those referred to emergency departments, this model could help take some pressure off doctors and nurses. That way, doctors and nurses can spend more time caring for seriously ill patients who need urgent help. Several studies on these physiotherapist-led models show benefits for both patients and the healthcare system. Patients report being more satisfied and better informed about their injury and treatment. They wait less, have fewer unnecessary tests, and need fewer repeat visits to the emergency department. However, similar studies have never been done in Scandinavia, even though some Danish emergency departments have tested similar models. Healthcare systems and the education of physiotherapists differ between Scandinavian countries and the countries mentioned above. So, we don't know if we would see the same benefits here. Also, there has been no research on whether this model is cost-effective, which is important for decision-makers when planning future healthcare budgets. With this research project, we want to test a model in Danish hospitals where specially trained physiotherapists take care of examining, treating, and discharging patients with muscle and joint pain and injuries. We will look at how this model affects patient experiences (like pain and satisfaction) and clinical outcomes (like repeat emergency visits and use of imaging tests), compared to the usual practice where doctors handle these patients. We will also study whether the model is cost-effective, meaning whether the benefits of using this approach are worth the costs, or even greater than the costs. The study will be conducted at 4-5 hospitals, where a total of 800 patients with minor musculoskeletal injuries will be included in connection with their visit at the emergency department. Patients will receive questionnaires at 1, 4, 12 and 26 weeks after injury regarding patient reported outcomes. Register data will be retrieved at 26 weeks regarding the patients' health care use during follow-up.
Interventions
OTHERAdvanced practice physiotherapy
Physiotherapists undergoing post-graduate education as advanced practice physiotherapists will independently diagnose, manage and discharge patients.
OTHERUsual Care
Nurses and physicians in the emergency department will diagnose, manage and discharge patients as usual
Sponsors
Slagelse Hospital
Gødstrup Hospital
Université de Montréal
Independent Research Fund Denmark
University of Aarhus
Danske Fysioterapeuter
Aarhus University Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Musculoskeletal pain and injury to the upper or lower extremities * Triaged non-urgent (blue) in the emergency department * Speaks and understands Danish
Exclusion criteria
* High velocity trauma * Cognitively unable to participate * Non-malignant conditions (cancer, inflammation, infection)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Brief pain inventory short form | From baseline (time of injury) to 12 weeks follow-up | BPI short form is a self-reported questionnaire, using the 7 items pain interference on functional ability, mood, sleep and work. The patient completes the assessment at baseline, 1, 4, 12 and 26 weeks after injury |
| Euroqol 5 Dimensions 5 Levels | From baseline to 26 weeks | The EQ5D assesses health-related quality of life using 5 items. It is used as the primary outcome for qualculation of QUALYs in the health economic analysis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PROMIS short form upper extremety | From baseline to 12 weeks | Contains questions about functional limitations due to injuries in the upper extremeties. Measured at baseline, weeks 1, 4, 12 and 26 after discharge |
| Work Productivity and Activity Impairment | From baseline to 12 weeks | The WPAI measures number of hours missed from work, volunteer work (unpaid work) and studies due to health related issues. Further it measures hours with reduced productivity at work due to health related issues. Assessed at baseline, weeks 1, 4, 12 and 26 using self-reported questionnaires |
| Visit-specific satisfaction questionnaire | Is collected at week 1 after baseline | VSQ-9 is a selfreported questionnaire with 9 items on different aspects of patient satisfaction with their visit to the emergency department |
| Health care use in primary care | From baseline to 26 week follow-up | Includes visits with general practice and physiotherapy practice during follow-up. This will be collected via the National Health Service Register |
| Return-visits to emergency department | From baseline to 12 week follow-up | Return-visits and phone calls to the emergency department due to the same injury during follow-up, assessed using self-report and register-based data. |
| PROMIS short form physical function | From baseline to 12 weeks after. | The questionnaire contains 8 questions on limitations in functional ability due to injuries in the lowe extremeties. It is collected via self-reported questionnaires at baseline, weeks 1, 4, 12 and 26 after baseline |
Countries
Denmark
Contacts
Primary ContactNanna Rolving, Associate professor
Backup ContactLouise Mortensen, PhD student
Outcome results
None listed