Poster Presentation Sydney Spinal Symposium 2026

Physiotherapist-led care in the emergency department for musculoskeletal conditions: a randomised controlled trial with economic evaluation (RESHAP-ED) (#120)

Ponsuge Chathurani Sigera 1 2 , Tarcisio Folly de Campos 1 2 , Danielle Coombs 1 2 , Ian A. Harris 1 3 , Marina B. Pinheiro 1 2 , Christopher Maher 1 2 , Gustavo Machado 1 2
  1. Institute of Musculoskeletal Health, Sydney Local Health District, Camperdown, NSW, Australia
  2. School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
  3. Department of Orthopaedic Surgery, Liverpool Hospital, Sydney, NSW, Australia

Aims

Physiotherapist-led models of care in the emergency department (ED) may improve care and system performance, but their effects on patient flow and health outcomes have not been rigorously evaluated in randomised trials.

 

Methods

RESHAP-ED was a pragmatic, randomised controlled trial that recruited adults (age ≥18 years) presenting to five EDs in New South Wales with an uncomplicated musculoskeletal condition (e.g., soft tissue conditions, musculoskeletal neck and low back pain, and fractures or dislocations not requiring orthopaedic review or surgery). Participants were randomly assigned to either physiotherapist-led care (intervention) or usual physician- or nurse-led care (control). The primary outcome was ED length of stay (LOS), analysed using a linear mixed-effects model.

 

Results

Between November 2023 and March 2025, 1491 participants were recruited. After excluding 16 participants post-randomisation, 1475 were included in the intention-to-treat analysis (737 intervention, 738 control). Overall, 755 (51%) of participants were female. Follow-up for the primary outcome was 100% complete. Mean ED LOS was 2·4 hours in the intervention group and 3·4 hours in the control group (mean difference -1·00 h [95% CI -1·20 to -0·80]). Participants in the intervention group had shorter waiting and treatment times, were more likely to be assessed within triage timeframes, and to be discharged within 4 hours. Pain intensity and quality of life were similar between groups at all timepoints. Adverse events were reported by 39 (6·6%) of 591 participants in the intervention group versus 33 (5·9%) of 555 participants in the control group, with no significant difference (p=0·715). The intervention was associated with lower costs (-$35·1, 95% CI -$69·0 to -$1·7) and a high probability (98·1%) of being cost-effective.

 

Conclusions

A physiotherapist-led model of care in the ED reduced LOS among patients presenting with uncomplicated musculoskeletal conditions, without compromising health outcomes or safety, and was cost-effective.