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

Physiotherapist-led models of care may improve care and emergency department performance, but their effects have not been rigorously evaluated in randomised trials.

由物理治疗师领导的护理模式可能会改善护理和急诊科的性能，但其效果尚未在随机试验中严格评估。

We compared the effectiveness, safety, and cost-effectiveness of physiotherapist-led care with usual care for patients presenting to the emergency department with musculoskeletal conditions.

我们比较了物理治疗师领导的护理与常规护理对于因肌肉骨骼疾病就诊于急诊科患者的疗效、安全性和成本效益。

Methods

RESHAP-ED was an open-label, pragmatic, randomised trial that recruited adults aged 18 years and older at five emergency departments in New South Wales, Australia, with uncomplicated musculoskeletal conditions (eg, soft tissue conditions, neck and back pain, and fractures or dislocations not requiring orthopaedic review or surgery).

RESHAP-ED是一项开放标签、实用、随机试验，招募了在澳大利亚新南威尔士州的五家急诊科就诊的18岁及以上的成年人，他们患有非复杂的肌肉骨骼疾病（例如软组织疾病、颈部和背部疼痛，以及不需要骨科复查或手术的骨折或脱位）。

Participants were randomly assigned (1:1), using statistician-generated randomly permuted blocks, to either physiotherapist-led care (intervention) or usual physician-led or nurse practitioner-led care (control).

参与者随机分配（1:1），使用统计学家生成的随机排列块，接受物理治疗师领导的护理（干预组）或常规医生领导或护士执业者领导的护理（对照组）。

The primary outcome was length of stay in the emergency department, calculated as time from arrival to discharge, analysed in the intention-to-treatpopulation using a linear mixed-effects model.

主要结果是急诊科的停留时间，从到达到出院计算，使用线性混合效应模型在意向治疗人群中进行分析。

The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12623000782639) and is completed.

该试验已在澳大利亚新西兰临床试验注册处（ACTRN12623000782639）前瞻性注册，并已完成。

Results

Between Nov 22, 2023 and March 29, 2025, 4219 patients were screened, 2728 were deemed ineligible for inclusion, and 1491 participants were randomly assigned (746 assigned to the physiotherapy-led intervention group and 745 assigned to the physician-led or nurse-led practitioner control group).

在2023年11月22日至2025年3月29日期间，共筛查了4219名患者，2728名患者被认为不符合纳入标准，1491名参与者被随机分配（746名被分配到物理治疗师领导的干预组，745名被分配到医生领导或护士领导的实践者对照组）。

Following the exclusion of 16 participants after randomisation, 1475 were included in the analysis (737 in the intervention group and 738 in the control group).

在随机分组后排除了16名参与者，共有1475名参与者被纳入分析（干预组737人，对照组738人）。

The mean age of participants was 40·1 years (SD 16·5). 719 (48·7%) participants were male, 755 (51·2%) were female, and one (0·1%) participant had unreported sex data.

参与者的平均年龄为40.1岁（标准差16.5）。719名（48.7%）参与者为男性，755名（51.2%）为女性，1名（0.1%）参与者的性别数据未报告。

Follow-up for the primary outcome was 100% complete.

主要结果的随访率为100%。

The mean length of stay in the emergency department was 2·4 h in the intervention group and 3·4 h in the control group (-1·0 h [95% CI -1·2 to -0·8]).

干预组在急诊科的平均住院时间为2.4小时，对照组为3.4小时（差值-1.0小时[95%置信区间-1.2至-0.8]）。

Adverse events were reported by 39 (6·6%) of 591 participants in the intervention group versus 33 (5·9%) of 555 in the control group (p=0·72).

干预组有591名参与者报告了不良事件，占6.6%，而对照组有555名参与者报告了不良事件，占5.9%（p=0.72）。

The intervention group had lower costs (-$35·1 [95% CI -69·0 to -1·7]) and a high probability (98·1%) of being cost-effective.

干预组的成本较低（-$35.1 [95%置信区间-69.0至-1.7]），并且有很高的可能性（98.1%）被认为是成本效益高的。

interpretation

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

在急诊科由物理治疗师主导的护理模式减少了出现非复杂性肌肉骨骼状况的患者的住院时间，没有损害健康结果或安全性，并且具有成本效益。

funding

Medical Research Future Fund.

医学研究未来基金。