Rose Gagnon1,2,3, Kadija Perreault1,2,3, Simon Berthelot3,4,5, Eveline Matifat6,7, François Desmeules6,7, Bertrand Achou8, Marie-Christine Laroche4, Catherine Van Neste4, Stéphane Tremblay4, Jean Leblond1,2, Luc J Hébert1,2,3. 1. Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Quebec, Canada. 2. Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Quebec, Quebec, Canada. 3. Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada. 4. CHU de Québec-Université Laval, Quebec, Quebec, Canada. 5. Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada. 6. Faculté de Médecine, École de Réhabilitation, Université de Montréal, Montreal, Quebec, Canada. 7. Maisonneuve-Rosemont Hospital Research Centre, Orthopaedic Clinical Research Unit, Centre de recherche de l'Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada. 8. HEC Montréal, Montreal, Quebec, Canada.
Abstract
OBJECTIVES: The objective was to evaluate the effects of direct-access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. METHODS: We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two-way analyses of variance, log-linear analysis, and chi-square tests. RESULTS:Seventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over-the-counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow-up for imaging tests, other professionals consulted, and hospitalization rates. CONCLUSION:Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge.
RCT Entities:
OBJECTIVES: The objective was to evaluate the effects of direct-access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. METHODS: We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two-way analyses of variance, log-linear analysis, and chi-square tests. RESULTS: Seventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over-the-counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow-up for imaging tests, other professionals consulted, and hospitalization rates. CONCLUSION:Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge.
Authors: Filippo Maselli; Leonardo Piano; Simone Cecchetto; Lorenzo Storari; Giacomo Rossettini; Firas Mourad Journal: Int J Environ Res Public Health Date: 2022-01-04 Impact factor: 3.390
Authors: Rose Gagnon; Kadija Perreault; Jason R Guertin; Simon Berthelot; Bertrand Achou; Luc J Hébert Journal: Clinicoecon Outcomes Res Date: 2022-02-19
Authors: Filippo Maselli; Leonardo Piano; Simone Cecchetto; Lorenzo Storari; Giacomo Rossettini; Firas Mourad Journal: Int J Environ Res Public Health Date: 2022-04-12 Impact factor: 4.614