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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 Quebec 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.

ContextIn several countries, physiotherapists (PT) have been integrated within emergency departments (EDs) to help manage patients with musculoskeletal disorders (MSKDs). Still, research on the effects of such initiatives is scarce.ObjectivesTo evaluate the effects of direct access PT on MSKD patients consulting the ED in terms of clinical outcomes and use of health care resources.Design, Setting, ParticipantsRandomized controlled trial, academic ED in Quebec City (Canada), participants 18-80 years presenting with a minor MSKD.InterventionDirect access PT at the EDControlEmergency Physicians lead management (EP).Main Outcome MeasureClinical outcomes (pain, interference of pain on function) and use of resources (ED return visit, interventions, diagnostic tests, consultations) were compared between groups at ED discharge and after 1 and 3 months using two-way ANOVAs, log-linear analysis and χ2 tests.ResultsSeventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). Participants in the PT group (n=40) had statistically lower levels of pain and pain interference at 1- and 3-months. They were recommended fewer imaging tests (38% vs. 78%; pConclusionPatients 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. The results of this study support the implementation of such models of care for the management of this population.Trial RegistrationThis trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT04009369Ethical approvalThis trial was approved by the Research Ethics Committee of the CHU de Québec - Université Laval #MP-20-2019-4307