Project 433905

Overcrowding in emergency departments (ED) is a major concern worldwide. Recent reports show that Canada has among the longest ED waiting times and patients suffering from musculoskeletal disorders (MSKD) represent at least 25% of all ED visits and this number is expected to increase with the aging population. Current medical management of MSKD is associated with high rates of opioids prescriptions with the majority of patients presenting to the ED for painful MSKD being discharged with an opioid prescription, even though opioids should not be the first-line treatment for the management of MSKD and while recommended non-pharmacological approaches, such as physiotherapy, are scarcely utilized. New collaborative models of care have been emerging in various settings, such as EDs, and physiotherapists (PT) have been identified as expert clinicians to care for patients with MSKD. Their involvement in these models in EDs allows for collaborative practice with physicians and nursing that is aimed to benefit ED performance, patient care and health care resource usage. In these roles, PTs can triage patients and, in some jurisdictions, order medical imaging or prescribe medications, in addition to providing recommended non-pharmacologic interventions for the management of MSKD. ED physiotherapy has emerged as a promising new ED care pathway, but evidence is still limited. Only a few RCTs have been conducted and no studies have assessed the efficacy or cost-utility of physiotherapy models of care for patients with MSKD in Canadian EDs. Evaluation of the benefits of such models is highly context-dependent and systematic evaluation of these models is warranted to support further implementation in Canada. The aim of this multicenter cluster RCT to evaluate the impact of this PT-led model of care compared to usual physician ED care for persons presenting with MSKD, in terms patients-related outcomes, healthcare resources utilization and healthcare costs.