A pragmatic, multicentre, two-arm, parallel randomised controlled trial comparing primary-contact physiotherapy with standard of care for musculoskeletal pain in emergency departments: the RESHAP-ED trial (Coordinating Investigator – Project Manager) Musculoskeletal conditions, including low back pain, are among the top 10 reasons for presentation to Australian emergency departments (EDs). Current evidence have shown that timely access to physiotherapy in EDs reduces wait-time, and overall ED length of stay. Primary-contact physiotherapists have been present in some Australian EDs for approximately 20 years, however the level of service provision varies across sites and access is inequitable. This may be because strong evidence of effectiveness is lacking, i.e. predominately observational studies or trials of low quality. The RESHAP-ED trial is a pragmatic, multicentre, two-arm, parallel randomised controlled trial. The trial will determine the effectiveness, cost-effectiveness, and scalability of a primary-contact physiotherapy pathway when compared to usual care (doctors and nurses service) pathway in managing musculoskeletal conditions in the ED. The study hypothesis is that a primary-contact physiotherapy pathway in the emergency department, to help manage patients who present with musculoskeletal conditions, will reduce time spent in emergency departments.

We hope the findings of this project reduce avoidable hospital admissions and length of stay for low back pain while ensuring high quality care and outcomes. The project aims to implement the ‘rpavirtual’ model of care to avoid unnecessary low back pain admissions to the hospital wards and reduce length of stay across Sydney Local Health District. The project will involve conducting an audit of inpatient management of low back pain and semi-structured interviews with clinicians and patients to understand current inpatient management practices. Then, we will adapt the existing ACI model of care for acute low back pain to a ‘virtual mode’ in partnership with ‘rpavirtual’ and use an interrupted time series design to test the ‘virtual hospital’ model as an alternative to inpatient admission for low back pain.

This trial aims to evaluate four implementation strategies (alone or in combination) to reduce opioid prescribing for back pain care in the ED. It will use a clustered, sequential multiple assignment randomised trial design across 44 EDs in NSW. Based on an interim analysis, non-responding sites with an absolute reduction of 10% or less in opioid prescribing from baseline will be re-randomised to receive additional and more intensive implementation strategies. The primary outcome is proportion of patients with back pain administered an opioid in ED. Funded by MRFF ($4.7M)