The RECITAL Trial addresses the growing burden on outpatient fracture clinics, which face increased demand for follow-ups and limited resources, resulting in long wait times and productivity losses for patients and carers. While virtual fracture clinics have been proposed as a solution for managing simple fractures, comprehensive evaluations of their safety, effectiveness, and cost-effectiveness are still needed. This prospective, two-arm, parallel group randomized controlled trial aims to determine if virtual care is non-inferior to in-person care for patients with simple fractures. The study uses a non-inferiority design and includes nested economic and process evaluations, along with semi-structured qualitative interviews with a subset of patients. The primary objective is to assess whether virtual care results in non-inferior physical function outcomes at 12 weeks, measured by the Patient-Specific Functional Scale (PSFS). Secondary objectives include comparing pain levels, health-related quality of life, patient experiences, cost-effectiveness, healthcare utilization, medication use, and safety (adverse events) at 6 and 12 weeks. Participants referred to Royal Prince Alfred’s virtual fracture clinic will be screened and, if eligible and willing, randomized to either virtual or in-person follow-up care. The intervention group will receive standard fracture management information and have follow-ups via phone or video calls with a physiotherapist. The control group will attend in-person clinic appointments with an orthopaedic doctor. Participants will complete a series of surveys as part of their clinical care. Funding: Sydney Research PhD Scholarship (awarded to Min Jiat Teng) Principal Investigator: Adrian Traeger, Min Jiat Teng, Miranda Shaw (RPA Virtual) Associate Investigators: Dr Owen Hutchings, (RPA Virtual), A/Prof Mark Horsley (Deputy Director Neurosciences, Bone & Joint, RPA Hospital), Dr Jeffrey Petchell (Head of Orthopaedic Department & Director of Trauma RPA Hospital), Prof Chris Maher (Director, Institute for Musculoskeletal Health), Dr Tessa Copp, (The University of Sydney), Dr Kristen Pickles (The University of Sydney) & Ms Rong Liu (RPA Virtual Hospital).

In 2018 over 120 000 people went to an emergency department in Australia because of low back pain. Most had ‘simple’ low back pain, where medical care such as diagnostic imaging (x-Ray, CT, MRI) and strong opioid medicines offer little benefit. Yet 3 in every 4 patients still received this kind of care. Unnecessary care can harm patients and diverts substantial resources from where they are most needed. NUDGED tests a new way to reduce unnecessary care in Australian hospitals.

This trial aims to test the effectiveness of 4 non-opioid interventions against the most used opioid medicine (oxycodone) for managing back pain in Australian EDs. This is a multi-arm multi-stage, non-inferiority, randomised controlled trial at 5 EDs in NSW. Adult patients who present to the ED with moderate/severe back pain (pain score, 4–10) will be included. Primary outcome is pain intensity (0–10 scale) measured at ED triage and at 1 hour.

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. 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. Principal Investigator: Dr Gustavo Machado (IMH) Associate Investigators: Dr Bethan Richards (IMH), Professor Chris Maher (IMH), Dr Teresa Anderson (Sydney Local Health District), Miranda Shaw (Sydney Local Health District), Dr Owen Hutchings (Sydney Local Health District), Cassandra Dearing (Sydney Local Health District), Dr James Edwards (Royal Prince Alfred Hospital), Dr Eileen Rogan (Canterbury Hospital), Dr Chris Needs (Royal Prince Alfred Hospital), Dr Danielle Coombs (IMH), Dr Rachael Dodd (University of Sydney), Dr Narcyz Ghinea (University of Sydney), Min Jiat Teng (Concord Hospital), Alla Melman (IMH). This project has received funding from Lifespan Research Network, University of Sydney and HCF Research Foundation. For more information about this project please contact: Dr Gustavo Machado e: gustavo.machado@sydney.edu.au

Patients with musculoskeletal conditions often seek care in emergency departments (ED). The problem is that the time required to manage these patients places a great deal of pressure on the ED medical and nursing staff, who are primarily trained and resourced to manage high acuity patients. Primary-contact physiotherapists could play a greater role in supporting the ED team in the management of patients presenting with musculoskeletal conditions. The RESHAP-ED trial is a multicentre, pragmatic, open-label, two-arm, parallel randomised controlled trial with nested process and economic evaluations. The trial will investigate whether a primary-contact physiotherapy service when compared to usual care (primary-contact by physicians or nurse practitioners) reduces the time patients spend in ED. A total of 1,370 patients with simple musculoskeletal conditions will be recruited from six EDs in New South Wales, Australia. The primary effectiveness outcome is the ED length of stay. Secondary outcomes include patient-reported outcomes, adverse events, and healthcare costs. The adjusted mean difference in ED length of stay and 95% confidence interval will be calculated using linear regression adjusted for hospital using a random effect model. This project is currently recruiting.

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. 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. Principal Investigator: Dr Gustavo Machado (IMH) Associate Investigators: Dr Bethan Richards (IMH), Professor Chris Maher (IMH), Dr Teresa Anderson (Sydney Local Health District), Miranda Shaw (Sydney Local Health District), Dr Owen Hutchings (Sydney Local Health District), Cassandra Dearing (Sydney Local Health District), Dr James Edwards (Royal Prince Alfred Hospital), Dr Eileen Rogan (Canterbury Hospital), Dr Chris Needs (Royal Prince Alfred Hospital), Dr Danielle Coombs (IMH), Dr Rachael Dodd (University of Sydney), Dr Narcyz Ghinea (University of Sydney), Min Jiat Teng (Concord Hospital), Alla Melman (IMH). This project has received funding from Lifespan Research Network, University of Sydney and HCF Research Foundation. For more information about this project please contact: Dr Gustavo Machado e: gustavo.machado@sydney.edu.au

The WAIT-less trial is a randomized controlled study aimed at reducing waiting times for Australians with musculoskeletal pain referred to public hospital physiotherapy clinics. Many lack private health insurance and face long waitlists, delaying recovery and increasing the risk of persistent, costly symptoms. The trial tests a physiotherapist-led triage and treatment service in NSW, Australia, designed to identify patients with simpler musculoskeletal issues that can be managed with less intensive resources—such as brief telephone appointments or app-based home exercises—freeing up in-person care for complex cases. The trial will recruit 368 participants (184 per arm) from six NSW hospitals, randomizing them to either the new triage service or usual in-person physiotherapy. Primary outcomes include physical function and waiting time, with secondary measures covering pain, health resource use, adverse events, adherence, and costs. Findings will inform whether this innovative approach can improve musculoskeletal care in Australia’s public health system.

ANZMUSC Clinical Trials Network has been established by research leaders with funding from the National Health and Medical Research Council (NHMRC) for five years (2018-2022) and is being led by Monash University. ANZMUSC Clinical Trials Network’s vision is to optimise musculoskeletal health through high quality, collaborative clinical research. They aim to do this through identifying key clinical research questions, improving the quality of research, increasing translation of research into policy and practice, fostering collaborations, endorsing clinical research, and advancing research through mentoring and education.