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.

WAIT-less: The effectiveness of a physiotherapist-led triage and treatment service on WAITing time for adults with musculoskeletal pain referred to Australian public hospital physiotherapy clinics. (Coordinating Investigator – Project Manager) Description: The WAIT-less trial is a single-blind, multicentre, two-arm, non-inferiority randomised controlled trial to evaluate the effectiveness, cost-effectiveness and potential for implementation of the physiotherapist-led triage and treatment service compared to usual clinic-based care for adults with musculoskeletal pain referred to public hospital outpatient physiotherapy clinics.

ADAPT-ED: adaptive trial of emergency department interventions for back pain (Coordinating Investigator – Project Manager) Description: Back pain is a major health issue and one of the most common presentations to Australian emergency departments. The challenge is to provide rapid pain relief to relieve patient distress and avoid delays in discharge and unnecessary hospitalisations. The problem is that potentially harmful opioids like oxycodone remain widely used and we lack relevant trial data to guide emergency clinicians’ choice of pain medicines. The ADAPT-ED is a multi-arm multi-stage, non-inferiority, randomised trial including 520 participants with moderate-severe back pain across five public hospital emergency departments in NSW and QLD, and two private hospital emergency departments in NSW, testing the comparative effectiveness of five medicines. The study will measure pain intensity within emergency department stay as the primary outcome.