Lancet - 2026-08-27 - Journal Article
Physiotherapist-led care for musculoskeletal conditions in the emergency department (RESHAP-ED): a randomised controlled trial with economic evaluation.
Sigera C, Campos TF, Coombs DM, Williams CM, Rogan E, Edwards J, Harris IA, Naganathan V, Harvey LA, Buchbinder R, McCaffery KJ, Howard K, Haywood P, Pinheiro MB, Shan S, Billot L, Llewellyn S, Maher CG, Machado GC, RESHAP-ED Investigators
Topics
Key Takeaway
Physiotherapist-led care reduced emergency department length of stay by 1.0 hour (95% CI -1.2 to -0.8) compared to physician/nurse practitioner-led care for uncomplicated musculoskeletal conditions, with 98.1% probability of cost-effectiveness.
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Summary
RESHAP-ED randomized 1475 adults with uncomplicated musculoskeletal ED presentations (soft tissue, neck/back pain, non-operative fractures/dislocations) 1:1 to physiotherapist-led versus physician/nurse practitioner-led care across five New South Wales EDs. Mean ED length of stay was 2.4 h in the physiotherapy group versus 3.4 h in the control group (difference -1.0 h, 95% CI -1.2 to -0.8). Adverse event rates were equivalent (6.6% vs 5.9%, p=0.72), and the intervention was cost-saving (mean -$35.1, 95% CI -69.0 to -1.7) with 98.1% probability of cost-effectiveness.
Key Limitation
The trial excluded patients requiring orthopaedic review or surgery, limiting generalizability to the subset of musculoskeletal ED presentations that are truly uncomplicated and pre-screened as not needing operative intervention.
Original Abstract
BACKGROUND
Long stays in the emergency department compromise patient safety and health system performance. Physiotherapist-led models of care may improve care and emergency department performance, but their effects have not been rigorously evaluated in randomised trials. We compared the effectiveness, safety, and cost-effectiveness of physiotherapist-led care with usual care for patients presenting to the emergency department with musculoskeletal conditions.
METHODS
RESHAP-ED was an open-label, pragmatic, randomised trial that recruited adults aged 18 years and older at five emergency departments in New South Wales, Australia, with uncomplicated musculoskeletal conditions (eg, soft tissue conditions, neck and back pain, and fractures or dislocations not requiring orthopaedic review or surgery). Participants were randomly assigned (1:1), using statistician-generated randomly permuted blocks, to either physiotherapist-led care (intervention) or usual physician-led or nurse practitioner-led care (control). The primary outcome was length of stay in the emergency department, calculated as time from arrival to discharge, analysed in the intention-to-treat population using a linear mixed-effects model. The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12623000782639) and is completed.
FINDINGS
Between Nov 22, 2023 and March 29, 2025, 4219 patients were screened, 2728 were deemed ineligible for inclusion, and 1491 participants were randomly assigned (746 assigned to the physiotherapy-led intervention group and 745 assigned to the physician-led or nurse-led practitioner control group). Following the exclusion of 16 participants after randomisation, 1475 were included in the analysis (737 in the intervention group and 738 in the control group). The mean age of participants was 40·1 years (SD 16·5). 719 (48·7%) participants were male, 755 (51·2%) were female, and one (0·1%) participant had unreported sex data. Follow-up for the primary outcome was 100% complete. The mean length of stay in the emergency department was 2·4 h in the intervention group and 3·4 h in the control group (-1·0 h [95% CI -1·2 to -0·8]). Adverse events were reported by 39 (6·6%) of 591 participants in the intervention group versus 33 (5·9%) of 555 in the control group (p=0·72). The intervention group had lower costs (-$35·1 [95% CI -69·0 to -1·7]) and a high probability (98·1%) of being cost-effective.
INTERPRETATION
A physiotherapist-led model of care in the emergency department reduced length of stay among patients presenting with uncomplicated musculoskeletal conditions, without compromising health outcomes or safety, and was cost-effective.
FUNDING
Medical Research Future Fund.