初级接触物理治疗在急诊科管理肌肉骨骼疾病中的有效性：RESHAP-ED随机对照试验方案

Effectiveness of primary-contact physiotherapy in managing musculoskeletal conditions in emergency departments: protocol for the RESHAP-ED randomised controlled trial.

作者信息

de Campos Tarcisio F, Coombs Danielle, Sigera Chathurani, Williams Christopher, Rogan Eileen, Edwards James, McCaffery Kirsten, Howard Kirsten, Billot Laurent, Maher Chris, Machado Gustavo C

机构信息

School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia.

出版信息

BMJ Open. 2025 Mar 12;15(3):e096044. doi: 10.1136/bmjopen-2024-096044.

DOI:10.1136/bmjopen-2024-096044

PMID:40074281

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11904353/

Abstract

INTRODUCTION

Patients with musculoskeletal conditions often seek care in an emergency department (ED). The problem is that the time required to manage these patients places an additional pressure on ED physician and nursing staff, who are primarily trained and resourced to manage high-acuity patients. Primary-contact physiotherapists could play a greater role in supporting ED physician and nursing staff in the management of patients presenting to the ED with musculoskeletal conditions.

METHODS AND ANALYSIS

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 pathway compared with usual care (primary-contact by physician and/or nursing staff pathway) reduces time spent in ED. Patients with simple musculoskeletal conditions will be recruited from EDs in New South Wales, Australia. The primary outcome is ED length of stay (LOS). Secondary outcomes will include acceptability, feasibility and cost-effectiveness of primary-contact physiotherapy, and explore patients' and clinicians' experience. To detect a 30 min between-group difference in ED LOS, 1370 patients will be required. Analyses of the primary and secondary outcomes will be conducted following the intention-to-treat principle. The adjusted mean difference in ED LOS and 95% CI will be calculated using linear regression adjusted for hospital using a random effect model.

ETHICS AND DISSEMINATION

The study received ethical approval from the Sydney Local Health District (RPAH zone) Human Research Ethics Committee (X23-0143). Findings from this study will be disseminated through publication in peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

Australia New Zealand Clinical Trials Registry: ACTRN 12623000782639; Universal Trial Number (UTN): U1111-1292-2883.

摘要

引言

肌肉骨骼疾病患者常前往急诊科就诊。问题在于，处理这些患者所需的时间给急诊科医生和护理人员带来了额外压力，他们主要接受的是处理急危重症患者的培训且资源有限。首诊物理治疗师在支持急诊科医生和护理人员处理因肌肉骨骼疾病前来就诊的患者方面可发挥更大作用。

方法与分析

RESHAP-ED试验是一项多中心、实用、开放标签、双臂平行随机对照试验，并嵌套了过程和经济评估。该试验将研究与常规护理（医生和/或护理人员首诊途径）相比，首诊物理治疗途径是否能减少在急诊科的停留时间。患有简单肌肉骨骼疾病的患者将从澳大利亚新南威尔士州的急诊科招募。主要结局是急诊科住院时间（LOS）。次要结局将包括首诊物理治疗的可接受性、可行性和成本效益，并探索患者和临床医生的体验。为检测两组之间在急诊科住院时间上有30分钟的差异，将需要1370名患者。主要和次要结局的分析将遵循意向性分析原则进行。使用随机效应模型，通过对医院进行调整的线性回归计算急诊科住院时间的调整平均差异和95%置信区间。