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Emerg Med J. Feb 2005; 22(2): 87–92.
PMCID: PMC1726666

Randomised controlled trial and cost consequences study comparing initial physiotherapy assessment and management with routine practice for selected patients in an accident and emergency department of an acute hospital

Abstract

Objective: The Department of Health is reviewing the effectiveness of accident and emergency (A&E) departments. This study aimed to compare health and economic effects of physiotherapy initial assessment and management with routine practice in an A&E department.

Methods: Randomised controlled trial and cost and consequences study. Patients presenting at A&E were eligible if suspected at triage to have soft tissue injury without fracture. The efficacy end point was "days to return to usual activities". Secondary end points included patient satisfaction with their care and further health outcomes and cost data.

Results: 766 of 844 (915) patients were randomised. The median days before return to usual activities (available for 73% of those randomised) was greater in the physiotherapist group (41 days compared with 28.5 days; hazard ratio 0.85 p = 0.071). The physiotherapy group expressed greater satisfaction with their A&E care (on a scale of 1 to 5, median was 4.2 compared with 4.0, p<0.001), were more likely to be given advice and reassurance, and more likely to be provided with aids and appliances. Costs were the same between the two arms.

Conclusion: There is evidence that physiotherapy leads to a prolonged time before patients return to usual activities. This study shows no clear danger from physiotherapy intervention and long term outcomes may be different but given these findings, a best estimate is that introducing physiotherapist assessment will increase costs to the health service and society. Routine care should continue be provided unless there is some reason why it is not feasible to do so and an alternative must be found.

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Selected References

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  • Sakr M, Angus J, Perrin J, Nixon C, Nicholl J, Wardrope J. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial. Lancet. 1999 Oct 16;354(9187):1321–1326. [PubMed]
  • Anderson DM, Blackwell RG, Tilley KC, Cockington RC. Use of physiotherapy in a children's casualty department. Med J Aust. 1982 Mar 6;1(5):203–203. [PubMed]
  • Pal B, Quennell P, Hawes S. A review of accident and emergency attendances for non-traumatic musculo-skeletal complaints. Rheumatol Int. 2000;19(5):171–175. [PubMed]
  • Daker-White G, Carr AJ, Harvey I, Woolhead G, Bannister G, Nelson I, Kammerling M. A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments. J Epidemiol Community Health. 1999 Oct;53(10):643–650. [PMC free article] [PubMed]
  • Jibuike OO, Paul-Taylor G, Maulvi S, Richmond P, Fairclough J. Management of soft tissue knee injuries in an accident and emergency department: the effect of the introduction of a physiotherapy practitioner. Emerg Med J. 2003 Jan;20(1):37–39. [PMC free article] [PubMed]
  • Essink-Bot ML, Krabbe PF, Bonsel GJ, Aaronson NK. An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA charts, and the EuroQol instrument. Med Care. 1997 May;35(5):522–537. [PubMed]
  • Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982 Sep-Oct;9(5):789–793. [PubMed]
  • Jensen MP, Karoly P, O'Riordan EF, Bland F, Jr, Burns RS. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain. 1989 Jun;5(2):153–159. [PubMed]
  • Oakley A, Rajan L, Robertson P. A comparison of different sources of information about pregnancy and childbirth. J Biosoc Sci. 1990 Oct;22(4):477–487. [PubMed]
  • Goldstein MS, Elliott SD, Guccione AA. The development of an instrument to measure satisfaction with physical therapy. Phys Ther. 2000 Sep;80(9):853–863. [PubMed]
  • Mugford M, Hutton G, Fox-Rushby J. Methods for economic evaluation alongside a multicentre trial in developing countries: a case study from the WHO Antenatal Care Randomised Controlled Trial. Paediatr Perinat Epidemiol. 1998 Oct;12 (Suppl 2):75–97. [PubMed]
  • Cooper NJ, Mugford M, Symmons DPM, Barrett EM, Scott DGI. Total costs and predictors of costs in individuals with early inflammatory polyarthritis: a community-based prospective study. Rheumatology (Oxford) 2002 Jul;41(7):767–774. [PubMed]
  • Thompson SG, Barber JA. How should cost data in pragmatic randomised trials be analysed? BMJ. 2000 Apr 29;320(7243):1197–1200. [PMC free article] [PubMed]
  • Sakr M, Kendall R, Angus J, Sanders A, Nicholl J, Wardrope J, Saunders A. Emergency nurse practitioners: a three part study in clinical and cost effectiveness. Emerg Med J. 2003 Mar;20(2):158–163. [PMC free article] [PubMed]
  • Taimela S, Diederich C, Hubsch M, Heinricy M. The role of physical exercise and inactivity in pain recurrence and absenteeism from work after active outpatient rehabilitation for recurrent or chronic low back pain: a follow-up study. Spine (Phila Pa 1976) 2000 Jul 15;25(14):1809–1816. [PubMed]

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