Emergency department overcrowding is one of the most persistent threats to patient safety in modern healthcare systems, and musculoskeletal complaints — sprains, back pain, minor fractures — account for a substantial slice of that burden. A large randomised trial now offers rigorous evidence that routing these patients to physiotherapist-led pathways, rather than defaulting to physician or nurse practitioner care, meaningfully changes ED performance metrics without compromising safety.
The RESHAP-ED trial enrolled 1,491 adults across five emergency departments in New South Wales, Australia, randomising them equally to physiotherapist-led care or standard physician/nurse practitioner-led care for uncomplicated musculoskeletal conditions — a category spanning soft tissue injuries, neck and back pain, and fractures or dislocations not requiring orthopaedic surgery. The trial was pragmatic and open-label, reflecting real-world clinical conditions, and used intention-to-treat analysis with linear mixed-effects modelling. The primary endpoint was total length of emergency department stay from arrival to discharge. An embedded economic evaluation assessed cost-effectiveness alongside clinical outcomes.
This finding matters well beyond Australia. Health systems globally are grappling with how to decompress emergency departments without diluting care quality. Physiotherapists have long been integrated into primary and outpatient musculoskeletal care, but their deployment as the primary treating clinician in acute emergency settings remains underutilised and poorly evidenced. RESHAP-ED is notable for its scale — nearly 1,500 participants across five sites — its prospective registration, and its inclusion of a full economic evaluation, addressing the typical gap between efficacy data and implementation feasibility. The pragmatic design strengthens generalisability, though the Australian public hospital context may limit direct transferability to health systems with different physiotherapy scopes of practice or staffing models. This trial appears incremental in concept but potentially paradigm-shifting in evidential weight: it provides the kind of Phase III-equivalent data that policymakers need to justify formal restructuring of ED triage pathways.