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

Wed, 12 Mar 2025 00:00:00 GMT

Title: Effectiveness of primary-contact physiotherapy in managing musculoskeletal conditions in emergency departments: protocol for the RESHAP-ED randomised controlled trial Authors: de Campos, T. F.; Coombs, D.; Sigera, C.; Williams, C.; Rogan, E.; Edward, J.; McCaffrey, K.; Howard, K.; Billot, L.; Maher, C.; Machado, G. C. 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.

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

Sat, 01 Mar 2025 00:00:00 GMT

Title: Effectiveness of primary-contact physiotherapy in managing musculoskeletal conditions in emergency departments: protocol for the RESHAP-ED randomised controlled trial Authors: de Campos, T. F; Coombs, D.; Sigera, C.; Williams, C. M.; Rogan, E.; Edwards, J.; McCaffery, K.; Howard, K.; Billot, L.; Maher, C.; Machado, G. C.; RESHAP-ED Investigators 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. Keywords: Emergency Departments; Health Services; Musculoskeletal disorders; Randomised Controlled Trial.

Secondary fracture prevention needs to happen in the country too: The first two and a half years of the Coffs Fracture Prevention Clinic

Wed, 01 Feb 2017 00:00:00 GMT

Title: Secondary fracture prevention needs to happen in the country too: The first two and a half years of the Coffs Fracture Prevention Clinic Authors: Fraser, S.; Wong, P. K. K. Abstract: Objective: To report the initial two and a half years' experience of one of the first Fracture Liaison Services in regional Australia. Design: Case study. Setting: Hospital Clinic, mid-north coast NSW. Participants: Patients aged ≥50 years with a fragility fracture identified at Coffs Harbour Health Campus July 2012 to December 2014. Intervention: Patients were identified by a Fracture Liaison Coordinator (FLC) and seen in Fracture Prevention Clinic (FPC) by a rheumatologist. Patients discharged from FPC were contacted via telephone on one occasion 12 months later. Main outcome measures: Number/characteristics of patients seen in or declining an appointment in FPC, type of bone protective therapy commenced and patient adherence with this. Results: An appointment in FPC was offered to 222 patients but declined by 56 patients. One hundred and sixty-six patients were seen in FPC, of whom 40% (n = 66/166) had a prevalent fragility fracture but only 12% (n = 8/66) were on bone protective therapy. Eighty-two percent (n = 136/166) commenced bone protective therapy. Of the 55 patients discharged from FPC with long enough follow-up to allow contact at 12 months, 60% (n = 33/55) required bone health advice during the follow-up telephone call at 12 months. Of the 31 patients who commenced bone protective therapy, 65% (n = 20/31) said they were adherent with medication. Conclusions: A FLC, committed clinician and supportive hospital environment were all that was required for an effective Fracture Liaison Service in a regional hospital. The number of patients who declined an appointment suggested the implications of a fragility fracture were often not appreciated. Keywords: fracture coordinator; fracture liaison; fracture prevention; osteoporosis; regional.

Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials

Sun, 01 Jan 2017 00:00:00 GMT

Title: Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials Authors: Fealy, S.; Taylor, R. M; Foureur, M.; Attia, J.; Ebert, L.; Bisquera, A.; Hure, A. Abstract: Background: Excessive gestational weight gain is associated with short and long-term adverse maternal and infant health outcomes, independent of pre-pregnancy body mass index. Weighing pregnant women as a stand-alone intervention during antenatal visits is suggested to reduce pregnancy weight gain. In the absence of effective interventions to reduce excessive gestational gain within the real world setting, this study aims to test if routine weighing as a stand-alone intervention can reduce total pregnancy weight gain and, in particular, excessive gestational weight gain. Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted between November 2014 and January 2016, and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Seven databases were searched. A priori eligibility criteria were applied to published literature by at least two independent reviewers. Studies considered methodologically rigorous, as per the Academy of Nutrition and Dietetics Quality Criteria Checklist for Primary Research, were included. Meta-analysis was conducted using fixed-effects models. Results: A total of 5223 (non-duplicated) records were screened, resulting in two RCTs that were pooled for meta-analysis (n = 1068 randomised participants; n = 538 intervention, n = 534 control). No difference in total weight gain per week was observed between intervention and control groups (weighted mean difference (WMD) -0.00 kg/week, 95% confidence interval (CI) -0.03 to 0.02). There was also no reduction in excessive gestational weight gain between intervention and control, according to pre-pregnancy body mass index (BMI). However, total weight gain was lower in underweight women (n = 23, BMI <18.5 kg/m2) in the intervention compared to control group (-0.12 kg/week, 95% CI -0.23 to -0.01). No significant differences were observed for other pregnancy, birth and infant outcomes. Conclusion: Weighing as a stand-alone intervention is not worse nor better at reducing excessive gestational weight gain than routine antenatal care.