Design: Open-label, pragmatic randomised trial with economic evaluation, five emergency departments
Population: 1,491 adults with uncomplicated musculoskeletal conditions
Primary outcome: Emergency department length of stay
Effect: 2.4 h vs 3.4 h; difference −1.0 h (95% CI −1.2 to −0.8)

RESHAP-ED was an open-label, pragmatic randomised trial at five emergency departments in New South Wales. It enrolled 1,491 adults with uncomplicated musculoskeletal presentations — soft tissue injuries, neck and back pain, and fractures or dislocations not needing orthopaedic review or surgery — and assigned them to physiotherapist-led care or usual physician or nurse practitioner care. Results were published in August.

Mean emergency department stay was 2.4 hours with physiotherapist-led care and 3.4 hours with usual care (difference −1.0 h, 95% CI −1.2 to −0.8). Adverse events were similar (6.6% vs 5.9%), costs were slightly lower, and the probability of cost-effectiveness was 98%. Primary outcome follow-up was complete.

For orthopaedic services this matters mainly at the front door: a physiotherapy-led stream can take simple presentations off the medical queue without increasing harm. The trial excluded anything needing orthopaedic input, so it does not change fracture clinic referral. Whether the model transfers to Indian emergency departments depends on physiotherapist availability and scope of practice.

Consider a physiotherapist-led stream for uncomplicated soft tissue, back and minor fracture presentations in the emergency department.
Keep anything needing orthopaedic review or surgery in the existing pathway; it was excluded from the trial.
Agree clear referral criteria from the physiotherapy stream to orthopaedics before starting.
Audit length of stay and re-attendance if the model is introduced.

Why it matters

It shows a workforce change can shorten emergency stays for the simplest musculoskeletal cases safely.

The statistics, in plain English

A one-hour difference with an interval of −1.2 to −0.8 hours is precise and well clear of zero. Adverse events at 6.6% vs 5.9% with P = .72 show no detectable difference. Open-label design matters less here because length of stay is an objective measure.