Data from: A randomised trial comparing the clinical effectiveness of different emergency department healthcare professionals in soft tissue injury management

OBJECTIVE: To evaluate the clinical effectiveness of soft tissue injury
management by emergency nurse practitioners (ENPs) and extended scope
physiotherapists (ESPs) compared to the routine care provided by doctors
in a UK emergency department (ED). DESIGN: Randomised, pragmatic trial of
equivalence. SETTING: One adult ED in England. PARTICIPANTS: 372 patients
were randomised; 126 to the ESP group, 123 to the ENP group and 123 to the
doctor group. Participants were adults (older than 16 years) presenting to
the ED with a peripheral soft tissue injury eligible for management by any
of the three professional groups. Patients were excluded if they had any
of the following: injury greater than 72 hours old; systemic disease;
dislocated joints; recent surgery; unable to give informed consent (eg,
dementia), open wounds; major deformities; opiate analgesia required;
concurrent chest/rib injury; neurovascular deficits and associated
fracture. INTERVENTIONS: Patients were randomised to treatment by ESPs,
ENPs or routine care provided by doctors (of all grades). MAIN OUTCOME
MEASURES: Upper-limb and lower-limb functional scores, quality of life,
physical well-being, preference-based health measures and the number of
days off work. RESULTS: The clinical outcomes of soft tissue injury
treated by ESPs and ENPs in the ED were equivalent to routine care
provided by doctors. CONCLUSIONS: As all groups were clinically equivalent
it is other factors such as cost, workforce sustainability, service
provision and skill mix that become important. This result validates the
role of the ENP, which is becoming established as an integral part of
minor injuries care, and demonstrates that the ESP should be considered as
part of the clinical skill mix without detriment to outcomes.
ISRCTN-ISRCTN trials register number 70891354.