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.

研究目的：评估英国急诊科（emergency department, ED）由急诊专科护士（emergency nurse practitioners, ENPs）与拓展执业范围物理治疗师（extended scope physiotherapists, ESPs）开展软组织损伤管理的临床有效性，并与急诊科医师的常规诊疗方案进行对比。
研究设计：随机实用型等效性试验。
研究场景：英格兰地区1家成人急诊科。
研究对象：共372例患者被随机分组，其中拓展执业范围物理治疗师组126例、急诊专科护士组123例、医师组123例。纳入标准为：年龄超过16岁的成年患者，因外周软组织损伤就诊于急诊科且可由三类专业人员开展诊疗。排除标准包括：损伤时长超过72小时、全身性疾病、关节脱位、近期手术史、无法签署知情同意书（如痴呆患者）、开放性伤口、严重畸形、需阿片类镇痛药物治疗、合并胸部或肋骨损伤、神经血管功能缺损以及合并骨折。
干预措施：将患者随机分配至由拓展执业范围物理治疗师、急诊专科护士诊疗，或由各级医师提供常规诊疗的组别。
主要结局指标：上下肢功能评分、生活质量、躯体健康状况、基于偏好的健康评估指标以及缺勤天数。
研究结果：急诊科内由拓展执业范围物理治疗师与急诊专科护士诊疗的软组织损伤患者，其临床结局与医师常规诊疗相当。
研究结论：由于三组患者的临床结局无显著差异，因此成本、劳动力可持续性、服务提供模式以及临床技能组合等其他因素成为关键考量因素。本研究验证了急诊专科护士的角色定位——其已逐渐成为轻伤诊疗的核心组成部分，同时证明拓展执业范围物理治疗师可作为临床技能组合的组成部分，且不会对诊疗结局造成负面影响。
ISRCTN临床试验注册编号：70891354。