Physio-led care in emergency departments reduces wait times for musculoskeletal patients, study finds

Embedding physiotherapist-led care in emergency departments could save NSW hospitals $19m annually and reduce stays by an hour

Major new research from the University of Sydney has found that physiotherapist-led care significantly reduced emergency department waiting and treatment times for people with back pain, fractures, dislocations and other musculoskeletal conditions.

The randomised controlled trial, the results of which have been published in The Lancet, recruited 1,491 patients who presented to five emergency departments in NSW between November 2023 and March 2025.

Chief Investigator, Associate Professor Gustavo Machado from the University’s Institute for Musculoskeletal Health, said:

“In Australia, more than 1.3 million emergency department visits annually are as a result of a musculoskeletal condition, including back pain, fractures, dislocation and joint injuries, placing considerable demand on already crowded hospitals.

“The trial showed that changing who provides the initial care from doctors and nurses to physiotherapists improved patient satisfaction, reduced the time patients spent in the emergency department, and saved hospitals money.

“With emergency department crowding one of the greatest pressures facing the health system, this trial offers a promising way to create capacity without compromising patient safety or clinical outcomes.”

Results of the trial 

Patients were randomly assigned to receive either standard care led by emergency physicians or nurse practitioners; or receive care led by a physiotherapist.

The research found that physiotherapist-led care led to significant improvements in care, without compromising clinical outcomes or safety. Patients in the intervention group:

• spent one hour less in the emergency department (2.4 vs 3.4 hours);

• were assessed 40 minutes sooner;

• were three times more likely to be seen within recommended triage timeframes; and

• reported higher satisfaction with their care.

The report found that the improvements in care did not compromise patient outcomes such as pain, quality of life or adverse events. An economic evaluation conducted as part of the trial also found that embedding physiotherapist-led care in emergency departments could save hospitals $19 million annually and release more than 540,000 hours of emergency department capacity each year if implemented across NSW.

Associate Professor Machado said: “These findings provide strong evidence for health services to consider physiotherapists as part of the frontline emergency department workforce for people with musculoskeletal conditions.”

The trial was a collaboration between the University of Sydney, Sydney Local Health District, South Eastern Sydney Local Health District, Northern Sydney Local Health District, Central Coast Local Health District, Sydney Health Partners, Agency for Clinical Innovation, the Australasian College for Emergency Medicine and Australian Physiotherapy Association.