Could Primary Contact Physical Therapy Improve Emergency Department Care While Being Efficient? A 3-Month...

OBJECTIVE: To evaluate the cost utility of 2 emergency department (ED) care models: management by an emergency physician (EP; usual care), and management by a primary contact physical therapist (PT) and an EP (PT + EP; intervention). DESIGN: Cost-utility analysis based on data collected during a pilot pragmatic randomized clinical trial over a 3-month period (NCT04009369). METHODS: We measured health-related quality of life (HRQoL) and health resource use at baseline, and 1 and 3 months, using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) and a standardized health care resource use questionnaire. Responses to the EQ-5D-5L were transformed into utility scores (Canadian conversion algorithm), and then into quality-adjusted life years (QALYs) using area-under-the-curve analyses. Costs and QALYs were used to derive incremental cost-effectiveness ratios for each perspective. We conducted a complete case analysis (main analysis), and missing data were imputed using multiple imputation (sensitivity analysis). RESULTS: After 3 months, participants managed by the PT + EP had a QALY gain of 0.195 (95% confidence interval [CI]: 0.179, 0.209), compared to 0.182 (95% CI: 0.168, 0.195) for those managed by the EP alone. The average total cost in the PT + EP group for the public payer was $469.23/patient (95% CI: $269.30, $708.85) and $878.37/patient for society (95% CI: $559.72, $1208.23), compared with $804.70/patient (95% CI: $225.58, $1972.78) and $1288.76/patient (95% CI: $551.84, $2452.48), respectively, in the EP group (2019 CAD). PT + EP management was dominant for the public payer and Canadian society perspectives. CONCLUSION: The addition of PTs in EDs may reduce expenses for the public payer and society, while improving HRQoL. J Orthop Sports Phys Ther 2026;56(2):109-118. Epub 27 November 2025. doi:10.2519/jospt.2025.13429.