Digital Assessment Routing Tool (DART): Pilot Study
- Conditions
- Musculoskeletal Diseases or Conditions
- Interventions
- Other: Digital Assessment Routing Tool [DART]Other: Physiotherapy-led remote triage (usual care)
- Registration Number
- NCT04904029
- Lead Sponsor
- Queen Mary University of London
- Brief Summary
In the pilot study, we aim to explore trial design, assess procedures, and collect exploratory data to inform the design of a future Randomised Controlled Trial.
The intervention involves a Digital Assessment Routing Tool (DART) that provides triage outcomes with recommended management pathways for participants with musculoskeletal problems. Participants complete DART either before or after their consultation with usual care clinicians (Physiotherapy-led remote triage). The triage outcome dispositions between DART and usual care clinicians will be compared.
A panel will be formed to provide consensus on disagreements that may result in adverse triage outcomes, as well as on a sample of agreements between DART and usual care clinicians.
- Detailed Description
The Digital Assessment Routing Tool (DART) is a first-contact web-based and mobile health system that uses clinical algorithms to triage patients with musculoskeletal disorders and recommend management pathways. This is achieved by completing an online web-based questionnaire that follows a clinical reasoning process commonly observed in face-to-face physiotherapy consultations. Based on the participant's answers, the clinical algorithm will generate sets of questions, leading up to a final triage disposition with a recommended management pathway. The triage outcomes with recommended management pathways are classified as follows;
1. Medical care
* A\&E referral
* Urgent GP
* Routine GP
* Consultant review
2. Physiotherapy care
* Post-fracture or surgery physiotherapy
* Physiotherapy referral
* Physiotherapy referral plus psychosocial support
3. Self-management
* Self-management with SOS
* Continue self-management advice
The usual care clinician, providing physiotherapy-led remote triage, will follow their clinical reasoning and proceed with the consultation as usual. The participants will receive both the DART assessment and usual care remote triage (crossover design). Patient care will not change (except time taken to reach a decision) as its a crossover design and only the clinician assessment will count. Note, participants will be randomised in two arms (DART, PT-remote triage or reversed) to account for order effects.
Outcomes will be collected at a single time point (Visit 1).
Post data collection, a panel consisting of researchers, physiotherapists and clinical leaders with a minimum of 5 years' experience in musculoskeletal health will provide consensus on all the disagreements between DART and physiotherapy-led remote triage that can result in adverse triage outcomes;
* Physiotherapy care or self-management when it should have been urgent medical care (A\&E referral or urgent GP).
* Self-management when it should have been either physiotherapy care or medical care and harm could result.
* Routine care when it should have been urgent care and harm could result.
In addition, random samples of triage outcomes will be assessed to decide whether they were the most appropriate outcome.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 78
- A current musculoskeletal injury for which they are seeking treatment
- Over 18 years old
- Able to read and speak English
- Live in the UK
- Able to access the internet
- Cognitive impairments or learning disabilities that limits the participants to follow study- related procedures
- Unwillingness or inability to follow protocol-related procedures
- Optima Health employees
- Has an assessment from a health care professional for the same condition within the last 7 days
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description 1. Physiotherapy-led remote triage 2. Digital Assessment Routing Tool (DART) Digital Assessment Routing Tool [DART] Participants complete their physiotherapy-led remote triage with the usual care clinician, which is followed by the Digital Assessment Routing Tool. 1. Digital Assessment Routing Tool (DART) 2. Physiotherapy-led remote triage Physiotherapy-led remote triage (usual care) Participants complete the Digital Assessment Routing Tool (DART), which is followed by physiotherapy-led remote triage with the usual care clinician. 1. Digital Assessment Routing Tool (DART) 2. Physiotherapy-led remote triage Digital Assessment Routing Tool [DART] Participants complete the Digital Assessment Routing Tool (DART), which is followed by physiotherapy-led remote triage with the usual care clinician. 1. Physiotherapy-led remote triage 2. Digital Assessment Routing Tool (DART) Physiotherapy-led remote triage (usual care) Participants complete their physiotherapy-led remote triage with the usual care clinician, which is followed by the Digital Assessment Routing Tool.
- Primary Outcome Measures
Name Time Method The agreement rate between triage outcomes with management pathways from physiotherapy-led and DART triage assessments. Immediately after the intervention. The primary outcome measure will be the agreement rate of triage decisions made by both the clinician and the Digital Assessment Routing Tool (DART). The possible triage outcomes with management pathways are classified in three categories, namely 1) Medical care, 2) Physiotherapy care, and 3) Self-management.
1. Medical care
* A\&E referral
* Urgent GP
* Routine GP
* Consultant review
* Physiotherapy care
2. Post-fracture or surgery physiotherapy
* Physiotherapy referral
* Physiotherapy referral plus psychosocial support
* Self-management
3. Self-management
* Self-management with SOS
* Continue self-management advice
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
Haydock Medical Centre
🇬🇧St Helens, Herts, United Kingdom