Digital Assessment Routing Tool (DART): Pilot Study

Overview

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.

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.