Podiatric Clinical Triage in a Foot and Ankle Orthopaedic Clinic: A Randomised Trial

Rationale: Hospitals are increasingly utilising allied-health professionals to provide clinical triage to patients. While these positions are routinely implemented, and several observational studies have reported positive outcomes, the effectiveness of this intervention has been rarely tested in a clinical trial. Aims and Objectives: The objectives of this study were to (i) evaluate a podiatry-led orthopaedic triage service using patient-reported outcome measures (PROMs), and (ii) determine if it is cost-effective in terms of incremental cost/quality-adjusted life years (QALYs). Methods: This pragmatic, randomised, wait-list-control trial recruited participants referred to an orthopaedic foot and ankle clinic at a tertiary-level health service. Trial registration was 31 March 2020. Participants were randomised to either immediate clinical triage (intervention) or to remain on the waiting-list (control). The primary outcome measure was change in foot pain as measured by the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ) at 6-months. Core outcome measures for chronic musculoskeletal pain were also measured and cost-effectiveness calculated. Results: One hundred and forty-eight participants were recruited, randomising 73 people to the intervention and 75 people to the control. No between-group differences in pain or demographics were detected at baseline. Foot pain as measured by the MOxFQ improved in both groups at 6-months follow-up, but no significant between-group differences were identified. Significant between-group differences, however, were detected in the patient global impression of change. Additionally, the intervention resulted in a 30% discharge rate, and is considered cost-effective, with each QALY gain costing < $30,000 in real-world scenarios. Conclusion: A clinical triage service has minimal impact on PROMS for foot and ankle pain or chronic musculoskeletal pain, but it is generally well-received, is cost-effective, and participants were more likely to report global improvement if they attended.