The NUDG-ED trial is a pioneering study designed to reduce low-value care for back pain in emergency departments through behavioral nudges. This 2×2 factorial, open-label, before-after, cluster randomized controlled trial involves eight emergency department sites in Sydney. Participants include emergency physicians and adult patients with musculoskeletal back pain. The trial tests four interventions: patient nudges, clinician nudges, both, or no nudge (control). Patient nudges involve posters in multiple languages (English, Arabic, Chinese, and Vietnamese) to correct misconceptions about imaging and opioid use for back pain. Clinician nudges are electronic alerts triggered when prescribing opioids or imaging, advising against these practices without red flags and suggesting evidence-based alternatives. The primary outcome is the proportion of emergency department encounters for back pain where non-indicated lumbar imaging or opioids are prescribed at discharge. This study aims to improve care quality by reducing unnecessary interventions and promoting better treatment practices.

The RECITAL Trial addresses the growing burden on outpatient fracture clinics, which face increased demand for follow-ups and limited resources, resulting in long wait times and productivity losses for patients and carers. While virtual fracture clinics have been proposed as a solution for managing simple fractures, comprehensive evaluations of their safety, effectiveness, and cost-effectiveness are still needed. This prospective, two-arm, parallel group randomized controlled trial aims to determine if virtual care is non-inferior to in-person care for patients with simple fractures. The study uses a non-inferiority design and includes nested economic and process evaluations, along with semi-structured qualitative interviews with a subset of patients. The primary objective is to assess whether virtual care results in non-inferior physical function outcomes at 12 weeks, measured by the Patient-Specific Functional Scale (PSFS). Secondary objectives include comparing pain levels, health-related quality of life, patient experiences, cost-effectiveness, healthcare utilization, medication use, and safety (adverse events) at 6 and 12 weeks. Participants referred to Royal Prince Alfred’s virtual fracture clinic will be screened and, if eligible and willing, randomized to either virtual or in-person follow-up care. The intervention group will receive standard fracture management information and have follow-ups via phone or video calls with a physiotherapist. The control group will attend in-person clinic appointments with an orthopaedic doctor. Participants will complete a series of surveys as part of their clinical care.