The purpose of this pilot feasibility study was to 1) determine the feasibility (recruitment, retention, and compliance to data collection) of conducting a randomized clinical trial comparing direct-access physiotherapy delivered within an interprofessional model of care for children and adolescents presenting to the PED with low acuity MSK complaints, to current usual care provided by a PED physician alone; and 2) assess the initial efficacy of the proposed model.
We performed a pragmatic parallel 2-arm, single blinded, single site, pilot superiority randomized control trial. Eligible children were randomly assigned to one of 2 groups: 1) Pediatric Physiotherapy (PPT) group (experimental): an interprofessional model including direct access to a pediatric physiotherapist immediately after triage for assessment and recommendation/intervention + PED MD confirmation of diagnosis and plan, or 2) Usual care control group (UC): receiving usual care directly from the PED MD alone. Consented participants were assessed at 4 time points: pre-PED visit (T0), post-visit prior to leaving the PED (T1), 2 weeks (T2), as well as 4 weeks (T3) post-PED visit (planned primary endpoint for full trial and end of follow-up period) to document clinical, satisfaction and service utilization outcomes.
Sixty-six participants (mean 12.1 yrs SD 3.0 yrs; 60% boys) were randomized. Children presented on average 26 hours post-injury, and 85% were in low acuity categories. Around 30% of children were diagnosed with fractures during their PED encounter. Feasibility results expected the a-priori set thresholds. Pain interference scores at 4 weeks were similar for both groups, but children without a fracture, pain interference scores at 4 weeks were significantly lower for those in the PPT group (difference of -4.69 points (95%CI, -9.65 to 0.282), p=0.032). Healthcare satisfaction was significantly higher for children in the PPT group for all domains and for the total score, and that was present for both children with and without fractures.
This pilot study was the first investigating the feasibility and initial impact of first-line physiotherapy in the pediatric emergency department and demonstrated that the proposed intervention is both feasible and acceptable to participants. Preliminary data suggest potential benefits in the primary outcome measures, warranting further investigation in a fully powered randomized controlled trial.
Our future work will address identified challenges, specifically targeting the population of children without fractures who may benefit the most from this novel approach designed to optimize access to care for children and their families.
pediatric
musculoskeletal
