Consolidation of Publicly Funded Outpatient Musculoskeletal Physiotherapy Services in Winnipeg, Manitoba: Effects on Accessibility and Service Delivery
Bibliographic record
Abstract
Purpose: In 2017, publicly funded outpatient musculoskeletal physiotherapy services in Winnipeg, Manitoba, were consolidated by closing seven hospital-based departments and limiting access to patients who met specific diagnostic criteria. Our purpose was to compare service delivery metrics and patient demographics before and after service consolidation. Method: We used an exploratory, retrospective cohort study design. Service delivery metrics and patient demographics were obtained from the regional database and compared using inferential statistics. Results: Initial physiotherapy assessments conducted per month decreased by 85.4% (absolute numbers decreased from 18,261 initial assessments in 23 months pre-consolidation to 6,715 in 61 months post-consolidation). Treatment duration (days from assessment to discharge) increased, whereas the number of appointments per patient and wait times decreased (all p < 0.001). The mean age of patients decreased by 5.2 years ( p < 0.001). More patients with wrist/hand conditions and fewer patients with surgical knee and hip conditions were seen post-consolidation. Patients attending at both time points generally came from the same neighborhoods, and measures of deprivation and marginalization were intermediate or higher on Canadian Index of Multiple Deprivation scales. Conclusions: Closing publicly funded outpatient physiotherapy services and changing eligibility limited access for many patients who may no longer be able to access necessary care if they cannot afford private services.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".