Direct-Access Physiotherapy to Improve Access to Quality Care for Children and Adolescents Presenting to the Pediatric Emergency Department With Musculoskeletal Problems: The PEDPT-MSK Pilot Randomized Control Trial
Bibliographic record
Abstract
OBJECTIVE: This pilot study aimed to evaluate the feasibility of conducting a randomized controlled trial (RCT) comparing direct-access physiotherapy for children and adolescents presenting to the pediatric emergency department (ED) with low acuity musculoskeletal complaints, to current usual care provided by a physician alone. DESIGN: Pragmatic parallel 2-arm, single-blinded, single site, feasibility pilot RCT. METHODS: Sixty-six patients (aged 6-17 years) were randomized into 2 intervention groups: (1) pediatric physiotherapy group (PT) (experimental), an interprofessional model including direct access to a pediatric physiotherapist immediately after triage for assessment and recommendation/intervention + ED physician confirmation of diagnosis and plan; or (2) usual care control group (UC), receiving usual care directly from the ED physician alone. Feasibility outcomes included eligibility, consent, retention, and follow-up completion rates. Clinical outcomes, including pain interference with function, satisfaction and health service use, were evaluated at baseline, post–ED visit, and follow-up visits at 1 and 4 weeks postintervention. RESULTS: Recruitment was completed within 2 months, with 53% of eligible patients enrolled. Retention to the end of study was 92% for randomized children, and similar between groups. The compliance to data collection for each clinical outcome measures ranged from 92% to 98% 4 weeks post–ED visit, and availability of administrative and clinical information from the child’s medical record was achieved 100% of the time. CONCLUSION: The pilot RCT demonstrated feasibility in terms of recruitment, retention, and compliance to trial procedures. A larger, fully powered trial is proposed to determine the efficacy of the intervention. J Orthop Sports Phys Ther 2025;55(6):440-450. Epub 29 April 2025. doi:10.2519/jospt.2025.13321
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".