Physiotherapy and physical activity in children with Perthes’ disease
Bibliographic record
Abstract
Aims: In the absence of clear and consistent clinical guidelines, this study aims to survey the current international consensus on recommendations for physiotherapy (PT), physical activity (PA), and weightbearing in patients with Perthes' disease. Additionally, the study seeks to identify factors influencing these recommendations, and to determine at which stage possible restrictions on physical activity are typically lifted. Methods: An online international cross-sectional survey using a purpose-designed questionnaire with a general section, and three cases of Perthes' disease, was distributed to surgeons through paediatric orthopaedic societies and research groups. Results: A total of 160 paediatric orthopaedic surgeons from 43 different countries (seven continents) participated. There was general agreement that impaired range of motion (ROM) and pain were important when prescribing PT, while the child's sex was not important. There was disagreement on whether age and Waldenström or Lateral Pillar classification were important factors in determining the need for PT. There was widespread agreement that stretching in the early stages of Perthes' disease was important, although Western and Southern Europe and the British Isles differed. There was considerable disagreement about strengthening exercises. 'Weightbearing as tolerated' in the early and fragmentation stages was generally recommended in the British Isles and Scandinavia (both > 90%), whereas other regions showed large variation. Regarding PA, there was broad agreement in allowing swimming and cycling, and discouraging high-impact activities including school sports in all stages. Conclusion: Maintaining ROM was crucial for most participants, with strong consensus to discourage high-impact activities during initial and fragmentation stages. Swimming and cycling were often allowed, but no clear consensus emerged on weightbearing restrictions or when to resume full activities. Consensus within the British Isles, Scandinavia, and Eastern Europe was high for both for PT and PA, but recommendations differed between countries. Recommendations from the British Isles and Scandinavia were less restrictive than their Eastern European counterparts.
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 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".