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.
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):1-11. Epub 29 April 2025. doi:10.2519/jospt.2025.13321.