Grant: Pro. Gr. - PA: Inst. of Musculoskeletal Health and Arthritis: IMHA Mandate Areas

Access to timely and efficient primary care, including in Emergency Departments, is a challenge in the Quebec Health Care system. In response to this longstanding problem, organizational innovations in care pathways are urgently needed. Direct-access physiotherapy, where physiotherapy services are available directly to patients, who can refer themselves without having to see a physician first, has been in place in Canada for more than 30 years. Evidence suggests benefits of direct access physiotherapy, particularly in the context of musculoskeletal conditions, in terms of initial management, clinical outcomes for patients, more efficient use of resources, and diminished health care costs, while maintaining high patient satisfaction. In the last 5 years, the emergence of direct-access physiotherapy models in adult Emergency Departments, including a pilot-project in Quebec City, has led to positive outcomes for patients and more optimal use of resources for the institution. It is now time to explore the impact of such a model in the Pediatric Emergency Department (PED). We propose to test the impact of a direct-access physiotherapy model in the PED on patient outcomes and resource utilization. We will perform a clinical trial where children and adolescents aged between 6-17 years, presenting to the PED with minor musculoskeletal complaints, will be randomized to being first seen by a physiotherapist for assessment and management of their condition, or to usual care with the PED-MD alone. We will measure pain interference with function (our primary outcome), other clinical outcomes, as well as health services metrics such as wait times, return visits to the PED or overall use of health care resources, and compare them between groups, as well as explore the recovery curves of children within each group over a period of 4 weeks after their PED visit.