Feasibility of Direct-Access Physical Therapy for Concussion Management in the Pediatric Emergency Department: A Pilot Implementation Study.
Isabelle Gagnon, Melissa Turner, Alexandra Lacasse-Courchesne and 10 others
PMID 40214177WHAT IT FOUND
In a pediatric emergency department pilot, children seen by a physical therapist plus physician had higher parent satisfaction, better recall of discharge instructions, more prognostic documentation, and more concussion clinic referrals than physician alone.
This is feasibility data, not proof of effectiveness.
Key findings
01Parents of children seen by a pediatric physical therapist plus physician had higher satisfaction in the Family and Overall domains than parents of children seen by physician alone.
02More parents of children seen by the pediatric physical therapist recalled receiving both required concussion discharge documents than parents of children seen by the physician alone.
03Children seen by the pediatric physical therapist had more documented prognostic items, more available 5P rule scores, and higher appropriate concussion clinic referral than children seen by the physician alone.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a pilot implementation study at one tertiary pediatric emergency department, so it cannot be assumed to work the same way in other settings. Physical therapist coverage was only 12 hours per week on 3 weekdays, so children presenting at other times were not eligible for the physical therapist model. The comparison was not based on random assignment. Children were grouped by whether their visit occurred on a weekday during physical therapist coverage hours and whether they were seen by a physical therapist. The sample seen by the physical therapist was modest, and the physical therapist group received physical therapist screening, physician review, physician disposition, and physical therapist education together. The effect of any single component cannot be separated. Only 199 parents completed the satisfaction survey, and the study did not include barriers, facilitators, or economic analysis for wider implementation. Parental satisfaction may have been influenced by the time allocated to the family rather than by the physical therapist's specific skills.
Declared interests
The School of Physical and Occupational Therapy, McGill University funded the work. The paper states that the funders played no role in the design, conduct, or reporting of the study.
The easy way to misread this
Do not read this as proof that adding a pediatric physical therapist causes better concussion care. It was a single-center pilot with limited hours, a modest sample, and a comparison not based on random assignment, so the findings show feasibility and association rather than effectiveness.