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Published on: January 20, 2019
Feasibility of Direct-Access Physical Therapy for Concussion Management in the Pediatric Emergency Department: A
Isabelle Gagnon1,2,3,4, Melissa Turner5, Alexandra Lacasse-Courchesne1
1School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
Insights
Direct-access pediatric physical therapy in the pediatric emergency department (PED) improved parental satisfaction and clinical information documentation for children with suspected concussions. This interdisciplinary approach enhances early concussion management and service organization.
Area of Science:
- Pediatric Emergency Medicine
- Physical Therapy
- Neurology
Background:
- Concussion assessment and management in pediatric emergency departments (PEDs) can be improved through interdisciplinary approaches.
- Direct access to pediatric physical therapy (PPT) within the PED is a novel strategy for enhancing care.
- Evaluating parental satisfaction, clinical documentation, and service organization is crucial for assessing feasibility.
Purpose of the Study:
- To determine the feasibility of an interdisciplinary model for concussion care in the PED.
- To assess parental satisfaction with early concussion management involving PPT.
- To evaluate the impact on clinical information documentation and service organization.
Main Methods:
- A single-center retrospective analysis of prospectively collected data.
- Inclusion of patients under 18 years old presenting to the PED with suspected concussion.
- Comparison between an interdisciplinary model (PPT + usual care) and usual care alone.
Main Results:
- Patients seen by PPT reported significantly higher satisfaction scores in both the Family and Overall domains.
- Prognostic information was collected more systematically in the group receiving PPT.
- The interdisciplinary model demonstrated potential for improved service organization.
Conclusions:
- Integrating PPT into the PED enhances early concussion management for pediatric patients.
- The interdisciplinary model is associated with improved parental satisfaction and clinical documentation.
- Further research is needed to establish sustainability and guide broader implementation.
Objectives:
The objective of this study was to determine the feasibility of implementing an interdisciplinary approach to concussion assessment and management, including direct-access pediatric physical therapy in the pediatric emergency department (PED), with regard to parental satisfaction with early concussion management, documentation of clinical information for prognosis, and service organization metrics.
Methods:
This was a single-center retrospective analysis of prospectively collected data. Patients <18 years old presenting to the PED with a suspected concussion were included and either received care using the interdisciplinary model of care (pediatric physical therapy + usual care) or usual care alone, depending on their time of presentation to the PED (12 hours/week of pediatric physical therapy coverage). Clinical and administrative data were collected from the participants' medical record. In addition, a random sample of participants received a quality improvement survey administered over the phone.
Results:
Three hundred and forty-seven patients were included in the study population (mean [SD] age = 7.56 [5.62] years), and 81 were seen by the pediatric physical therapist. Those seen by the pediatric physical therapist had a significantly higher average satisfaction score for the Family domain (94.69 [11.60]) of the Pediatric Quality of Life Health care Satisfaction scale, than those who were not (89.02 [20.17]), as well as for Overall satisfaction (pediatric physical therapy = 95.45 [12.34] vs usual care = 89.21 [21.21]). Prognostic information was collected more systematically in patients seen by the pediatric physical therapist.
Conclusions:
The presence of a pediatric physical therapist in the PED could improve early management of children presenting for suspected concussions. Further research will help determine factors related to sustainability and prepare for broader implementation.
Impact:
Physical therapists, shown to be a positive addition in adult emergency departments, mostly for musculoskeletal conditions, were introduced in a PED in an interdisciplinary model of concussion care and were associated with improvements in satisfaction, clinical information documentation, and service organization.
Lay Summary:
The study investigated whether direct access to pediatric physical therapy in the pediatric emergency department (PED) would enhance parental satisfaction, early concussion management, documentation, and service organization. Conducted at a single center, it analyzed data from patients under 18 years old with suspected concussions, comparing those who received care from a pediatric physical therapist plus usual care to those who received only usual care. Results showed that parents of children seen by the pediatric physical therapist reported higher satisfaction, and prognostic information was more systematically collected, suggesting that incorporating pediatric physical therapists into the PED could improve overall care and service organization.
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