Abstract
Background:
Musculoskeletal knee disorders are a common reason for pediatric consultations, yet many primary care providers lack confidence in managing these conditions, often leading to over-referral to orthopedic surgeons and longer wait times. Advanced Practice Physiotherapists (APPs) have demonstrated effectiveness in adult orthopedic care models, particularly in improving access and optimizing care pathways, but limited research exists in pediatric populations The primary objective was to evaluate diagnostic concordance between an APP and a pediatric orthopaedic surgeon in a pediatric sports medicine clinic. Secondary objectives included concordance for triage recommendations, imaging utilization, conservative treatment recommendations, consultation time, and patient satisfaction.
Objectives:
The Advanced Practice Physiotherapist will demonstrate high diagnostic and triage concordance with the pediatric orthopedic surgeon. We also hypothesize that the APP model will provide comparable imaging use, treatment recommendations, consultation duration, and patient satisfaction, supporting its role in pediatric musculoskeletal care.
Methods:
A cross-sectional study was conducted with 26 pediatric patients aged 7 to 17 presenting with non-surgical or simple surgical-potential knee conditions. Each healthcare provider independently diagnosed the patients and provided triage recommendations. Proportion of raw agreement and Cohen’s kappa coefficients (with 95% confidence intervals) were used to assess inter-rater agreement for diagnosis, triage decisions, conservative treatment recommendations, and imaging tests ordered. Fisher’s exact tests were used to compare differences in conservative treatment recommendations and imaging utilization between providers. Student’s t-tests were used to compare consultation duration and patient satisfaction scores.
Results:
Diagnostic concordance showed a raw agreement of 92.3% and a Cohen’s kappa of 0.91 (95% CI: 0.79–1.00). Triage decisions demonstrated a raw agreement of 92.2% with a kappa of 0.85 (95% CI: 0.67–1.00). No significant differences were found in imaging prescriptions between providers (p > 0.05). Conservative treatment recommendations were also largely similar, with the exception of home exercise programs, which were prescribed more frequently by the APP (80.8% vs 38.5%; p < 0.05). Consultation times were comparable (APP: 26.2 ± 9.6 min; Surgeon: 24.4 ± 9.3 min; p > 0.05), as were patient satisfaction scores (APP: 89.3%; Surgeon: 88.2%; p > 0.05).
Conclusion:
Advanced Practice Physiotherapist demonstrated high diagnostic and triage agreement with the pediatric orthopaedic surgeon in managing knee pathologies. Conservative treatment recommendations and imaging utilization were generally consistent, with minor differences. This model of care may provide an effective and patient-centered strategy to improve access to pediatric orthopaedic services.