Methodological considerations
Only a few studies of the quality of care have used a randomized controlled design. This study also had a large sample of participants, sufficient power and is original, which, taken together, is a major strength. The fact that the assessment was made by different physical therapists and orthopedic surgeons can also be regarded as a strength, as it reflects the normal healthcare system and increases the generalizability of the findings.The questionnaire used in this study has good validity. As a review of patient satisfaction with healthcare reported a mean response rate of 67% for questionnaires [The duration of the assessment was set according to the hospital’s standard practice and it therefore differed between the groups (PT triage 60 min, standard care 30 min). However, the longer duration of the PT-led triage assessment may have affected the outcome, as previous studies have reported that an adequate time may be a determinant of satisfaction [The PTs was judged to be consistent regarding the decision about continued care for the patients due to the checklist. However, the physicians making the assessment in the standard care group, did not have a standardized protocol to follow during the assessment. Therefore, there might be differences regarding the physicians’ decisions on patients’ suitability for surgical intervention.There is no data available on how many patients in the standard care group that were deemed to be eligible for surgical intervention during the initial assessment. If there were a difference between the groups regarding number of patients assessed to be a surgical candidate between the groups, it might have influenced the result.Due to the covid-19 pandemic, the expected dropout was changed from 20 to 50%. Some patients did not wish to visit the orthopedic clinic due to the covid-19 pandemic and they therefore withdrew their verbal consent to participate in the study before the start of the intervention. The covid-19 pandemic also increased the waiting time for an orthopedic assessment by an OS due to fewer OS working at the clinic. As a result, some patients withdraw their consent due to the long waiting time (n = 39). In addition, more patients than usual were sent to other hospitals for an assessment and some patients (n = 20) were lost because the first author (LG) was not informed about the date of the assessment. Since the dropouts/exclusions were larger in the OS group than the PT-led triage group (n = 88 versus n = 38), this might have influenced the results.