Review - Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland

Article: Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland
Article status: accepted
Author: Ken Chance-Larsen
Review date: 16 March 2022
DOI: 10.14426/opj/rkc20220609

Peer review (Chance-Larsen) – Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland

Overall, I think this is a worthwhile article and potentially important work, and I hope that you proceed to improve and resubmit. I agree with Ralph Hammond that it seems more of a service improvement project at the moment, and that several changes are required for it to be seen as a pilot project. Consider the actual aim of your project and also the inherent purposes of doing a pilot project, is it to evaluate feasibility of rolling out such a project on a bigger or more permanent scale?

1. Complete, coherent, and well-organized presentation: The article is presented well, with effective use of language throughout. The structure is logical. There is no Discussion section, this should be added. There are some grammatical errors that would benefit from proofreading.

2. Sufficient explanation of the significance of the problem: You offer relevant contextual information and base factual background on sources that appear both trustworthy and meaningful to the topic. I am a little uncertain about the relevance of motor development, this seems somewhat outside of the scope or focus for your article. If your argument is that motor development is required for physical activity to be possible, you should perhaps offer a stronger rationale for this.

You could also consider strengthening the argument for the importance of promoting physical activity for children and adolescents, linking to studies showing how habits developed in this life phase can develop into life-long habits. There is also the potential for social and academic gains to be achieved through physical activity (see

3. Clear demonstration of the relevance to the field (beyond the case presented): I think this is an important initiative and you deserve a lot a credit for undertaking this pilot project. It is potentially useful for the individual pupils, for society, and for the physiotherapy students as part of their learning. Perhaps you could explain if the intention is to use the results of this pilot to expand with similar parameters or if you envisage this to become part of qualified physiotherapists job roles.

4. Original contribution to the topic of physiotherapy education: See 3. Above.

5. Compelling presentation of the problem within a theoretical framework (where appropriate): You could consider expanding on the wider contextual factors, where the background is one of societies and health care systems which tend to focus on curative and interventional healthcare, rather than the promotion and protection of good health which you set out to achieve with your intervention.

6. Establishment of a relationship between the problem and other relevant literature: There is a lot of literature around integrating movement and physical activity into the classroom, and you could offer a wider basis for the potential role physiotherapists/physiotherapy students cold play here.

7. Appropriate research design and method: It is unclear how you obtained the information that shaped your results.

8. Accurate and useful interpretation: Difficult to comment on this as you give no information about how and from who you collected feedback.

9. Sound argument and analysis: Also limited due to missing information.

10. Effective conclusion about the implications for physiotherapy education, research, and/or practice: See below.

Detailed comments and feedback


Consider the points made under each heading, then update to abstract to reflect any changes.


  1. You have not offered a citation to support this sentence: “It has been shown that one third of adolescents report musculoskeletal (MSK) pain monthly and prevalence of MSK pain increases from childhood to adolescence.”
  2. Physical activity is not the same as motor development, how can you be sure the latter is a problem? We should be careful not to create problems if no problem exists, and of creating an intervention or treatment need when none is required.

Methods – School physiotherapy pilot

  1. You present the aim in this section, it fits better at the end of the Introduction. Consider if the aim is as you describe it, or if by undertaking a pilot project you are setting out to find out if this model is useful, viable, etc.
  2. This sentence “Physiotherapy students, who participated in this pilot , were at the end of their studies and this practice was at least their third placement.” could be made clearer, it is not obvious to the reader (at least me) how much clinical placement experience the students have under their belt at the time of taking part in the pilot.
  3. It would be useful to know the age range and overall number of the pupils involved.
  4. By this sentence “Shared reflection was perceived important for students.” did you mean important for students or someone else? Or important by students?
  5. It would be useful to know how the apparent popularity of the groups was measured (if a pupil didn’t enjoy the groups she might not openly share this),
  6. Can you clarify some aspects around this sentence: “Students were involved in health evaluations, where they provided health-promoting advice especially to overweight, obese and inactive pupils.” Did the students target only those pupils who were overweight, obese, or inactive? How was this established? Was this selective information-sharing hidden from the other pupils? There are some potential ethical issues around how this was carried out, please provide more information.
  7. The spinal assessments for scoliosis needs to be explained further, including any associated limitations. Was it the forward bend test (Adan’s test), plumb line, anything else? Was it testing for idiopathic and postural scoliosis?


  1. You could offer more information about how you evaluated the project; how did you collect feedback and from who?
  2. It would also be useful to understand the cost associated with such a project, not least to be able to justify this approach on a long-term basis from a cost-benefit perspective.


No section on this. Consider writing this section to discuss the possible implications and limitations of your pilot project, and to offer insights into the viability and value of expanding the initiative on a bigger and/or continuing basis.


I don’t think you have presented compelling arguments for why school physiotherapy is ‘necessary’. By “…for improving physiotherapy for school-aged children and adolescents.” you have possibly fallen into the trap of aligning the profession (physiotherapy) with an intervention. Or I might have misunderstood the intended meaning here.


One Reply to “Peer review (Chance-Larsen) – Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland”

  1. We would like to thank you collegial discussion of issues brought up in this paper and all the valuable comments.

    We have made changes which we feel appropriate and possible based on this work. Our work is a service improvement project and that’s why we weren’t able to show results of pilot, but we added discussion section. We clarified the contextual factors of the paper and added details to the requested questions. We have strengthened the arguments of the importance of promoting physical activity for pupils and linked studies about that. We also added details about the physical education and school health care system in Finland. We described the project more specific and added references to feedback from students, pupils and the teachers. We weren’t able to evaluate the long-term cost-benefits of this project, because we didn’t follow up that.

    We are encouraged by your interest and valuable comments, and are hoping to continue the development of this project.

    We are very grateful for your time and advice and look forward to further discussion.
    The authors.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.