Patient profile - a descriptive study of the patient profile in patients referred to physiotherapy in primary care in Denmark. Methods and results

1
Patient profile - a descriptive study of the
patient profile in patients referred to
physiotherapy in primary care in
Denmark.Methods and results

• Nils-Bo de Vos Andersen PT, Inger Qvist PT
  Flemming Pedersen PT Jesper Ottosen PT, Marianne
  Kongsgaard PT, MHP Christine Ib PT David.
  Hoyrup Christiansen PT,MHsc.
• Primary Health Care
  Physiotherapy
• The Regions in Denmark/ Danish
  Physiotherapy Association

2
Methods

• Descriptive cross-sectional study
• All patients, referred to physiotherapy by
  general practitioner because of musculoskeletal
  disorders in the period January 2012 to May 2012,
  were invited to participate in the study.
• A total of 201 physical therapist in 30 clinics
  collected clinical data and questionnaire at
  encounter, using an already existing database
  FysDB
• Inclusion criteria
• - Patients had to be over 18 years
• - Able to speak and understand Danish
• - No referral to home care
• - Not receiving physiotherapy for the same
  problem within the last 3 months

3
Clinical data and questionaire

• Diagnostic coding
• Symptom of musculoskeletal system was
  registered in accordance with the Danish version
  of the International Classification of Primary
  Care 2nd Edition (ICPC-2).
• The Standard Evaluation Questionnaire
• Pain and functional level in different body
  regions, duration, frequency, location, intensity
  (0-10) of the pain, sleep disorders (0-100), pain
  during daily activities, loss of function daily
  activities
• Orebro Musculoskeletal Pain Screening
  Questionnaire
• Fear avoidance behavior (0-30), Coping
  (0-10).
• Mental Health Scale (SF 36) Mental wellbeing
  (0-100)
• EQ-5D-5L Index Health-related quality of life
  (0.0 -1.0)
• Health related factors Smoking, BMI and physical
  activity

4
(No Transcript)
5
Results
Referred from General Practitioner N 5.621

• Did not meet inclusion criteria
• n 736
• Age lt 18 år (n402)
• Language (n 155)
• Phys. within lt3 month (n164)
• Referred for home treatment (n15)

Invited to participate in the study n 4.885
Did not want to paticipate n1.603
Wish to participate in the study n 3.281 (67 )

• Qustionaires missing 508
• Clinical (n 148)
• Questionaire (n 259)
• Both (n101)

Included in the study n 2.773 (57 )
6
Results Results
ICPC-2 DK Classification (n2773)
Columna/chest
Neck (L01) 21.4
Low back (L03) 25.8
Back/chest (L02/L04) 7.3
Total 54.5
Upper extremities
Shoulder (L08) 11.8
Arm/hand (L09-L12) 4.9
Total 16.7
Lower extremities
Hip(L13) 4.7
Knee (L015) 6.9
Thigh/lower leg/foot(L014/16/17) 8.0
Total 19.6
Other 7.8
Missing 1.4
.
7
Results

• 66 women and 34 men.
• Average age 48 years
• No difference in gender in the 4 Regions of DK
• 51 indicated to have had one or more previous
  episodes of the same problem
• 17 had undergone a previous surgery relevant to
  their current pain
• 0.8 indicated by the physiotherapist to have
  possible specific serious pathology/ red flags
• 9.2 reported on sick leave.
• 5 have a current claim of damages

8
Results

• Duration 24 acute (lt 1 month.), 28
  subacute (1-3 month.)
• 48
  cronic/longstanding (gt3 month.), (29 gt 12
  month.)
• Pain 37 reported constant
  pain, 51 daily pain
• Pain level Mean pain level 6.6 (SD 2.2)
  
• Medicine 40 take daily painkillers
• Sleep 46 reported having
  sleep disturbance because of the pain
• 
  
  
• 
  
  Pain spreading
  n ()
• 
  
  No body regions 135
  (4,9)
• 
  
  1-2 body regions 1365
  (49,7)

9
Fear avoidance, Coping and Mental health

• Fear avoidance beliefs
• Mean score 15.8 (SD 8.3)
• 72 had a score indicating moderate to high
  levels of fear avoidance beliefs - no differences
  in gender, but elderly patients tend to have
  lower levels of fear avoidance
• Coping
• Mean score 4.6 (SD 2.8).
• 60 had a score indicating moderate to severe
  difficulties, to manage pain - no difference in
  gender and age.

Mental health
Functional limitations
10
Preliminary longitudinal results
11
Summary of keypoints and perspectives

• This is the first study profiling patients
  referred to physiotherapy in primary practice in
  Denmark.
• Patients referred to physiotherapy were
  characterized by
• Female
• Chronic and recurrent pain
• Bothered by pain from multiple body regions
• Sleeping disturbance
• Fear avoidance beliefs
• Low coping with the pain
• Affected mental health
• These parameters seem to be important indicators
  of physiotherapy assessment and treatment in
  primary practice.
• Physiotherapists in primary practice may play an
  important role to prevent permanent disability
  and chronicity by supporting patients in
  remaining active through advice / guidance and
  appropriate treatment strategies

12
Summary of keypoints and perspectives

• Knowing the patientprofile, we intend to analyse
  collected longitudinal data and registerdata in
  order to understand the possible prognosis of
  these patients
• Enhance physiotherapist knowledge and abilities
  in order to identifing and stratifiing patients
  with a possible poor prognosis
• Improve communication in primary care between,
  physiotherapist and general practitioners, and
  also municipal communities, and second care
  sector
• Promote a development of ongoin longitudinal
  datacollection in primary care physiotherapy,
  integrating into national databases