Patient profilePatient profile

- a descriptive study of the patient profile - a descriptive study of the patient profile in patients referred to physiotherapy in patients referred to physiotherapy

in primary care in Denmark.in primary care in Denmark.

Methods and resultsMethods 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

Methods

Descriptive cross-sectional studyDescriptive cross-sectional study

All patients, referred to physiotherapy by general practitioner because of All patients, referred to physiotherapy by general practitioner because of musculoskeletal disorders in the period January 2012 to May 2012, were musculoskeletal disorders in the period January 2012 to May 2012, were invited to participate in the study. invited to participate in the study.

A total of 201 physical therapist in 30 clinics collected clinical data and A total of 201 physical therapist in 30 clinics collected clinical data and questionnaire at encounter,questionnaire at encounter, using an already existing database FysDB using an already existing database FysDB

Inclusion criteria:Inclusion criteria:

- Patients had to be over 18 years- Patients had to be over 18 years

- - Able to speak and understand DanishAble to speak and understand Danish

- No referral to home care- No referral to home care

- Not receiving physiotherapy for the same problem within the - Not receiving physiotherapy for the same problem within the last 3 months last 3 months

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

Did not meet inclusion criteria n= 736: Age < 18 år (n=402) Language (n= 155) Phys. within <3 month (n=164) Referred for home treatment (n=15)

Invited to participate in the studyn= 4.885

Referred from General PractitionerN= 5.621

Did not want to paticipate n=1.603

Wish to participate in the studyn= 3.281 (67 %)

Qustionaires missing = 508 Clinical (n= 148) Questionaire (n= 259) Both (n=101)

Included in the study n= 2.773 (57 %)

Results

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ResultsResultsICPC-2 DK Classification (n=2773)ICPC-2 DK Classification (n=2773) %%

Columna/chestColumna/chestNeck (L01)Neck (L01) 21.421.4Low back (L03)Low back (L03) 25.825.8

Back/chest (L02/L04)Back/chest (L02/L04) 7.37.3TotalTotal 54.554.5

Upper extremities Upper extremities Shoulder (L08)Shoulder (L08) 11.811.8Arm/hand (L09-L12)Arm/hand (L09-L12) 4.94.9TotalTotal 16.716.7

Lower extremities Lower extremities Hip(L13)Hip(L13) 4.74.7Knee (L015)Knee (L015) 6.96.9Thigh/lower leg/foot(L014/16/17)Thigh/lower leg/foot(L014/16/17) 8.08.0TotalTotal 19.619.6Other Other 7.87.8MissingMissing 1.41.4

Results

66 % women and 34 % men. 66 % women and 34 % men.

Average age: 48 yearsAverage age: 48 years

No difference in gender in the 4 Regions of DKNo difference in gender in the 4 Regions of DK

51 % 51 % indicated to have had one or more previous episodes of the same indicated to have had one or more previous episodes of the same problemproblem

17% had undergone a previous surgery relevant to their current pain17% had undergone a previous surgery relevant to their current pain

0.8% indicated by the physiotherapist to have possible specific 0.8% indicated by the physiotherapist to have possible specific serious pathology/ red flagsserious pathology/ red flags

9.2% reported on sick leave9.2% reported on sick leave..

5 % have a current claim of damages5 % have a current claim of damages

Results Duration: Duration: 24% acute (< 1 month.), 28% subacute (1-3 month.) 48% cronic/longstanding (>3 month.), (29% > 12 month.)

Pain: 37% reported constant pain, 51 % daily pain

Pain level: Mean pain level 6.6 (SD 2.2)

Medicine: 40 % take daily painkillersMedicine: 40 % take daily painkillers

Sleep: 46% reported having sleep disturbance because of the painSleep: 46% reported having sleep disturbance because of the pain

Pain spreading: n (%)n (%)

No body regions 135 (4,9No body regions 135 (4,9))

1-2 body regions 1365 (49,7)1-2 body regions 1365 (49,7)

3-4 body regions 906 (33,0)3-4 body regions 906 (33,0)

5-7 body regions 342 (12,4)5-7 body regions 342 (12,4)

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.

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OE Columna UE Andet

Smerter ved daglige aktiviteter funktionsstab daglig aktiviteter

Mental healthFunctional limitations

Preliminary longitudinal resultsPreliminary longitudinal results

Summary of keypoints and perspectivesSummary of keypoints and perspectives This is the first study profiling patients referred to physiotherapy in This is the first study profiling patients referred to physiotherapy in

primary practice in Denmark.primary practice in Denmark.

Patients referred to physiotherapy were characterized by:Patients referred to physiotherapy were characterized by:

FemaleFemale Chronic and recurrent pain Chronic and recurrent pain Bothered by pain from multiple body regionsBothered by pain from multiple body regions Sleeping disturbance Sleeping disturbance Fear avoidance beliefsFear avoidance beliefs Low coping with the painLow coping with the pain Affected mental health Affected mental health

These parameters seem to be important indicators of physiotherapy These parameters seem to be important indicators of physiotherapy assessment and treatment in primary practice. assessment and treatment in primary practice.

Physiotherapists in primary practice may play an important role Physiotherapists in primary practice may play an important role to to prevent permanent disability and chronicity by prevent permanent disability and chronicity by supporting patients in supporting patients in remaining active remaining active through advice / guidance and appropriate treatment through advice / guidance and appropriate treatment strategiesstrategies

Summary of keypoints and perspectivesSummary of keypoints and perspectives

Knowing the patientprofile, we intend to analyse collected Knowing the patientprofile, we intend to analyse collected longitudinal data and registerdata in order to understand the longitudinal data and registerdata in order to understand the possible prognosis of these patientspossible prognosis of these patients

Enhance physiotherapist knowledge and abilities in order to Enhance physiotherapist knowledge and abilities in order to identifing and stratifiing patients with a possible poor identifing and stratifiing patients with a possible poor prognosisprognosis

Improve communication in primary care between, Improve communication in primary care between, physiotherapist and general practitioners, and also physiotherapist and general practitioners, and also municipal communities, and second care sectormunicipal communities, and second care sector

Promote a development of ongoin longitudinal datacollection Promote a development of ongoin longitudinal datacollection in primary care physiotherapy, integrating into national in primary care physiotherapy, integrating into national databasesdatabases