One in six physiotherapy practices in primary care offer musculoskeletal ultrasound - an explorative survey.

BACKGROUND: The first aim of this research was to investigate the current prevalence of musculoskeletal ultrasound in Dutch physiotherapy practices. The second aim was to explore experiences of physiotherapists with musculoskeletal ultrasound in a primary care setting with patients presenting with shoulder complaints. METHODS: A random sample of 1000 owners of primary care physiotherapy practices was sent a questionnaire to investigate the prevalence of musculoskeletal ultrasound. A second questionnaire was sent to physiotherapists using musculoskeletal ultrasound to explore experiences with it in patients with shoulder complaints. RESULTS: The net response rate of the first questionnaire was 57.7%. In 18% of the physiotherapy practices musculoskeletal ultrasound was offered. Sixty-nine physiotherapists returned the second questionnaire. Physiotherapists indicated they most often used musculoskeletal ultrasound in patients with shoulder complaints, mainly for suspected tissue damage (83.7%), followed by making a diagnosis (63.3%) and for determining the choice of treatment (36.7%). Physiotherapists reported the biggest advantage was that they were better able to diagnose presenting shoulder complaints. The most frequently mentioned disadvantage of the use of musculoskeletal ultrasound was that assessment is difficult and that there is a risk that findings may not be sufficiently linked to history and physical examination. CONCLUSION: One in six physiotherapy practices in the Netherlands offer musculoskeletal ultrasound. It is mainly used for patients with shoulder complaints, with an emphasis on detecting tissue damage and as an aid for diagnosis. Physiotherapists trained to work with musculoskeletal ultrasound seem enthusiastic and are at the same time aware of its disadvantages.

Do therapist effects determine outcome in patients with shoulder pain in a primary care physiotherapy setting?

OBJECTIVES: To explore whether a therapist effect exists in physiotherapists treating patients with shoulder pain and to identify if personality traits of the physiotherapist influences patients outcome. DESIGN: Observational cohort study. SETTING: Primary care physiotherapy practices. PARTICIPANTS: Data on patients with shoulder complaints that started and finished treatment between 2009 and 2012 were derived from the NIVEL Primary Care Database. Personality traits of the physiotherapist were identified using the Big Five Inventory. Data of 2814 patients and 56 physiotherapists were analysed using multi level linear regression. MAIN OUTCOME MEASURE: Severity of complaint was measured on a 10-point Likert scale at the start and end of treatment. Change score is used as outcome. RESULTS: A therapist effect exists in the rehabilitation of patients with shoulder complaints in a physiotherapy setting; the physiotherapist explained 12% of variance and the personality trait extraversion showed a significant association (P=0.03) with change in treatment outcome. CONCLUSION: Current explorative study suggests that patients who were treated by therapists that tend to be more outgoing and energetic achieved better treatment results. Additional studies are needed to unravel the interplay between personality traits and other variables of importance, like patients' personality traits or psychological factors, in treating patients with shoulder complaints.

Exploring physiotherapists' personality traits that may influence treatment outcome in patients with chronic diseases: a cohort study.

BACKGROUND: During treatment of patients with Chronic Diseases (CD) the therapist-patient interaction is often intense, and the strategies used during treatment require physiotherapists to assume a coaching role. Uncovering therapist factors that explain inter-therapist variation might provide tools to improve treatment outcome and to train future therapists. The purpose of this study was to explore the so-called 'therapist-effect', by looking at the influence of intrinsic therapist factors, specifically personality traits, on treatment outcome in patients with CD. METHODS: A cohort study was performed using data from the NIVEL Primary Care Database (NPCD) in 2011-2012 and an additional questionnaire. Patients with CD (n = 393) treated by Dutch physiotherapists working in outpatient practices (n = 39) were included. Patient and treatment outcome variables were extracted from NPCD. The course of complaint was measured using the Numeric Rating Scale. Therapist variables were measured using a questionnaire consisting of demographics and the Big Five traits: Extraversion, Neuroticism, Agreeableness, Conscientiousness and Openness to experiences. Data were analysed using multilevel linear regression. RESULTS: Only Neuroticism was found to be significant (Neuroticism F = 0.71, P = 0.01; therapist gender F = 0.72, P = 0.03; life events F = -0.54, P = 0.09; patient gender F = -0.43, P = 0.10; patient age F = 0.01, P = 0.27). Subgroup analyses of 180 patients with Osteoarthritis and 30 therapists showed similar results. CONCLUSIONS: There are indications that patients with CD who are treated by therapists who tend to be calmer, more relaxed, secure and resilient have a greater reduction in severity of complaints compared to patients treated by therapists who show less of these traits. Being a male therapist and having experienced life events influence outcome positively. However, more extensive research is needed to validate the current findings.

Pain intensity, neck pain and longer duration of complaints predict poorer outcome in patients with shoulder pain--a systematic review.

BACKGROUND: Shoulder complaints are common and have an unfavourable prognosis in many patients. Prognostic information is helpful for both patients and clinicians in managing the complaints. The research question was which factors have prognostic value on (un)favourable outcome in patients with shoulder complaints in primary care, secondary care and occupational settings. METHODS: Update of a systematic review in primary care, secondary care and occupational settings. RESULTS: Nine articles were published since the original review in 2004. Six were of high quality covering a wide variety of prognostic factors and outcome measures. Four studies were conducted in primary care settings. A best evidence synthesis, including the results of the previous systematic review on this topic shows that there is strong evidence that higher shoulder pain intensity, concomitant neck pain and a longer duration of symptoms predict poorer outcome in primary care settings. In secondary care populations, strong evidence was found for the association between greater disability and poorer outcome and between the existence of previous shoulder pain and poorer outcome. CONCLUSION: Clinicians may take these factors into account in the management of their patients. Those with a worse prognosis may be monitored more frequently and the treatment plan modified if complaints persist.

An overview of 5 years of patient self-referral for physical therapy in the Netherlands.

BACKGROUND: Self-referral for physical therapy was introduced in 2006 in the Netherlands. Internationally, debate on self-referral is still ongoing. OBJECTIVE: The aim of this study was to evaluate the effects of self-referral for physical therapy in the Netherlands, focusing on volume of general practice and physical therapy care (incidence rates and utilization of services). DESIGN: The study was based on monitoring data from existing data sources. METHODS: Longitudinal electronic medical record data from general practitioners (GPs) and physical therapists participating in the NIVEL Primary Care Database were used, as well as public data from Statistics Netherlands. Descriptive statistics and Poisson multilevel regression analyses were used for analyzing the data. RESULTS: Incidence rates of back (including low back), shoulder, and neck pain in general practice declined slightly from 2004 to 2009. No linear trends were found for number of contacts in GP care for back (including low back) and neck pain. The number of patients visiting physical therapists and the proportion of self-referrers are growing. Self-referrers receive treatment less often after initial intake than referred patients, and the mean number of visits is lower. LIMITATIONS: This study was based on data of various patient populations from existing data sources. CONCLUSIONS: The current study indicates that self-referral in the Netherlands has fulfilled most expectations held prior to its introduction, although no changes to the workload of GP care have been found. Use of physical therapy grew, but due to population aging and increasing prevalence of chronic diseases, it remains unclear whether self-referral affects health care utilization. Therefore, cost-benefit analyses are recommended.

Physiotherapists' compliance with ankle injury guidelines is different for patients with acute injuries and patients with functional instability: an observational study.

QUESTIONS: What are the characteristics of patients with acute ankle injuries or functional instability of the ankle? Do physiotherapists treat these patients according to evidence-based guidelines? What are the determinants of adherence to the guidelines? DESIGN: Observational study using multi-level analyses of data from the National Information Service for Allied Health Care in the Netherlands. This network continuously collects healthcare-related information on characteristics of patients and their referral, health problem, and treatment plan. PARTICIPANTS: 1413 patients treated for ankle injuries. OUTCOME MEASURES: Adherence to the guidelines was measured using three quality indicators: number of sessions, interventions, and accomplished treatment goals. RESULTS: Interventions and treatment goals were often aimed at the improvement of body functions, especially in patients with functional instability. Although not advised in the guidelines, manual manipulation was applied during treatment in 21% of the patients with functional instability. On average, patients with acute ankle injuries have a 38% chance of being treated according to the guidelines. Adherence can be explained partly by the duration of the complaint, whether the complaint is recurrent, the patient's age and the experience of the therapist, but it depends substantially on the therapist. CONCLUSION: There is some discrepancy between the guidelines and practice, especially regarding the interventions applied to patients with functional instability. However, there is large variation between therapists. The sooner a patient presents for treatment and the greater the experience of the physiotherapist with ankle injuries, the greater the likelihood that treatment will follow the guidelines.

A method to identify talent: visual search and locomotion behavior in young football players.

The present study examined differences in visual search and locomotor behavior among a group of skilled 10-12 year-old football players. The participants watched video clips of a 4-to-4 position game, presented on a large screen. The participants were asked to take part in the game by choosing the best position for the reception of the ball passed by one of the players in the clip. Participants' visual search and locomotor behavior were collected continuously throughout the presentation of the clip. A within-group comparison was made based upon the participants' interception score, i.e., more at the correct position. The findings show that the high-score group looked more to the ball area, while the players in the low-score group concentrated on the receiving player and on the hips/upper-body region of the passing player. The players in the high-score group covered a significantly greater distance compared to the low-score group. It was concluded that differences in visual search and locomotion behavior can be used as indicators for identifying talented junior football players.