Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
J Orthop Sports Phys Ther. 2012 Aug;42(8):705-15. doi: 10.2519/jospt.2012.3957. Epub 2012 Mar 8.
Retrospective longitudinal cohort.
To describe the clinical characteristics of patients with low back pain according to physician referral source, and to identify associations between referral source and discharge functional status, as well as number of physical therapy visits.
Little is known about associations between physician referral source and outcomes of physical therapy care for patients with low back pain. Exploring these associations can contribute to better understanding of physician-physical therapist relationships and may lead to improved referral patterns.
Data from a proprietary clinical database were examined retrospectively. Physician referral source was classified as primary care, specialist, or occupational medicine. Outcomes were overall health status at discharge and number of physical therapy visits. Descriptive statistics and bivariate associations between referral source and each outcome were assessed by calculating differences and 95% confidence intervals (CIs) in means and proportions. To account for potential confounding, multilevel linear regression was used to adjust for baseline clinical covariates, effects related to clustering of patients treated by individual clinicians, and clinicians working within individual clinics.
Bivariate and multilevel analyses revealed significant associations between referral source and discharge overall health status, as well as number of visits. After multilevel adjustment for covariate and clustering effects, primary care and occupational medicine referrals were associated, on average, with point increases of 1.6 (95% CI: 0.7, 2.6) and 4.8 (95% CI: 2.7, 6.9) in discharge overall health status scores, respectively, compared to specialist referral. Similarly, primary care and occupational medicine referrals were associated, on average, with 0.44 (95% CI: 0.27, 0.61) and 0.83 (95% CI: 0.44, 1.22) fewer visits, respectively, compared to specialist referral.
After accounting for clinical covariates and clustering, patients with low back pain who were referred by occupational medicine and primary care physicians tended to have better functional outcomes and required fewer physical therapy visits per episode of care.
Prognosis, level 2c.
回顾性纵向队列研究。
根据医生转诊来源描述腰痛患者的临床特征，并确定转诊来源与出院功能状态以及物理治疗就诊次数之间的关联。
对于物理治疗治疗腰痛患者的医生转诊来源与治疗结果之间的关联知之甚少。探讨这些关联可以帮助更好地理解医生与物理治疗师之间的关系，并可能导致转诊模式的改善。
对专有临床数据库中的数据进行回顾性分析。将医生转诊来源分为初级保健、专科和职业医学。结果为出院时的整体健康状况和物理治疗就诊次数。通过计算均值和比例的差异和 95%置信区间（CI），使用描述性统计和两变量关联评估转诊来源与每种结果之间的关联。为了考虑潜在的混杂因素，使用多级线性回归来调整基线临床协变量、与个体临床医生治疗的患者聚类相关的效果以及个体诊所内的临床医生。
单变量和多变量分析显示，转诊来源与出院整体健康状况以及就诊次数之间存在显著关联。在对协变量和聚类效应进行多级调整后，与专科转诊相比，初级保健和职业医学转诊平均使出院整体健康状况评分分别增加 1.6（95%CI：0.7，2.6）和 4.8（95%CI：2.7，6.9）。同样，与专科转诊相比，初级保健和职业医学转诊平均分别减少 0.44（95%CI：0.27，0.61）和 0.83（95%CI：0.44，1.22）的就诊次数。
在考虑临床协变量和聚类后，由职业医学和初级保健医生转诊的腰痛患者往往具有更好的功能结果，并且每例治疗的就诊次数更少。
预后，2c 级。
