J. Scheele, PhD, Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
Phys Ther. 2014 Mar;94(3):363-70. doi: 10.2522/ptj.20120330. Epub 2013 Oct 3.
In the Netherlands, direct access to physical therapy was introduced in 2006. Although many patients with back pain visit physical therapists through direct access, the frequency and characteristics of episodes of care are unknown.
The purposes of this study were: (1) to investigate the prevalence of direct access to physical therapy for patients with low back pain in the Netherlands from 2006 to 2009, (2) to examine associations between mode of access (direct versus referral) and patient characteristics, and (3) to describe the severity of the back complaints at the beginning and end of treatment for direct access and referral-based physical therapy.
A cross-sectional study was conducted using registration data of physical therapists obtained from a longitudinal study.
Data were used from the National Information Service for Allied Health Care, a registration network of Dutch physical therapists. Mode of access (direct or referral) was registered for each episode of physical therapy care due to back pain from 2006 to 2009. Logistic regression analysis was used to explore associations between mode of access and patient/clinical characteristics.
The percentage of episodes of care for which patients with back pain directly accessed a physical therapist increased from 28.9% in 2006 to 52.1% in 2009. Characteristics associated with direct access were: middle or higher education level (odds ratio [OR]=1.3 and 2.0, respectively), previous physical therapy care (OR=1.7), recurrent back pain (OR=1.7), duration of back pain <7 days (OR=4.2), and age >55 years (OR=0.6).
The study could not compare outcomes of physical therapy care by mode of access because this information was not registered from the beginning of data collection and, therefore, was missing for too many cases.
Direct access was used for an increasing percentage of episodes of physical therapy care in the years 2006 to 2009. Patient/clinical characteristics associated with the mode of access were education level, recurrent back pain, previous physical therapy sessions, and age.
荷兰于 2006 年引入了物理治疗的直接就诊模式。尽管许多腰痛患者通过直接就诊的方式接受物理治疗师的治疗，但关于就诊的频率和特征尚不清楚。
本研究旨在：（1）调查 2006 年至 2009 年荷兰腰痛患者直接就诊物理治疗的流行率；（2）探讨就诊方式（直接就诊与转诊）与患者特征之间的关系；（3）描述直接就诊和转诊物理治疗的开始和结束时背部疼痛的严重程度。
使用从一项纵向研究中获得的物理治疗师注册数据进行横断面研究。
使用荷兰物理治疗师注册网络国家联合医疗保健信息服务的数据。2006 年至 2009 年，因腰痛就诊的每一次物理治疗护理均记录就诊方式（直接就诊或转诊）。采用逻辑回归分析探讨就诊方式与患者/临床特征之间的关系。
因腰痛直接就诊物理治疗师的护理比例从 2006 年的 28.9%增加到 2009 年的 52.1%。与直接就诊相关的特征包括：中等或高等教育水平（比值比[OR]分别为 1.3 和 2.0）、既往物理治疗护理（OR=1.7）、复发性腰痛（OR=1.7）、腰痛持续时间<7 天（OR=4.2）和年龄>55 岁（OR=0.6）。
本研究无法比较不同就诊方式的物理治疗效果，因为该信息从数据收集开始就未进行登记，因此对于太多病例缺失。
2006 年至 2009 年，直接就诊在物理治疗护理中所占比例逐渐增加。与就诊方式相关的患者/临床特征包括教育水平、复发性腰痛、既往物理治疗次数和年龄。
