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Background. Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. Objective. The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. Design. The design was a prospective, single-blind, multicenter, superiority, cluster-randomized controlled trial. Setting. The setting included 143 primary care physical therapist practices. Participants. The participants were 208 people who had hip/knee OA and were 40 to 80 years of age. Intervention. e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. Measurements. Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions. Results. The e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy. Limitations. The response rate at 12 months was 65%. Conclusions. The blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA., Osteoarthritis (OA) is the most common chronic condition of the joints. (1) Prevalence of this rheumatic disease increases with age and mostly affects the hip and knee. Based on radiographic [...]

Background and Purpose. One-time physical therapist consultation, prior to possible referral for physical therapy intervention, may enhance the quality of patient care, particularly if the referring physician is uncertain as to whether intervention by a physical therapist will be beneficial. The purpose of this study was to describe the use of consultation by a group of primary care physicians (PCPs) who could refer patients for a one-time consultation. Subjects and Methods. A 7-month observational study was conducted in the Netherlands with 59 pairs of randomly selected PCPs and physical therapists practicing in primary health care. Data were collected for the PCPs, the physical therapists, and the patients. Self-administered questionnaires (completed at the start and at the completion of the study), consultation request and report forms, and treatment referral records from health insurance agencies were used to obtain data. National reference data on patients referred by PCPs for intervention by a physical therapist were used to compare the data of patients referred by PCPs for a one-time consultation. The number and nature of consultation requests were determined as well as patient characteristics. The PCPs' satisfaction with the outcome and process of a one-time consultation and its impact on PCPs' management decisions also were described. Results. The number of referrals for a one-time consultation was 352 (X = 5.9 per PCP, SD = 5.4, range = 0-20), resulting in a mean referral rate of 4.7 per 1,000 patients (SD = 4.6). Characteristics of patients referred for a one-time consultation differed from national reference data of patients referred by their PCP for intervention by a physical therapist. Discussion and Conclusion. The results show that PCPs used the opportunity for a one-time physical therapist consultation and were satisfied with the outcome and process of consultation. The findings suggest that a one-time consultation is an appropriate and beneficial component of PCPs' patient management process. [Hendriks EJM, Kerssens JJ, Dekker J, et al. One-time physical therapist consultation in primary health care. Phys Ther. 2003;83:918-931.] Key Words: Communication, Cooperation, Physical therapist consultation, Primary health care., In the Netherlands, as in many other countries, primary care physicians (PCPs), also called "general practitioners" or "family doctors," occupy a pivotal position in the provision of care. (1-3) Their [...]

Background and Purpose. The purposes of this study were to describe the use of ultrasound by Dutch physical therapists and to address the question of whether this use is what would be considered correct. Subjects and Methods. Physical therapists in the Dutch primary health care system gathered data on 17,201 patients, addressing reasons for referral, treatment goals (in terms of impairments and disabilities), and physical therapy interventions. Patients treated with ultrasound (n= 3,959) were compared with a reference group of patients who were not treated with ultrasound (n= 13,242). Results. Physical therapists applied ultrasound for soft tissue injuries of recent onset, mainly aiming to reduce pain and swelling. Ultrasound was used in all phases of treatment and was not restricted to the first 3 weeks of treatment. Ultrasound was combined relatively infrequently with exercise and relatively frequently with massage. Conclusion and Discussion. Regarding the indications for referral and treatment goals chosen, the actual use of ultrasound corresponds to assumptions about expected use. The timing of its application and the combination with other forms of therapy do not correspond in all aspects to the assumptions made. [Roebroeck ME, Dekker J, Oostendorp RAB. The use of therapeutic ultrasound by physical therapists in Dutch primary health care. Phys Ther. 1998;78:470-478.], Key Words: Appropriate are, ICIDH, Physical theraphy, Survey research, Ultrasound. Ultrasound is an intervention that is frequently used by physical therapists. In the northeastern United States, 64% of physical therapists [...]

Background and Purpose. The physical therapy management of patients with pain often lacks a theoretical or conceptual basis. The purpose of this study was to compare treatments of patients with back and knee pain with a treatment framework (conceptual model) that we developed. This framework emphasizes physiological recovery, or reduction of impairments (eg, reduction of swelling), followed by emphasis on the reduction of disabilities. Expectations were derived concerning treatment goals and interventions in the course of treatment. Subjects. Patients with back pain (n=1,085) and patients with knee trauma (n=416) were treated by 83 Dutch physical therapists. Methods. Survey data were gathered on impairments and disabilities and on treatment goals and interventions. Results. For both groups of patients, two out of a maximum of eight treatment goals were directed at alleviating impairments in accordance with the framework. Goals directed toward the alleviation of disabilities did not show a similar relationship to the framework. For two treatment goals, the course of treatment was in accordance with the framework for both groups of patients. Conclusion and Discussion. The framework is only partially reflected in Dutch physical therapist practice. The use of such a framework, however, may be a helpful tool in gaining more insight into physical therapy in daily practice. [van Baar ME, Dekker J, Bosveld W. A survey of physical therapy goals and interventions for patients with back and knee pain. Phys Ther. 1998;78:33-42.], Key Words: Intervention, Pain, Physical therapy, Survey research. Physical therapists are increasingly discussing the importance of studying the relationship between diagnoses and treatment.[1-3] Recently, it was shown that diagnostic categories [...]

Background and Purpose. The diagnosis made by a physical therapist gives direction to the selection of therapeutic interventions. Therefore, in an investigation, specific relationships between diagnoses and therapeutic interventions are expected. This study was designed to test whether such relationships exists. Subjects and Methods. Data on diagnosis, treatment goals, and interventions were gathered on 8,714 patients by 74 physical therapists. The diagnosis and treatment goals were defined in terms of impairments and disabilities. Results. Specific relationships were found to exist between those impairments and disabilities that were chosen as a basis for forming treatment goals and the application of interventions. These relationships are particularly marked at the impairment level. Conclusion and Discussion. It is concluded that the diagnostic categories validly predict which interventions are applied and that the selection of interventions depends on which treatment goals are pursued [Dekker J, van Baar ME, Curfs EC, Kerssens JJ. Diagnosis and treatment in physical therapy an investigation of their relationship Phys Ther 1993,73 568-5801.], The need for studies on the diagnoses made by physical therapists and the relationship of these diagnoses to treatment has only recently been recognized.[1-3] Although physical therapists evaluate their patients' [...]