Objectives: To determine patient characteristics, frequency of use, type of symptoms and treatment outcomes in patients with knee or ankle symptoms, separately, for patients referred by their general practitioner (GP) and patients who self-referred. Design: Longitudinal study. Setting: Dutch primary care physical therapy practices. Participants: All patients who visited a physiotherapist with knee or ankle symptoms between 2006 and 2012. Method: Data were collected from the NIVEL Primary Care Database. The mode of access (self-referred or GP-referred) was determined for all patients. For analyses, descriptive statistics, unpaired t-tests, Chi-square test and logistic regression analyses were applied. Results: The study included 6179 patients with knee or ankle symptoms. The use of self-referral increased from 26% in 2006 to 56% in 2012, and stabilised between 2010 and 2012. Self-referred patients were younger, had a higher education level and had a shorter duration of symptoms compared with GP-referred patients. Self-referred patients had fewer treatment sessions than GP-referred patients. Conclusions: Among patients with knee or ankle symptoms, younger patients, and those with a higher education level, a shorter duration of symptoms and recurrent symptoms were more likely to self-refer than other patients. Self-referred patients had fewer treatment sessions. After 2009, the frequency of self-referrals to physical therapists stabilised. Future studies should examine the effectiveness of physical therapy for patients who self-refer with acute knee and ankle symptoms.

Ankle, Direct access, Knee, Physiotherapy
dx.doi.org/10.1016/j.physio.2017.03.008, hdl.handle.net/1765/126065
Department of General Practice

Lankhorst, N.E, Barten, J.A. (J. A.), Meerhof, R. (R.), Bierma-Zeinstra, S.M, & van Middelkoop, M. (2017). Characteristics of patients with knee and ankle symptoms accessing physiotherapy: self-referral vs general practitioner's referral. Physiotherapy. doi:10.1016/j.physio.2017.03.008