BackgroundResponsiveness and minimal important change (MIC) are central measurement properties when interpreting scores from health questionnaires. The aim of the study was to evaluate the responsiveness and MIC of the Danish version of the shortened version the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH) in patients with shoulder disorders referred to primary care physiotherapy treatment.MethodsThe study included 261 patients who completed questionnaires at baseline and 3 and 6 months follow up. Absolute and relative change scores was analysed using receiver-operating-characteristics (ROC) curve analysis with the Patient Global Impression of Change (PGIC) as external anchor.ResultsAt both 3 and 6 months follow up, the Area under the Curve (ROC AUC) exceeded 0.70 and MIC was 9.1 and 13.6 at 3 and 6 months respectively.ConclusionThe Danish version of the Quick-DASH demonstrated adequate ability to measure changes in disability over 3 and 6 months in patients with shoulder disorders undergoing primary care physiotherapy treatment.

Background: Musculoskeletal disorders are common in the general population and a leading cause for care seeking. Despite the large number of patients with musculoskeletal disorders seeking care, little is known of the clinical course, pathways and predictors of healthcare utilization among these patients. The purposes of the study were to 1) describe the clinical course and related healthcare utilization in primary care physiotherapy and secondary healthcare among patients with neck, shoulder and low-back pain treated in physiotherapy practice, and 2) identify independent clinical, socio-demographic, psychological and general health predictors of healthcare utilization. Methods: The study was a prospective cohort study of patients seeking physiotherapy treatment for neck, shoulder, or low-back pain in physiotherapy practices across Denmark. A total of 759 physiotherapy patients completed questionnaires containing information on clinical course and potential predictors of healthcare utilization. Healthcare utilization was obtained from the Danish National Health Service Register and National Patient Register. Associations between potential predictors and low/high primary care physiotherapy utilization and hospital contacts in relation to specific neck, shoulder or low-back disorders were analysed using binomial regression analyses and adjusted for age, sex, duration of pain and comorbidity. Results: During 6 months follow-up, patients experienced clinically relevant improvements in pain, fear avoidance and psychological wellbeing. Patients with higher baseline pain and disability and who were on sickness leave were more likely to have high primary care physiotherapy utilization. Hospital contacts were predicted by higher levels of pain, disability and low psychological wellbeing. Conclusions: Clinical factors and sickness leave seems to be the main predictors of primary care physiotherapy utilization, whereas for secondary care contacts, psychological factors may also be of importance. The study contributes to the ongoing research into clinical pathways and may identify future target areas to reduce healthcare utilization in patients with musculoskeletal disorders.

Background With increasing interest in direct access to physiotherapy, it is important to consider the physiotherapists (PTs) ability to make correct management decisions, because identification of differential diagnostic pathologies and timely referral for specialist care is vital for patient safety. The aims of the study were to investigate PTs ability to make correct management decisions in patients presenting with musculoskeletal conditions and to identify explanatory factors associated with this ability. Furthermore, we wanted to explore the PTs views on the identified factors. Methods The study was a mixed methods study with an explanatory sequential design consisting of a questionnaire survey and semi-structured interviews. The questionnaire comprised 12 clinical vignettes describing patient scenarios for musculoskeletal conditions, non-critical medical conditions and critical medical conditions. Based on this, the PTs indicated whether the patient should be managed by the PT or were in need of medical referral. Associations between correct decisions and explanatory variables was analyzed by mixed- effects logistic regression. Interviews were performed with nine PTs to explore their reactions to the results. A directed content analysis was performed. Results A total of 195 PTs participated in the questionnaire survey and 9 PTs were interviewed. Overall, PTs were more likely to make correct management decisions in the musculoskeletal conditions category, whereas wrong decisions were more often chosen for underlying medical conditions categories. Positive associations between correct management decision in the critical medical category were found for experience: odds ratio (OR) 2.73 (1.33;5.57) and passed quality audit OR 2.90 (1.50;5.58). In the interviews, PTs expressed concerns about the differential diagnostic abilities. They all noted, that experience is immensely important in the clinical reasoning process because the ability to recognise diagnostic patterns evolves over time. Furthermore, the quality audit seems to address and systematize the clinical reasoning process and workflow within the clinics. Conclusion The lack of ability to make correct management decision in critical medical categories and the uncertainties expressed by PT’s should raise concern, as direct access to physiotherapy is already well-established and the results indicate that patient safety could be at risk. The findings that experience and passed quality audit was associated with correct management decisions highlights the need for ongoing awareness and education into differential diagnostics.

Background: Musculoskeletal conditions are the single largest contributor to years lived with disability worldwide. Most musculoskeletal conditions can be managed and treated in primary care, but for a small proportion of these patients the symptoms are caused by serious pathology. Although the general practitioner usually performs initial screening for serious pathology, evaluation and treatment by physiotherapists are often part of the treatment pathway. It is however unclear, how many patients in primary care physiotherapy have symptoms caused by a serious pathology. Historically the prevalence of serious pathology in primary care has been investigated in small populations with spine specific conditions, thus a more general prevalence in the group of patients with musculoskeletal conditions is yet to be estimated. Therefore, the aim of this study was to estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy evaluation and treatment. Methods: The study was a prospective nationwide register-based cohort study. We identified all referrals for primary care musculoskeletal physiotherapy in the Danish National Health Insurance Service Register between 1 January 2014 and 31 December 2017. Records of hospital contacts were extracted from the Danish National Patient Register within 180 days from first physiotherapy contact, identifying all diagnoses of serious pathology. Period prevalence proportions with 95%CI of the serious pathology categories were estimated. Results: A total of 1,568,704 courses of treatment were included in the analysis. The overall prevalence of serious pathology was 2.30%.The prevalence of neoplasm was 2.11%, of which 1.13% was malignant neoplasms. The prevalence of cauda equina syndrome was 0.01%, fractures 0.13%, infections 0.01% and inflammatory pathology of the spine 0.06%. Higher prevalence's were observed among patients with a previous history of serious pathology, aged above 50 and more comorbidity. Conclusions: Although serious pathology among musculoskeletal physiotherapy patients is rare, the present study found an overall prevalence of serious pathology which exceeded the guideline endorsed prevalence estimates of serious pathology of 1%.

Background: Musculoskeletal conditions are the single largest contributor to years lived with disability worldwide. Most musculoskeletal conditions can be managed and treated in primary care, but for a small proportion of these patients the symptoms are caused by serious pathology. Although the general practitioner usually performs initial screening for serious pathology, evaluation and treatment by physiotherapists are often part of the treatment pathway. It is however unclear, how many patients in primary care physiotherapy have symptoms caused by a serious pathology. Historically the prevalence of serious pathology in primary care has been investigated in small populations with spine specific conditions, thus a more general prevalence in the group of patients with musculoskeletal conditions is yet to be estimated. Therefore, the aim of this study was to estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy evaluation and treatment.Methods: The study was a prospective nationwide register-based cohort study. We identified all referrals for primary care musculoskeletal physiotherapy in the Danish National Health Insurance Service Register between 1 January 2014 and 31 December 2017. Records of hospital contacts were extracted from the Danish National Patient Register within 180 days from first physiotherapy contact, identifying all diagnoses of serious pathology. Period prevalence proportions with 95%CI of the serious pathology categories were estimated. Results: A total of 1,568,704 courses of treatment were included in the analysis. The overall prevalence of serious pathology was 2.30%.The prevalence of neoplasm was 2.11%, of which 1.13% was malignant neoplasms. The prevalence of cauda equina syndrome was 0.01%, fractures 0.13%, infections 0.01% and inflammatory pathology of the spine 0.06%. Higher prevalence's were observed among patients with a previous history of serious pathology, aged above 50 and more comorbidity. Conclusions: Although serious pathology among musculoskeletal physiotherapy patients is rare, the present study found an overall prevalence of serious pathology which exceeded the guideline endorsed prevalence estimates of serious pathology of 1%.