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The effects of the extended physiotherapy examination scheme for patients with low-back pain.

INTRODUCTION
The extended physiotherapy examination scheme (EES) was developed to assist general practitioners in their assessment of patients with complex low-back pain (LBP). The aim was to compare LBP patients in the EES and patients in current physiotherapy practice (CP) with respect to characteristics, healthcare utilisation and sick leave.


METHODS
Data from three cohorts were included, one covering the EES and two covering CP for LBP patients in Danish primary care physiotherapy. Baseline questionnaire data were collected, and 78-week follow-up was conducted in Danish registries. Patients were stratified according to their risk profile by the STarT Back Tool, and regression analyses were used to analyse healthcare utilisation and sick leave.


RESULTS
A total of 746 patients in the EES and 361 in CP were included. Patients in the EES had sick leave more often and were characterised by a longer pain duration and more disability than CP patients. The probability of contact to secondary care was doubled among patients in the EES with a high-risk profile and patients in the EES showed a trend towards a higher degree of sick leave.


CONCLUSIONS
LBP patients in the EES are more burdened than patients in CP. Consequently, for some subgroups in the EES, a higher referral rate and more sick leave were detected. These findings may be the result of vague referral criteria, lack of appropriate screening tools or inadequate monitoring of the EES.


FUNDING
This study was funded by the Central Denmark Region and the Region of Southern Denmark.


TRIAL REGISTRATION
not relevant.