How well does physiotherapy work? A new database can provide answers
There is very little systematic research on how patients respond to physiotherapy. A new Norwegian database should provide insights into how well treatments work for patients.
People of all ages, and with various illnesses, disabilities or injuries visit physiotherapists. But beyond that basic knowledge, Norwegian researchers don’t know much about who actually goes to physiotherapy and the benefits they gain from treatment.
“We really don’t know which patients go to physiotherapy, what kind of treatment they get and how they do afterwards,” said Kari Anne Evensen, a researcher at the Norwegian University of Science and Technology (NTNU) who is managing a project with colleague Ottar Vasseljen to build a database on physiotherapy in Norway. “We need better information about this, which was the basis for creating the database.”
The database is being built with information collected from public and private physiotherapists in nine municipalities in all health regions in Norway under the auspices of a research programme called Fysioprim.
Help with priorities and rehab
Researchers have collected information from roughly 3000 patients to date, and are continuing to add new patients to the database.
“This database will allow us to determine what kinds of patients are offered physiotherapy, what goals are set for them, and whether the goals are achieved," says Evensen.
The information should help the Norwegian health care system and physiotherapists both with setting priorities and with patient rehabilitation. Evensen says the database will also provide information for future research.
An article describing the methodology behind the database has just been published in the journal BMC Health Services.
Patient sample designed to be representative
The project is a collaboration between NTNU, the University of Oslo and Trondheim municipality. Most physiotherapists in Trondheim are participating in the study.
“Physiotherapists have asked their patients to provide information about their condition, progress and whether the goals of the treatment are achieved,” Evensen said.
Altogether, nearly 200 physiotherapists have participated in the study.
It is important for researchers that the patients who are actually included the study be representative of the larger population of people who go to a physiotherapist, since the study can’t include all patients in Norway.
“We have therefore compared patients who have joined the study with numbers from Helfo (the Norwegian Health Economics Administration). All private physiotherapists with municipal operating agreements in Norway report to Helfo regarding the patients they treat and the kinds of problems they have. This shows us that the patients in our database are representative of patients overall who are treated by the physiotherapy service,” says Evensen.
Patients in the database have been divided into three groups: Adult patients who go to private practice physiotherapists, children who receive follow-up from physiotherapists who are employed by the municipality, and elderly who receive follow-up from physiotherapists employed by the municipality.
The database contains a great deal of information about the patients.
“The patients add information about themselves when they start with the physiotherapist, and are followed up with questionnaires over the course of their treatment,” Evensen says.
All patients answer questions about their living situation, functional level, pain, psychosocial factors, and evaluation of treatment.
“This can help the physiotherapist become more aware of factors that are important to consider during the course of treatment,” she says.
Together, the patient and physiotherapist set goals for the treatment and agree on an action plan. The physiotherapists respond to questions about what kind of treatment the patients receive, among other information.
She points out that the studies that will be based on the new database will only be observational studies, with information on patient outcomes. Thus, the studies will not be randomized, controlled trials, which is a way for researchers to see how different types of treatments work for different groups of patients, she said.
“However, we will get a good overview of how the physiotherapy service in Norway works today, and to what extent it helps patients,” she says.
- Reference: Kari Anne I. Evensen et al.: Characteristics, course and outcome of patients receiving physiotherapy in primary health care in Norway: design of a longitudinal observational project, BMC Health Services Research, December 2018