Identification of factors associated with the number of treatment sessions in the physical therapy: An Explorative Cross Sectional design.

Abstract

Background: In the Netherlands the treatment index is used by health insurance companies to determine the efficiency and quality of physical therapy care. The treatment index measures the provided number of treatment sessions, by using a limited number of factors to correct for case-mix differences. However, Scientific evidence about factors that influence the variation in physical therapy care and the number of treatment sessions is limited. More insight into factors that explain this variation may guide quality improvement purposes in physical therapy. Aim: The primary objective is to describe factors associated with the number of treatment sessions for patients with neck and low back pain. Methods: Data from the national database of the Royal Dutch Society for Physical Therapy (KNGF) were used. The dataset contained information about the treatment episodes for 252,383 patients with neck pain and 295,126 patients with low back pain. The dependent variable was the number of treatment sessions and the independent variables were the factors age, gender, mode of access, type of therapy, duration of health complaints, social economic status and practice size. Data were analyzed by multilevel regression analysis because of the hierarchical nested nature of the database. Results: Age, gender, mode of access (through self-referral or formal referral), type of therapy (manual or physical therapy) and duration of health complaints (acute or chronic) were associated with the number of treatment sessions for neck and low back pain. The second level variable practice size was only associated for patients with neck pain. Conclusion: The factors mode of access and duration of health complaints show the strongest association with the number of treatment sessions,Patients through self-referral or with chronic complaints needed more treatment sessions compared to patients through formal referral or with acute complaints. These factors are currently not included in the treatment index. Implications of key findings: This study provides insight in the treatment index and these results can be used to guide quality improvement in the physical therapy. The health insurance companies need to re-evaluate the factors that are included in the correction of the treatment index.