Ambulante Physiotherapie in Orthopädie und Unfallchirurgie: Kann der Erfolg überhaupt beurteilt werden?

Abstract

This prospective study analyses the quality and number of physiotherapy reports, cooperation between physiotherapist and orthopaedic surgeons as well as correctness of the physiotherapy in relation to the prescription within the German medical health system. We pose the question to whether or not the reported information is sufficient to evaluate outpatient physiotherapy. In 264 physiotherapeutic prescriptions, given to the patients for conservative treatment or during postoperative rehabilitation by an orthopaedic outpatient clinic, we prospectively evaluated the report quality. The types of prescription and performed physiotherapy were compared. The ability of the patient to demonstrate or to verbalise exercises, as has to be learned during therapy, was analysed and the number of questioned follow-up forms documented. We also tried to evaluate the efficiency of different types of physiotherapy. We received 33 reports in 264 prescriptions, i.e., the obligation to report was only followed in 12.5 % of the cases. Depending on the type of physiotherapy, there was a range between 0 % in electric field treatment, 0 % in active muscle training with weights and resistant exercises as well as in thermo- and swimming therapy, 10.8 % in passive mobilisation, 16.8 % in regular physical therapy and 33 % in classic massage treatment. In 261 cases, i.e., in 98.8 % of the prescriptions, the physiotherapist was asked via the patient for another prescription. Only in one patient did the physiotherapist call the doctor personally to ask for a variation of the treatment during the prescribed series. In 193 prescriptions the patients should have learned to do the exercises by themselves as a home therapy programme. Only 5 patients were able to demonstrate this at the reassessment appointment. The allover complication rate was 2.3 % including nausea, vertigo or increasing pain. In all these cases the type of prescription was not followed. In the outpatient treatment of orthopaedic or trauma patients there is not sufficient cooperation between physiotherapists and surgeons. This may lead to prolonged postoperative rehabilitation time or may question the success of conservative treatment completely. The efficiency of physiotherapy could not be evaluated due to lack of prescription reports. Therefore, a new control mechanism to support the patient and the responsible outpatient surgeons should be introduced.