Profile of children referred to primary health care physiotherapy: a longitudinal observational study in Norway

Kari Anne I Evensen, Siw Sellæg, Anne-Cath Stræte, Anne E Hansen, Ingebrigt Meisingset, Kari Anne I Evensen, Siw Sellæg, Anne-Cath Stræte, Anne E Hansen, Ingebrigt Meisingset

Abstract

Background: Physiotherapy services are an important part of the primary health care services for children, serving a broad spectrum of children referred from different sources and for a variety of reasons. There is limited knowledge about their characteristics and outcome. The aim of this study was to describe the profile, i.e. referral patterns, baseline demographical and clinical characteristics, as well as treatment outcome at follow-up 6 months after baseline, of children receiving physiotherapy in primary health care.

Methods: Children referred to primary health care physiotherapy in a large municipality in Norway were invited to participate in this longitudinal observational study. The children's demographics, referral sources, causes of referral, functional diagnoses, influence on their daily activities, main goals and planned treatments were registered at baseline. Goal attainment and treatment compliance were registered at follow-up maximum 6 months after baseline.

Results: The physiotherapists registered baseline characteristics for 148 children. Parent-reported data at baseline were available for 101 (68.2%) of these children. Children were mainly referred from child health care centres (n = 74; 50.0%), hospital (n = 25; 16.9%) and kindergarten (n = 22; 14.9%). The most frequent causes of referral were concerns for motor development (n = 50; 33.8%), asymmetry (n = 40; 27.0%) and orthopaedic conditions (n = 25; 16.9%). Eighty-one (54.7%) children were below the age of 1 year. There was partly agreement between causes of referral and the physiotherapists' functional diagnoses. Parents of 69 (71.1%) children reported that their child's daily activities were little to not at all affected by the problem or complaint for which they were referred. Follow-up data were registered for 64 children. The main treatment goal was achieved in 37 (57.8%) and partly achieved in 26 (40.6%) children and the treatment was carried out as planned in 55 (87.3%) children.

Conclusions: The large variation in the profile of children receiving physiotherapy in a primary health care setting in Norway shows how primary health care physiotherapists can contribute to fulfil the broad purpose of the primary health care services.

Trial registration: ClinicalTrials.gov Identifier: NCT03626389 . Registered on August 13th 2018 (retrospectively registered).

Keywords: Child health care centre; Children; Cohort; Database; Electronic registration; Goal attainment; Municipality; Physiotherapy; Primary health care services; Public health nurse.

Conflict of interest statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Financial support was obtained by the Norwegian Fund for Post-Graduate Training in Physiotherapy, Trondheim Municipality and the Norwegian University of Science and Technology.

Figures

Fig. 1
Fig. 1
Flow chart of children included in FYSIOPRIM. FYSIOPRIM = Research program for Physiotherapy in Primary Health Care. PT = Physiotherapis. aInitial PT-registration included age, sex, referral source and cause of referral. bBaseline PT-registration at the first consultation included PT’s functional diagnosis, whether the child was starting physiotherapy or had an examination only, and main treatment goal and planned treatment identified by the PT and parents together. cBaseline parent-report after the first consultation included the child’s living situation and daily arena, child and parents’ country of birth, parents’ highest level of education, whether the child was born preterm, use of hospital services, pain and influence on daily activities. dFollow-up PT-registration included number of consultations, goal attainment and treatment compliance assessed by the PT and parents together, and whether the child continued physiotherapy
Fig. 2
Fig. 2
Parent-reported influence of the problem or complaint on the child’s daily activities (n = 97)

References

    1. World Health Organization. Primary health care. 2019 [Available from: .
    1. Peacock-Chambers E, Ivy K, Bair-Merritt M. Primary Care Interventions for Early Childhood Development: A Systematic Review. Pediatrics. 2017;140:6.
    1. Kuo AA, Inkelas M, Lotstein DS, Samson KM, Schor EL, Halfon N. Rethinking well-child care in the United States: an international comparison. Pediatrics. 2006;118(4):1692–1702. doi: 10.1542/peds.2006-0620.
    1. Norwegian Directorate of Health. Nasjonal faglig retningslinje for det helsefremmende og forebyggende arbeidet i helsestasjon, skolehelsetjeneste og helsestasjon for ungdom. Norwegian Directorate of Health; 2019.
    1. Lovdata. Forskrift om kommunens helsefremmende og forebyggende arbeid i helsestasjons- og skolehelsetjenesten. In: Department of Health and Welfare, editor. .
    1. Blair M, Rigby M, Alexander D. Issues and opportunities in primary health Care for Children in Europe: the final summarised results of the models of child health appraised (MOCHA) 2018.
    1. Clancy A, Gressnes T, Svensson T. Public health nursing and interprofessional collaboration in Norwegian municipalities: a questionnaire study. Scand J Caring Sci. 2013;27(3):659–668. doi: 10.1111/j.1471-6712.2012.01079.x.
    1. Johansen K, Persson K, Sarkadi A, Sonnander K, Magnusson M, Lucas S. Can nurses be key players in assessing early motor development using a structured method in the child health setting? J Eval Clin Pract. 2015;21(4):681–687. doi: 10.1111/jep.12366.
    1. Johnston MV. Clinical disorders of brain plasticity. Brain & development. 2004;26(2):73–80.
    1. Eyre JA. Development and plasticity of the corticospinal system in man. Neural Plast. 2003;10(1-2):93–106.
    1. Lobo MA, Galloway JC. Enhanced handling and positioning in early infancy advances development throughout the first year. Child Dev. 2012;83(4):1290-302.
    1. Novak I, Morgan C. High-risk follow-up: Early intervention and rehabilitation. Handb Clin Neurol. 2019;162:483-510.
    1. Lobo MA, Harbourne RT, Dusing SC, McCoy SW. Grounding early intervention: physical therapy cannot just be about motor skills anymore. Phys Ther. 2013;93(1):94-103.
    1. Anderson DI, Campos JJ, Witherington DC, Dahl A, Rivera M, He M, et al. The role of locomotion in psychological development. Front Psychol. 2013;4:440.
    1. Evensen KAI, Robinson HS, Meisingset I, Woodhouse A, Thielemann M, Bjorbaekmo WS, et al. Characteristics, course and outcome of patients receiving physiotherapy in primary health care in Norway: design of a longitudinal observational project. BMC Health Serv Res. 2018;18(1):936.
    1. Johansen K, Persson K, Sonnander K, Magnusson M, Sarkadi A, Lucas S. Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services. PloS one. 2017;12(7):e0181398.
    1. Pentland D, Forsyth K, Maciver D, Walsh M, Murray R, Irvine L, et al. Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review. J Adv Nurs. 2011;67(7):1408-25.
    1. Bowen S, Martens P, Need to Know T. Demystifying knowledge translation: learning from the community. J Health Serv Res Policy. 2005;10(4):203-11.
    1. Campbell SK. The child's development of functional movement. In: Campbell SK, Wander Linden DW, Palisano RJ, editors. Physical therapy for children. Third ed: Saunders Elsevier Inc.; 2006. p. 33-76.
    1. Immonen J, Aarli A, G S, Evensen K. Tågange. Retningslinjer for kunnskapsbasert oppfølging av barn henvist for tågange i Trondheim kommune. Et samarbeid mellom Enhet for fysioterapitjenester i Trondheim kommune og Institutt for samfunnsmedisin og sykepleie ved NTNU gjennom forskningsprogrammet FYSIOPRIM. Trondheim kommune; 2018 [Available from: ].
    1. Renli M, IH K, Evensen K. Inntåing. Retningslinjer for kunnskapsbasert oppfølging av barn henvist for inntåing. Et samarbeid mellom Enhet for fysioterapitjenester i Trondheim kommune og Institutt for samfunnsmedisin og sykepleie ved NTNU gjennom forskningsprogrammet FYSIOPRIM. Trondheim kommune; 2018 [Available from: ].
    1. Almenning A, B H, M S, Evensen K. Barneplattfot. Retningslinjer for kunnskapsbasert oppfølging av barn henvist for plattfot. Et samarbeid mellom Enhet for fysioterapitjenester i Trondheim kommune og Institutt for samfunnsmedisin og sykepleie ved NTNU gjennom forskningsprogrammet FYSIOPRIM. Trondheim kommune; 2018 [Available from: ].
    1. Eide G, Eid B, Viken R, Kvisvik I, I. S-S, Færø V, et al. Spedbarnsasymmetri. Retningslinjer for kunnskapsbasert oppfølging av barn henvist for spedbarnsasymmetri. Et samarbeid mellom Enhet for fysioterapitjenester i Trondheim kommune og Institutt for samfunnsmedisin og sykepleie ved NTNU gjennom forskningsprogrammet FYSIOPRIM. Trondheim kommune; 2018 [Available from: ].
    1. Evensen KAI, Eide G, Immonen J. Utvikling av retningslinjer for kunnskapsbasert barnefysioterapi i primærhelsetjenesten. Fysioterapeuten. 2018(7):24-9.
    1. Johansen K, Lucas S, Bokstrom P, Persson K, Sonnander K, Magnusson M, et al. 'Now I use words like asymmetry and unstable': nurses' experiences in using a standardized assessment for motor performance within routine child health care. J Eval Clin Pract. 2016;22(2):227-34.
    1. Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association. 2013;25(4):348-94.
    1. Evans AM, Rome K. A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. European journal of physical and rehabilitation medicine. 2011;47(1):69-89.
    1. Uden H, Kumar S. Non-surgical management of a pediatric "intoed" gait pattern - a systematic review of the current best evidence. J Multidiscip Healthc. 2012;5:27-35.
    1. Cras SL, Bouck J, Brausch S, Taylor-Haas A, Reder RD. Management of idiopathic toe walking -- in children and young adults ages 2 through 21 years Cincinnati Children's Hospital Medical Center; 2011.
    1. Carl J. Dunst, Carol M. Trivette, Deborah W. Hamby, (2007) Meta-analysis of family-centered helpgiving practices research. Mental Retardation and Developmental Disabilities Research Reviews 13 (4):370-8.
    1. Kallioinen M, Eadon H, Murphy MS, Baird G, Guideline C. Developmental follow-up of children and young people born preterm: summary of NICE guidance. BMJ (Clinical research ed). 2017;358:j3514.
    1. Piper MC, Pinnell LE, Darrah J, Maguire T, Byrne PJ. Construction and validation of the Alberta Infant Motor Scale (AIMS). Can J Public Health. 1992;83 Suppl 2:S46-50.
    1. Movement Assessment Battery for Children - Second Edition (Movement ABC-2). Examiner's manual. Henderson S, Sugden D, Barnett A, editors. London: Harcourt Assessment; 2007.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel