IJSPT

ORIGINAL RESEARCH

DO GENERAL MEDICAL PRACTITIONERS EXAMINE INJURED RUNNERS? Videbaek, S.1 Jensen, A.V.2 Rasmussen, S.1 Nielsen, R.O.3

ABSTRACT Background: General Medical Practitioners (GMP) in Denmark perform clinical examinations of patients with musculoskeletal pain. However, the prevalence proportion of examinations caused by running-related injuries remains unknown. Purpose: The primary purpose of the present study was to estimate the prevalence proportion of consultations in general medical practice caused by running-related injuries. The secondary purpose was to estimate the prevalence proportion of injured runners, who consult their GMP, that are referred to additional examinations or treatments. Study Design: A survey-based study. Methods: An online survey was distributed in October and November 2015 to more than 370 GMPs in Denmark and completed by 27. Results: The median prevalence proportion of consultations caused by running-related injuries in the prior two weeks was 0.80% [25th percentile = 0.00%; 75th percentile = 1.43%]. Ten (37%) GMPs reported to refer between 0-24% of the injured runners to additional examination or treatment, whereas thirteen (48%) of GMPs referred between 25-49% and four (15%) referred 50-74% of injured runners. Conclusion: Although a very small part (3 mes per RRI Exclusion of two quesons examining details of the typical runner seen with RRI in GMP Addion of ankle sprain in the eligible category of frequent RRI Uning and regrouping quesons regarding diagnoscs and treatments of RRIs Definions: Linguisc modificaons of the introductory remarks to certain quesons Rewording of available opons of treatments and type of pracce.

Test and evaluaon Performed by GMPs

Final Quesonnaire Design opmizaon and connuous scale quesons changed to eligible intervals in aim for increased compliance

Distribuon

(i) NordKAP ∼ 340 asked* 14 fulfilled

(ii) GMP conference 16 asked 3 fulfilled

(iii) GMPs contacted by phone 17 asked 6 fulfilled

(iv) GMPs contacted face-to-face 5 asked 4 fulfilled

Respondents n = 27 n = 3 of these were contacted to confirm or correct suspicious and missing answers

Final number of completed quesonnaire replies n = 27

Figure 1. Flowchart showing questionnaire development, distribution, and responses. GMP = General Medical Practitioner, RRI = Running-related injury. *Number of GMPs in the North Denmark Region The International Journal of Sports Physical Therapy | Volume 12, Number 3 | June 2017 | Page 452

the purpose of the present study. In pilot study one, an interview was conducted independently with each of four GMPs upon completion of the questionnaire. The interview was aimed at collecting feedback on the level of comprehensibility of the questionnaire instructions and questions, as well as specific suggestions for improvements or modifications of the questions. Pilot study two was performed by two independent GMPs and carried out in a similar manner as the procedure in pilot study one. In each phase, the questionnaire was thoroughly modified according to the feedback, and after pilot study two the final questionnaire was distributed. Details concerning the evaluation and modification upon completion of each pilot study are visualized in Figure 1. Description of main questions in survey First, two questions focused on the number of overall consultations in GMP practice caused by both RRIs and non-RRIs: “1) How many consultations do you have per day in an average working week? (State in whole numbers)” and “2) How many consultations have you had in total during the last period of two working weeks? (State in whole numbers)”. Secondly, three questions were targeting consultations caused by RRIs: “3) Have you had at least one consultation concerning a person with a RRI over the past year?”, “4) How many consultations regarding RRIs have you had in total during the last period of two working weeks?” (State in whole numbers)” and “5) How many consultations regarding RRIs have you had per month over the past year? (State in whole numbers)”. The GMPs where informed that all questions should be answered to the best of their assessment. When combining the continuous scale data from the question asking about the GMPs total number of consultations during the last period of two working weeks and the question about the total number of consultations regarding RRIs during the last period of two working weeks, the prevalence proportion of consultations caused by RRIs was estimated using the following equation:

The time frame of the prior two working weeks were chosen as the basis for the primary estimate of this study to reduce the risk of subjective recall bias. The question about monthly number of consultations regarding RRIs over the past year was included in order to be able to test the robustness of the primary estimate to this choice of time frame. The secondary purpose of the study was to estimate the proportion of injured runners referred to additional examinations or treatments. To investigate this, a questionnaire section with the following two questions was designed: “What is the proportion of the RRIs which you refer to secondary examinations and/or treatment?”, with the eligible answers: “0-24%”; “25-49%”; “50-74%”; “75-100%” or “Don’t know”; and “If you refer the patient, to whom do you refer? (select all that apply)”, with the eligible options: “Physiotherapist”; “Chiropractor”; “Orthopaedic surgeon”; “Specialist in sports medicine”; “Acupuncturist” and “Other”. Data management and statistical analysis: Data were analysed using Stata/IC version 14.1 (StataCorp, College Station, Texas, USA). Continuous data were evaluated using quartile-quartile plots to evaluate if data were normally distributed, and since they did not follow a normal distribution, we used the median- instead of the mean estimate. Descriptive statistics were used to present the data according to questionnaire categories. In some questions, respondents had the opportunity to include more than one response; therefore the number of responses could exceed 100%. Trial registration This was a survey-based study. No trial registration was made. RESULTS In total, 27 GMPs completed the questionnaire. Baseline characteristics of the responding GMPs together with the representativeness according to gender,

Total number of consultations caused by RRI in the last two working weeks .100=%consultations caused by RRI in the last tw wo working weeks ultations in the Total number of consu last two working weeks The International Journal of Sports Physical Therapy | Volume 12, Number 3 | June 2017 | Page 453

seniority, type of practice and number of listed patients were compared to all GMPs in the Central Denmark Region (Table 1).9 According to gender, seniority and type of practice no significant differences were found. The number of listed patients was significantly different, as the included GMPs had a higher number of listed patients than the average of all GMPs in the Central Denmark Region. All the responding GMPs have had at least one consultation concerning a person with a RRI in the past

year. The median proportion of consultations caused by RRIs in the last period of two working weeks was 0.80% [25th percentile = 0.00%; 75th percentile = 1.43%]. The median of the monthly proportion of consultations caused by RRIs was 0.71% [25th percentile = 0.23%; 75th percentile = 1.20%] (Table 2). A proportion of 25-49% of the consulting injured runners, were referred to additional examination and/or treatment by 48% (n = 13) of the GMPs. None of the GMPs referred 75-100% of the consulting injured runners to additional examination and/ or treatment (Figure 2). In case of referral, more

Table 1. Representativeness of participating general medical practitioners (GMPs) with regard to gender, seniority, type of practice, number of listed patients per GMP, interest in sports medicine, qualifications in sports medicine, personal interest in running Participating GMPs % (n) n total = 27

All GMP in one Region in DK % (n) n total = 871

p-value

Gender Male Female

59.3% (16) 40.7% (11)

61.1% (532) 38.9% (339)

0.84

Number of years in practice* 20

34.6% (9) 7.7% (2) 26.9% (7) 30.8% (8)

24.1% (210) 18.4% (160) 32.0% (279) 25.9% (222)

0.36

Type of practice Single-handed Group

18.5% (5) 81.5% (22)

24.7% (215) 75.3% (656)

0.46

Number of list patients per GMP* 1999

0.0% (0) 19.2% (5) 53.8% (14) 26.9% (7)

8.0% (70) 50.9% (443) 36.2% (315) 4.9% (43)

DO GENERAL MEDICAL PRACTITIONERS EXAMINE INJURED RUNNERS?

General Medical Practitioners (GMP) in Denmark perform clinical examinations of patients with musculoskeletal pain. However, the prevalence proportion...
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