Background: In 2006, direct access to physical therapy was introduced in the Netherlands. Before this policy measure, evaluation and treatment by a physical therapist were only possible following referral by a physician.Objective: The objectives of this study were to investigate how many patients use direct access and to establish whether these patients have a different profile than referred patients.Methods: Electronic health care data from the National Information Service for Allied Health Care (LiPZ), a nationally representative registration network of 93 Dutch physical therapists working in 43 private practices, were used.Results: In 2006, 28% of the patients seen by a physical therapist came by direct access. Patients with non–further-specified back problems, patients with nonspecific neck complaints, and higher-educated patients were more likely to refer themselves to a physical therapist, as were patients with health problems lasting for less than 1 month. Younger patients made more use of direct access. In addition, patients with recurring complaints more often referred themselves, as did patients who had received earlier treatment by a physical therapist. Patients with direct access received fewer treatment sessions. Compared with 2005, there was no increase in the number of patients visiting a physical therapist.Limitations: Data came only from physical therapists working on general conditions in general practices. Severity of complaints is not reported.Conclusions: A large, specific group of patients utilized self-referral, but the total number of patients seen by a physical therapist remained the same. In the future, it is important to evaluate the consequences of direct access, both on quality aspects and on cost-effectiveness.

General practitioners have an ideal position to motivate inactive patients to increase their physical activity. Most patients are able to exercise in regular local facilities outside the health care setting. The purpose of this study was to get insight into general practitioners perceptions and current practices regarding referral of patients to local exercise facilities. Furthermore, collaboration with exercise providers in the community was investigated, and motivators and barriers for referral. A written questionnaire sent to a representative random sample of 800 Dutch general practitioners. Descriptive statistics and Chi2 tests were used. All responding general practitioners (340) recommend their patients to take more exercise when necessary and 87 % say to refer patients sometimes. Limited motivation of the patient (44 %) and reduced health status (34 %) are the most mentioned barriers for advising patients to increase physical activity. When referred, most patients are send to a physical therapist (69 %) but also local exercise facilities were mentioned (54 %). The most important barrier for referring patients to local exercise activities are patients limited financial possibilities (46 %). Restricted knowledge of local exercise- or sport facilities was an additional barrier (19 %). There is little structural collaboration between general practitioners and exercise providers, but when collaboration exists general practitioners refer more often. Positive experiences of patients (67 %), affordable offers (59 %) and information of local exercise facilities (46 %) are seen as important promoting factors for referral. Although 32 % of the general practitioners think that good collaboration would be stimulating, regular meetings with sports and exercise providers were considered the least important for increasing referral (3 %). Dutch physicians have a positive attitude towards stimulating physical activity but referral to local exercise facilities is low. Referral is partly hindered by restricted knowledge of local exercise facilities. Although general practitioners think that collaboration is important for physical activity promotion, it should not cost them much extra time. A coordinator with knowledge of the local situation can facilitate contacts between GP practices and sports providers.

Although physiotherapy (PT) plays an important role in improving activities of daily living (ADL functioning) and discharge rates, it is unclear how many nursing home residents receive treatment. Furthermore, there is a lack of insight into the determinants that influence the decision for treatment. In this study, we investigated how many nursing home residents receive PT. In addition, we analysed the factors that contribute to the variation in the provision of PT both between nursing homes and between residents.

Objective: Evaluation of the efficacy of Le Bon Départ (LBD) treatment and Sensory Integration (SI) treatment on motor performance of children with developmental coordination disorder. Design: A single subject design with multiple baseline and alternating treatments. Order of treatment and length of phase were randomized. Measurements were blinded. Setting: Department of Occupational Therapy at the Academic Hospital Vrije Universiteit Amsterdam, The Netherlands. Subjects: Five boys and one girl with developmental coordination disorder (age: 6.0–8.1 years). Interventions: Baseline condition, Le Bon Départ treatment and Sensory Integration treatment. Main outcome measures: The Movement ABC, Praxis Tests, a rhythm test and visual analogue scales. With the exception of the Praxis Tests, lower scores indicate better performance. Results: During both treatments, the performance on the Movement ABC (x̄ = 7.21) and the scores on the visual analogue scales (x̄ = 46.64) were significantly better than in the baseline (Movement ABC_baseline: x̄ = 17.38; visual analogue scales_baseline: x̄= 68.18). After treatment 2, performance on the Praxis Tests and scores on the visual analogue scales were significantly better than after treatment 1 (Praxis Tests: 113.54 versus 104.68; visual analogue scales: 34.74 versus 58.54). All six children performed better on the Movement ABC during treatment as compared to the baseline. Le Bon Départ led to significant improvement on all dependent variables, Sensory Integration on the visual analogue scales only. The improvements after Le Bon Départ were larger than the improvements after Sensory Integration treatment. On the rhythm test this difference was significant: LBD led to an improvement of 43.01 points, while the improvement after SI was 17.59 points (p < 0.05). Conclusion: Motor performance of children with developmental coordination disorder improved significantly on all dependent variables after the combination of treatments. Le Bon Départ led to more improvement than Sensory Integration. LBD appears to be a valuable treatment method for children with developmental coordination disorder.

Unhealthy diets and inactivity are still common among patients with cardiovascular diseases. This study evaluates the effects of the telephonic lifestyle intervention ‘Hartcoach’ on risk factors and self-management in patients with recent coronary events. This was a randomised trial in five Dutch hospitals. Patients (18–80 years), less than eight weeks after hospitalisation for acute myocardial infarction or (un)stable angina pectoris were randomised to the Hartcoach-group, who received telephonic coaching every four weeks for a period of six months (in addition to usual care), and a control group receiving usual care only. Simple random allocation was used (without relation to prior assignment). Measurements were taken by research nurses blinded for group allocation. Differences after six months of participation were compared using linear or logistic regression models with treatment-group and baseline score for the outcome under analysis as covariates, resulting in adjusted mean change (b). Altogether 374 patients were randomised (173 Hartcoach + usual care, 201 usual care only). Follow-up was obtained in 331 patients who still participated after six months. Hartcoach had significant favourable effects on body mass index (BMI) (b = –0.32; 95% CI:(–0.63– –0.003)), waist circumference (b = –1.71; 95% CI:(–2.73– –0.70)), physical activity (b = 15.08 (score); 95% CI:(0.13, 30.04)) daily intake of vegetables (b = 13.41; 95% CI:(1.10–25.71)), self-management (b = 0.11; 95% CI:(0.00–0.23)) and anxiety (b = –0.65; 95% CI:(–1.25– –0.06)). Hartcoach slightly increased the total number of risk scores on target (b = 0.45; 95% CI:(0.17-0.73)). Hartcoach has modest impact on BMI, waist circumference, physical activity, intake of vegetables, self-management and anxiety. Therefore, it may be a useful maintenance programme in addition to usual care, to support patients with recent coronary events to improve self-management and reduce risk factors.