[Prescriptions in outpatient physiotherapy for low back pain - descriptive analysis to relate indication key and...

In Germany, in comparison to occupational therapy and speech therapy, physiotherapy is the most often prescribed treatment, with a prescription volume of 3 billion Euro in 2009. The catalogue of prescribable therapies (CPT; "Heilmittelkatalog") is a matter of controversial discussion. It represents the rationale which should support the physician in adhering to the efficiency principle.

To describe the coded indications used by physicians to justify a physiotherapy prescription for patients with back pain, in order to verify its plausibility. Furthermore, we aimed to describe the manner in which patient subgroups differ regarding factors given in the CPT to allocate patients to various domains of indication.

A descriptive-exploratory secondary analysis of data from a prospective multicentre (84 private physiotherapy practices) observational trial was conducted. The Bother index of the Musculoskeletal Function Assessment Questionnaire (German, 16-Item version), the Work Ability Index and an 11-step box scale on pain intensity were measured as outcome.

Coded indications related to dysfunction/pain due to joint-blockages dominated clearly (WS1a 30%, WS2a 35.3%). Patients who were allocated to the domains of indication WS1 and WS2 did not differ regarding botherment in daily life at the beginning of therapy (SES=0.05).

It is hardly possible to identify clear prescription patterns. Results did not show any clear differences regarding major criteria for efficient prescription in line with the CPT. The weaknesses discussed should be targeted in future studies and should be considered during subsequent revisions of the CPT.