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J Physiother. 2011;57(1):41-6. doi: 10.1016/S1836-9553(11)70006-6.

Physiotherapists' compliance with ankle injury guidelines is different for patients with acute injuries and patients with functional instability: an observational study.

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Department of Allied Health Care, NIVEL, Netherlands Institute of Health Services Research, The Netherlands.



What are the characteristics of patients with acute ankle injuries or functional instability of the ankle? Do physiotherapists treat these patients according to evidence-based guidelines? What are the determinants of adherence to the guidelines?


Observational study using multi-level analyses of data from the National Information Service for Allied Health Care in the Netherlands. This network continuously collects healthcare-related information on characteristics of patients and their referral, health problem, and treatment plan.


1413 patients treated for ankle injuries.


Adherence to the guidelines was measured using three quality indicators: number of sessions, interventions, and accomplished treatment goals.


Interventions and treatment goals were often aimed at the improvement of body functions, especially in patients with functional instability. Although not advised in the guidelines, manual manipulation was applied during treatment in 21% of the patients with functional instability. On average, patients with acute ankle injuries have a 38% chance of being treated according to the guidelines. Adherence can be explained partly by the duration of the complaint, whether the complaint is recurrent, the patient's age and the experience of the therapist, but it depends substantially on the therapist.


There is some discrepancy between the guidelines and practice, especially regarding the interventions applied to patients with functional instability. However, there is large variation between therapists. The sooner a patient presents for treatment and the greater the experience of the physiotherapist with ankle injuries, the greater the likelihood that treatment will follow the guidelines.

[Indexed for MEDLINE]
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