Direct access to physical therapy for patients with low back pain in the Netherlands: prevalence and predictors

Phys Ther. 2014 Mar;94(3):363-70. doi: 10.2522/ptj.20120330. Epub 2013 Oct 3.


Background: In the Netherlands, direct access to physical therapy was introduced in 2006. Although many patients with back pain visit physical therapists through direct access, the frequency and characteristics of episodes of care are unknown.

Objective: The purposes of this study were: (1) to investigate the prevalence of direct access to physical therapy for patients with low back pain in the Netherlands from 2006 to 2009, (2) to examine associations between mode of access (direct versus referral) and patient characteristics, and (3) to describe the severity of the back complaints at the beginning and end of treatment for direct access and referral-based physical therapy.

Design: A cross-sectional study was conducted using registration data of physical therapists obtained from a longitudinal study.

Method: Data were used from the National Information Service for Allied Health Care, a registration network of Dutch physical therapists. Mode of access (direct or referral) was registered for each episode of physical therapy care due to back pain from 2006 to 2009. Logistic regression analysis was used to explore associations between mode of access and patient/clinical characteristics.

Results: The percentage of episodes of care for which patients with back pain directly accessed a physical therapist increased from 28.9% in 2006 to 52.1% in 2009. Characteristics associated with direct access were: middle or higher education level (odds ratio [OR]=1.3 and 2.0, respectively), previous physical therapy care (OR=1.7), recurrent back pain (OR=1.7), duration of back pain <7 days (OR=4.2), and age >55 years (OR=0.6).

Limitations: The study could not compare outcomes of physical therapy care by mode of access because this information was not registered from the beginning of data collection and, therefore, was missing for too many cases.

Conclusions: Direct access was used for an increasing percentage of episodes of physical therapy care in the years 2006 to 2009. Patient/clinical characteristics associated with the mode of access were education level, recurrent back pain, previous physical therapy sessions, and age.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Episode of Care
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Logistic Models
  • Low Back Pain / epidemiology
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Physical Therapy Modalities / statistics & numerical data*
  • Prevalence
  • Referral and Consultation / statistics & numerical data
  • Socioeconomic Factors