JMIR Publications

ABSTRACT

Background:

Many patients have been treated by physical therapists after an infection with coronavirus disease (COVID-19). The unique situation of the COVID-19 pandemic allows for a natural experiment to examine changes in the quantity of the healthcare provision over time.

Objective:

This retrospective cohort study aimed to gain insight into physical therapy provision for adult patients recovering from COVID-19 in primary care in the Netherlands over the first 2.5 years of the pandemic. More specifically, we aimed to gain insight in 1) changes in the patient population over time, 2) changes in the quantity of the healthcare provision and associated factors, and 3) use of advised outcome measures in physical therapy after COVID-19.

Methods:

We employed a retrospective cohort study using routine healthcare data from electronic health records of physical therapy practices in Dutch primary care. In total, 71,152 treatment-trajectories for COVID-19 starting between March 1st 2020 till December 18th 2022 were included. Multilevel generalized linear mixed model analyses were executed to examine changes over time in the patient population and the quantity of physical therapy treatment-trajectories (i.e., duration in weeks and number of consultations). Outcome measures were analyzed using descriptive statistics.

Results:

Completed treatment-trajectories had an overall duration of 24 weeks with 28 consultations, with a decreasing trend in quantity of the provided physical therapy over time (P<.001). Also, a parabolic effect of age (P<.001) was found, showing a maximum number of consultations and duration of the treatment-trajectory for elderly aged 60-79 years and smaller quantities for younger and older patients. Treatment-trajectories for women were in general 1.5 weeks longer than those of men (ß: 1.5, SE: 0.12, P<.001), but did not include more consultations (P=.76). In 85% of completed treatment-trajectories a baseline score on at least one of the included advised outcome measures was registered. Median (p25-p75) baseline scores were 420 (340-490) meters on the 6-minute-walking-test (6MWT; n=25,735), 13 (10-17) seconds on the 5-times-sit-to-stand (n=2,281), 5.8 (5-6.3) points on the fatigue-severity-scale (n=897), 8 (7-10) points on the patient-specific functional scale (PSFS; n=52,040), 10 (9-12) points on the short-physical-performance-battery (n=4,429) and 30 (22-38) kilograms grip-strength (n=3,209). Difference-scores could be examined for the 6MWT, grip-strength and the PSFS.

Conclusions:

This study shows the possibilities of using routinely collected healthcare data to gain insight in the real-world provided physical therapy in Dutch primary care for COVID-19. Overall, patients showed severe perceived fatigue, and declined functional capacity and lower limb strength at the start of physical therapy. The quantity of the provided physical therapy declined over the first 2.5 years of the pandemic, differed between age-categories and gender, and was generally lower than the quantity reimbursed by the Dutch government via the basic health insurance.