Open Access Journal of Sports Medicine Table 5. Additional tests ordered after consultation (%) Total population (n = 230) X-rays Ultrasound Laboratory tests Exercise test MRIscan CT scan No 57.4 13.2 1.7 3.0 31.3 0.4 25.6 51.1 10.0 2.2 2.2 27.8 0 30.0 Self-referrers Referred by GP** 58.8 11.3 2.1 4.1 34.0 0 22.7 Note: **Referring medical professional. Abbreviations: CT, computed tomography; GP, general practitioner; MRI, magnetic resonance imaging. Referred byphysiotherapist/paramedic 67.9 14.3 0 0 28.6 0 25.0 Referred bymedical specialist 66.7 20.0 0 6.7 40.0 6.7 20.0 were the most common diagnoses. Of all patients, 48.7% had a knee injury, 17.4% had complaints at/around the ankle, and 11.4% had an injury at the pelvis or thigh. Absence from sport or work Table 4 shows the reported absence from sport and/or work. About two-thirds of the patients reported some degree of absence from sport, compared with only 8.4% being absent from work. Most patients who were absent from sport had stopped practicing for a considerable amount of time. Nevertheless, self-referrers who were absent from sport or work presented to the sports physician at an earlier stage. Of those patients who stopped practicing their sporting activity and who had been referred by their general practitioner, most presented to the sports physician after a longer period of time. However, there were no signifi cant between-group differences regarding absence from sport (P = 0.11) or absence from work (P = 0.52). Additional investigations Table 5 presents an overview of the additional tests that were ordered. Sports physicians frequently requested additional tests, especially for new injuries. In most cases, these were X-rays (57.4%), magnetic resonance imaging (31.3%), and ultrasound examinations (13.2%). Treatment About 50% of the patients were given advice on special exercises or were referred to a physiotherapist or manipulative 30 Sport & Geneeskunde | maart 2013 | nummer 1 therapist (Table 6). Self-referrers were less often referred to other therapies; moreover, for 31.5% of these patients, only practical medical advice was given, compared with 15.5% for patients referred by their general practitioners. Discussion In this study, 39.3% of patients consulting a sports physician at the Sports Medical Center, University Medical Center Groningen, came without a referral from another medical professional. The basic characteristics (age, gender, and level of sport) of the self-referrers were similar to those of other patients visiting the center. In The Netherlands, patients referred to sports medicine physicians and self-referrers seem to have a different need for care. In general, the referred patients (signifi cantly more often practicing team sports) had previously been treated and were referred to secondary care for further examination. Self-referrers (signifi cantly more often individual athletes) were less likely to have been treated previously for sports-related complaints compared with the referred group. Probably for this reason, self-referrers reported shorter absence from work or sports. They preferred consulting a sports physician rather than a general practitioner in the fi rst instance; however, the reasons for this decision were not explored in this study. It has been reported that general practitioners are less specifi c in the registration of their diagnosis and advice for sport-related complaints.3 In this study, all patients consulting a sports physician received a specifi c diagnosis and related treatment. Pagina 29
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Sport & Geneeskunde nummer 1 | Maart 2013 Lees publicatie 19Home