Clinical assessment and treatment of patients presenting with longstanding hip and groin pain in primary care: a survey study among physical therapists and general practitioners in Sweden.

Abstract

Background: Methods of assessment, treatment and referral rates of patients presenting with longstanding hip and groin pain (LHGP) are not well documented. The aim of this study was to investigate assessment and treatment of patients with LHGP among general practitioners (GPs) and physical therapists (PTs) in primary care.

Methods: An anonymous web-based survey was developed specifically for this study and distributed to GPs and PTs at primary care centers in the southern part of Sweden. The survey covered the use of different methods of assessment and treatment for LHGP, the perceived importance these methods, and referral rates to orthopedic care. Responses from clinicians were reported in frequencies and percentages, and differences in assessment methodology between professions were examined with chi-square tests.

Results: PTs (n = 104) and GPs (n = 62) referred less than 25% of patients with LHGP to orthopedic care. Both professions used clinical assessments as range of motion tests, but PTs were more likely to use specific clinical tests (PTs 76% vs. GPs 19%, p = < 0.001), GPs used more imaging (GPs 98% vs. PTs 58%, p = < 0.001) and neither profession used validated patient-reported outcome measures (GPs 2% vs. PTs 11%, p = 0.134). GPs and PTs ranked patient history and range of motion as the most important factors for diagnosis. GPs and PTs both reported providing patient education and advice on physical activity as part of the treatment. GPs commonly prescribed pain medication, including NSAIDs (97%), paracetamol (100%), and opioids (69%). 77% of PTs reported treatment duration less than 3 months, with treatment consisting of combinations of exercise therapy and manual therapy.

Conclusions: GPs and PTs in primary care referred 25% or less of patients with LHGP to orthopedic care. Both professions generally used assessment for LHGP in line with clinical recommendations. However, some assessment methods differed between GPs and PTs, and neither used validated patient-reported outcome measures. Treatment strategies mainly included pain medication (GPs), exercise and manual therapy (PTs), and education (both professions). Inconsistent with clinical recommendations, GPs commonly prescribed opioids as part of pain management, and PTs report treatment duration of less than 3 months.

Clinical trial number: NA.