The part of the guideline that concerns Libraries treatment of patients with functional instability

concerns persistent injuries, ie, existing for six weeks or more at the start of treatment. In the current study, it was necessary to change the definition of acute injuries. In LiPZ, they are defined as injuries that have existed for four weeks or less, instead of six weeks or less as defined in the guideline. This is because LiPZ only has the option of 0–4 weeks or 1–3 months. Three quality indicators that have been established in previous research (van der Wees et al 2007) were applicable in LiPZ. These three indicators are presented in Table 1. Descriptive statistics were calculated for all variables. Because patients were nested within physiotherapists, a multi-level find more model was used to estimate adherence and determinants for adherence. GSK-3 inhibitor Since the outcome is a binary variable, multilevel logistic regression analysis was

used, the analysis was done with MLwiN 2.02 (Rasbash et al 2005),using the following estimation procedure: PQL with second order and constrained level 1 variance. All patient variables (gender, duration of the complaint, urbanisation, recurrence of the complaint, age, education) and all therapist variables (gender, age, and the number of patients with ankle injuries treated) were centered around their grand means, so that the estimated adherence has an interpretable meaning (Snijders et al 1999). Intra-class correlation (ICC) was calculated as a measure of variation between physiotherapists. Due to a small data set, it was not possible to make estimations in the group of patients with functional instability. Between 2003 and 2010, 1.7% of all patients in LiPZ consulted a physiotherapist with an ankle injury (n = 1413). More than 71% had acute complaints. They were treated by 117 physiotherapists

MRIP working in 49 practices. Data were not complete for all patients. Table 2 presents the characteristics of the patients and physiotherapists. On average, patients with acute complaints received just over five treatment sessions during a period of 4.5 weeks. The mean number of sessions for patients with functional instability was nine, spread over about eight weeks. Table 3 presents data regarding treatment goals and interventions. For patients with either an acute ankle injury or functional instability, walking and stability of joints were the most important treatment goals and functional training was the most frequently applied intervention. In 37–44% of all patients, no treatment goal was chosen at the level of mobility-related activities. Although not advised in the guideline, in 21% of the patients with functional instability manual manipulation was chosen as one of the interventions most frequently applied.