Physical Therapy Provision After COVID-19 in the Netherlands: Retrospective Cohort Study

Abstract Background Many patients have been treated by physical therapists after an infection with COVID-19. The policy changes and unique situation of the COVID-19 pandemic necessitate a retrospective analysis. Objective This study examined 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. The primary aim was to examine changes in the amount of health care provision and associated factors. Furthermore, we aimed to gain insight into the patient population and changes over time, as well as the use of advised outcome measures in physical therapy after COVID-19. Methods We conducted a retrospective cohort study using routine health care data from the electronic health records of physical therapy practices in Dutch primary care. In total, 71,152 COVID-19 treatment trajectories initiated between March 1, 2020, and December 18, 2022, were included. Multilevel generalized linear mixed model analyses examined changes over time in the patient population and in the amount of physical therapy within treatment trajectories (ie, 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 the amount of physical therapy provided 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 among older patients aged 60 to 79 years, with smaller quantities for younger and older patients. Treatment trajectories for women were 1.5 weeks longer than those for men (β 1.5, SE 0.12; P <.001) but did not include more consultations ( P =.76). In 83% (59,184/71,152) of treatment trajectories, a baseline score on at least one of the included advised outcome measures was registered. Median (IQR) baseline scores were 420 (340-490) m on the 6-minute walking test (n=27,035); 13 (10-17) seconds on the 5-times sit-to-stand test (n=2337); 5.8 (5‐6.3) points on the Fatigue Severity Scale (n=995); 8 (7-10) points on the Patient-Specific Functional Scale (PSFS; n=55,074); 10 (9-12) points on the Short Physical Performance Battery (n=4665); and 29 (22-38) and 30 (24-40) kg of grip strength, respectively, on the left (n=12,306) and right (n=12,293) hand. Difference scores could be examined for the 6-minute walking test, grip strength, and the PSFS. Conclusions This study demonstrates the potential of routinely collected health care data to describe real-world physical therapy provision for COVID-19 in Dutch primary care. Patients showed severe perceived fatigue, reduced functional capacity, and lower-limb strength at the start of physical therapy. The amount of physical therapy declined over the first 2.5 years of the pandemic, differed by age and gender, and was generally lower than the amount reimbursed by the Dutch government through basic health insurance.