Margit Kooijman

64 TABLE 5. Main purposes of MSU More than 50% of the respondents receive regular requests for MSU from colleagues in patients with shoulder complaints (table 4). Another 23% receive these requests often to always. In the general patient population around 44% of the MSU physiotherapists never or sometimes receive these requests. For both populations, it mainly concerns requests from general practitioners and colleagues from their own physiotherapy practice and in both populations 25% use history and clinical information provided by the applicant without examining the patient themselves. Advantages and disadvantages Regarding the open-ended question as to the biggest advantage of MSU, physiotherapists most frequently indicated its role in better diagnosing shoulder complaints, which helps them with prognosis and treatment. Almost 90% agreed with the proposition that dynamic examination is the most important advantage compared to other diagnostic imaging. The most frequently mentioned disadvantage was that assessment is difficult and that there is a risk that findings may not be sufficiently linked to history and physical examination. Because physiotherapists’ central starting point is the patient with his complaints, many MSU physiotherapists (85%) first performed history and physical examination and used MSU additionally. However, more than 65% disagreed that history and physical examination are more important than MSU findings. When clinical findings contradict results of MSU, 21% trusted MSU, 32% discussed it with a colleague or GP, 14% trusted the clinical findings, 6% directly referred to the GP and 27% indicated their strategy depended on the particular findings. Of the MSU physiotherapists, 66% advised patients to contact their GP more quickly and 95% indicated they directed patients to the GP more specifically. Discussion The purpose of current study was to investigate the current prevalence of MSU in Dutch physiotherapy practices and to explore experiences of MSU physiotherapists with MSU in a primary care setting in patients with shoulder complaints. It shows that in 18% Patients with shoulder complaints (%) General patient population (%) I use MSU mainly for: Reassurance of the patient 16.3 24.5 Choice of treatment 36.7 36.7 Adjustment of treatment 8.2 12.2 Evaluation of treatment 28.6 24.5 Doubts of diagnosis 28.6 18.4 Making a diagnosis 63.3 75.5 Suspicion on tissue damage 83.7 75.5 Indication for physiotherapy 12.2 12.2