Demographic Characteristics of the Patients Referred to Physical Therapy Outpatient Clinic

Objective: Physical medicine and rehabilitation is a medical science which has very wide scope, although pain is the main symptom in patients admitted physical therapy polyclinic. The aim of the present study was to examine the demographic features of the patients who were admitted to the physical medicine outpatient clinic in 20102014 years. Method: The medical records of 46729 patients, who were admitted to the outpatient clinics affiliated with Abant Izzet Baysal University Faculty of Medicine and Association of Public Hospitals, were retrospectively reviewed. Of these patients, 29721 (63.6%) were females and 17,008 (36.4%) were males. The mean age of the patients was 51.7 years. The mean age was 53.3 years in female patients and 48.9 years in male patients. Results: Of the patients, 10111 had lumbar problems, 7816 in knee, 5612 in neck, and 3652 in shoulder, respectively. The present study attempted to present in detail the characteristics of the patients who were admitted to the outpatient clinics. Conclusion: Such studies may guide hospitals in taking necessary precautions depending on the volume of patients who present to the outpatient clinics for follow-up and treatment.


INTRODUCTION
Physical medicine and rehabilitation is a medical science which has very wide scope, although pain is the main symptom in patients admitted physical therapy polyclinic.The medical history and physical examination are the utmost importance in the diagnosis and treatment of the conditions in the practice of physical medicine and rehabilitation (PMR).The imaging techniques and laboratory tests are utilized if necessary (1).The methods used in physical medicine can be complicated depending on the disease.This branch of the medicine uses manual therapy, injections, kinesiotape, and many other methods of complementary medicine, in addition to patient education, exercises, drug therapies, and physical therapy devices.
Among patients presenting to physicians in the United States, 10.9% had musculoskeletal disorders, and of these patients, 2% had lumbar pain (2).The incidences of chronic and degenerative joint disorders also increase with aging.The rate of joint problems is 5% in the 16-24 age group, and this rate is as high as 54% in patients aged above 85 years.Degenerative disorders of the musculoskeletal system and non-inflammatory diseases that cause mechanical pain are among the most common health problems.Of patients aged 65 years and above, 90% exhibit radiological evidences of the degenerative joint disease, osteoarthritis (3).The prevalence of osteoarthritis is 57% in the population aged 55 years and above in the United States, and 24% of these patients report impairment in performing daily activities (4).
The aim of the present study was to examine the demographic features of the patients who were admitted to the physical medicine polyclinic in 2010-2014 years.In this regard, a comparison with other studies might provide clues about common disorders in the area and associated factors.

MATERIAL AND METHODS
The medical records of 46.729 patients, who were admit-ted to the outpatient clinics affiliated with Abant Izzet Baysal University Faculty of Medicine and Association of Public Hospitals in 2010-2014 years, were retrospectively reviewed.Demographic data and patient characteristics were retrieved from the medical records.The study included only outpatients.The patients presenting to the outpatient clinics are generally from the Bolu province, and patients residing in the neighboring provinces are also admitted on occasion.The study attempted to determine disorders of the musculoskeletal system in patients living in the same area.wereretrieved from the medical records.The study included only outpatients.The patients presenting to the outpatient clinics are generally from the Bolu province, and patients residing in the neighboring provinces are also admitted on occasion.The study attempted to determine disorders of the musculoskeletal system in patients living in the same area.

Statistical Analysis
The sociodemographic features of the patients were expressed as mean, standard deviation, and percentage.The patient groups were compared depending on the diagnosis groups (physical medicine, rheumatologic, neurologic, and orthopedic) using one-way ANOVA.Post-hoc multiple comparisons test with Bonferonni correction was used to determine the differences between the groups.

DISCUSSION
Pain is the main symptom in patients presenting to the physical medicine and rehabilitation outpatient clinics.Pain was previously considered as a symptom of the diseases; however, pain itself, particularly chronic pain, is accepted today as a syndrome and disease.The epidemiological studies on pain investigate the burden of pain in a population and how pain differs according to age, gender, ethnicity, and population.The results of the studies evaluating the prevalence of pain may vary greatly.Pain, as a symptom, is a complex response comprising objective, subjective, sensorial, and psychogenic components.As a result, the response given to pain differs from one person to another and this response can even change in the same person between different time periods.Medical therapies as well as invasive interventions are used in the treatment of pain, and many disciplines are involved in pain management.
Of the patients suffering from pain in a study conducted in the United States, 9.9% had acute pain, 6.9% had subacute pain, and 64.4% had chronic pain; the prevalence of chronic pain was found to be 87.4% in Hong Kong (5,6).The prevalence of chronic pain was 76.6% in the 18-65 years age group in Turkey, and higher prevalence rates were reported in Northern, Middle, and Eastern areas, particularly in the rural areas (81.4%) of Turkey (7).In the present study, patients were classified according to specific diagnoses.Of these patients, 202 were only diagnosed with acute pain and 132 were diagnosed with chronic pain.
In the study by Portenoy et al., the rate of pain was 47% in the hip and lower extremities, 40% in the back, 28% in the head and neck region, and 24% in the shoulder and upper extremities (8).In Spain, the most common sites of involvement are the lower extremities, back, and head-  .9%,respectively.The prevalence of pain in Turkey was reported to be higher in females (79.8%) compared to males (56.8%).Pain was even more prevalent among females living in the urban areas in western parts of Turkey, and the prevalence of pain increased in parallel to increasing age (7).Most studies on the prevalence of pain reported higher prevalence rates in females and higher rates with increasing age (11) (13).The current retrospective study reviewed patients who were admitted to the physical medicine and rehabilitation outpatient clinics for the duration of one years.Of these patients, 60.3% (2154) were females and 39.6% (1417) were males.The most common cause of pain was discopathies (21.4%), while 84.9% of the herniations occurred in the lumbar area and 15% occurred in the cervical area.The second most common cause of pain was arthrosis occurring in 19.8% of the patients, and of these patients, 43.9% had gonarthrosis, 34.6% had cervical spondylosis, 12.1% had lumbar spondylosis, 7.4% had generalized arthrosis, and 1.6% had coxarthrosis.The third most common cause of pain was soft tissue rheumatic disease, and of these patients, 81.3% had fibromyalgia, 10.9% had myofascial pain syndrome, and 7.8% had other rheumatic diseases of the soft tissue.The fourth most common cause of pain was arthritis, and of these patients, 36% had non-specific arthritis, 28.6% had acute articular rheumatism, 19.6% had spondyloarthritis, and 6.9% had gout.The studies that evaluated the prevalence of various disorders in certain age groups reported that disc herniations most frequently occurred in the 21-40 years age group (64.9%) and arthrosis most frequently occurred in the 51-70 years age group (55.8%) (14).Another study that evaluated patients presenting to the PMR outpatient clinics for a duration of three months reported that the proportions of females and males were 68.2% and 31.8%,respectively, and 22.5% of the patients were aged above 60 years.Among the patients aged above 60 years, the prevalence of degenerative joint diseases was 45.6%, the prevalence of osteoporosis was 23.7%, the prevalence of inflammatory disorders was 2.8%, the prevalence of soft tissue disorders was 5%, the prevalence of vertebral disorders was 14.2%, the prevalence of orthopedic disorders was 2.8%, and the prevalence of neurological disorders was 5.9%.In one study, vertebral disorders were the second most common cause of pain in males with the exception of degenerative and inflammatory disorders, and osteoporosis was the second most common cause of pain in females (15).In the present study, a total of 10,111 patients presented with low back pain (21.6%), 5,612 patients presented with neck pain (12%), 3,052 patients presented with shoulder pain (6.5%), and 7,818 patients presented with knee pain (16.7%).A significant proportion of our patients were in the 20-30 years age group (44.96%).
Among patients who were admitted to the algology outpatient clinic for pain management over a duration of two years, low back pain, shoulder pain, and headache were the most common causes of presentation, and the three most common diagnoses were low back pain, musculoskeletal pain and headache.The mean VAS score was 7.3, and the pain was usually of a tingling or throbbing character, and 73% of the patients had chronic pain (16).In the present study, low back pain and knee pain were the most common causes of admission to the outpatient clinics.
In one study that evaluated patients presenting with pain between 2000 and 2010, 160 patients were aged 18 years and below, 4,447 patients were aged between 19-64 years, and 2,040 patients were aged 65 years and above, and the study evaluated 6,647 patients, 49.9% of which were males and 50.1% were females.Of these patients, 22.6% had myofascial pain, 21.2% had neuropathic pain, 15.7% had lumbar pain, and 6.2% had neckshoulder-arm pain (17).Some psychophysical studies conducted in healthy individuals reported that females had lower pain threshold than males and higher pain scores were reported by female patients, indicating a low pain tolerance in female patients (18).In a study conducted in PMR clinics at Ankara Numune Education and Research Hospital in 1998, 76.4% of the patients presenting to the outpatient clinics were in the 65-70 age group.In the same study, gonarthrosis and generalized osteoarthritis were reported as the most common disorders in both genders (19).In the present study, females composed 63.6% of the patients presenting to the outpatient clinics.Of the patients, 33.28% were aged 60 years or above.
In another study, of patients aged 65 years or above presenting to the physical medicine and rehabilitation centers for treatment, 52.36% were males and 47.64% were females, and the reason for admission was rheumatic diseases in 81.98% of males and 86.13% of females; orthopedic rehabilitation after sustaining a fracture in 41.44% of males and 48.51% of females; neurological rehabilitation after stroke in 27.92% of males and 27.72% of females (p>0.05);pulmonary exercises due to disorders such as asthma and COPD in 27.03% of males and 18.81% of females (p<0.01); and physical therapy due to cervical disc herniation in 22.52% of males and 31.68% of females (p<001) (20).The proportion of patients requiring orthopedic, neurologic, and rheumatologic rehabilitation was 3.16%, 3.24%, and 2.19%, respectively.
The present study attempted to present in detail the characteristics of the patients who were admitted to the outpatient clinics.We cannot apply our results for general population due to the broad exclusion criteria.Such studies may guide hospitals in taking necessary precautions depending on the volume of patients who present to the outpatient clinics for follow-up and treatment.

Table 1 .
Data indicating the monthly distribution of the admissions to the outpatient clinicsThe monthly distribution of the admissions are presented in Table1, and the distribution of the patients according to diagnostic groups is presented in Table2, and the most frequent reasons for admissions are presented in Table3.myalgia and fibrositis.131 were diagnosed with and administered therapy for osteoporosis, and 132 were followed as an outpatient with the diagnosis of scoliosis.
were admitted to the physical medicine and rehabilitation outpatient clinics affiliated with Abant Izzet Baysal University Faculty of Medicine and Association of Public Hospitals.Of these patients, 29721 (63.6%) were females and 17008 (36.4%) were males.The mean age of the patients was 51.7 years.The mean age was 53.3 years in female patients and 48.9 years in male patients.Of the patients, 1358 (2.9%) were in the 0-19 years age group, 8,806 (18.84%) were in the 20-30 years age group, 21012 (44.96%) were in the 40-59 years age group, and 15553 (33.28%) were above 60 years.The youngest patients were below 1 year of age (total 13 patients) and

Table 2 .
The rates of diagnoses according to treatment methods in outpatients

Table 3 .
The most frequent reasons for admission (12) the study byChung andWong, the most frequent complaints were low back pain (22.2%), headache (19.9%), upper extremity pain (18.5%), lower extremity pain (16.4%), and abdominal pain (11.3%)(6).The most common sites of involvement in the study by Kuru et al. were shoulder, low back, neck, back, and knees(12).The most common sites of involvement in the study by Elliott et al. were low back and joints, while low back pain was more common in young and male patients and joint pain was more common in the older age groups and in females