It also depends on the therapist, with 95% of the therapists treating between 3% and 92% of their patients according to the guideline. The ICC was 39.7% (model 1), indicating that 39.7% of the total variance is PF 2341066 due to the physiotherapist. Table

4 presents the results of the analysis of possible predictors of guideline adherence. It shows that older patients, patients with recurrent complaints, and patients with longer existing complaints are treated according to the guideline less often. Adding the variables on therapist level decreases the ICC to 34%. Together, age, gender, and number of patients treated with ankle injuries explain 21% of the variance at the physiotherapist level. Only experience of the therapist with ankle injuries has a statistically significant relationship with guideline adherence; physiotherapists who treat few patients with ankle injuries follow the recommendations from the guideline less often. The present study demonstrates that adherence to recommendations from the ankle injuries guideline is not achieved very commonly by many physiotherapists. Whether a patient is treated according to the guideline depends to a substantial degree on the therapist. In this sample, 95% of the therapists treated between 3% and 92% of

their patients according to the guideline. In more detail, our data show that for 60–78% of the patients the applied interventions were in line with the guideline. Even so, for a substantial part the interventions and treatments goals were aimed at the improvement of function Selleckchem Veliparib and not mobilityrelated activities, especially in patients with functional instability. Therefore, the use of manual manipulation in this group (21%) is remarkable since this intervention is not advised in the guideline. From Phosphatidylinositol diacylglycerol-lyase previous research it is known that there is variation in adherence to recommendations from practice guidelines. For instance, Bekkering and colleagues (2005) found that in only 20% of the patients the number of treatment sessions was in line with the low back pain guideline, whereas in 91% adequate advice was given. Overall adherence in the trained group of physiotherapists

was 40%. Swinkels and colleagues (2005) showed that in more than 50% of patients with low back pain the recommendations on treatment goals and interventions were followed, but that substantial variation in guideline adherence exists among physiotherapists, a finding that has been confirmed in this study. From previous research based on interviews, it is also suspected that physiotherapists who treat few patients with a certain condition, such as ankle injuries, have more difficulty in using the guideline than physiotherapists who treat these patients more regularly (Fleuren et al 2008). The current study confirms that the more experience physiotherapists have with the specific complaint, the more likely it is the patient will be treated according to the guideline.