From Vital and Health Statistics of the National Center for Health Statistics Number 120 � July 11, 1986 

+ 

PROPERTYOF w -

PUBLICATW!S M3ANCH 

EDITORIAL LIBRARY 

Physiotherapy Office Visits: National Ambulatory 

Medical Care Survey: United States, 1980-81 

Cheryl Nelson, Division of Health Care Statistics 

Physiotherapy oflice visits in the United States increased 1985 by the Division of Health Care Statistics of the National 

from 2.0 percent in 1975 to 4.6 percent in 1981 (figure 1). This Center for Health Statistics. 

report describes patient visits during 1980 and 1981 to offlce- Because the estimates presented in this report are based on 

based ambulatory care physicians in which physiotherapy a sample rather than on the entire universe of oillce visits, they 

services were ordered or provided (physiotherapy oftlce visit). are subject to sampling variability. A brief description of the 

This information was obtained by combining the 1980 and 1981 sample design, guidelines for judging the precision of the estiesults of the National Ambulatory Medical Care Survey. This mates, and key terms used in the survey are provided in the 

rvey, a probability sample survey of ofilce-based physicians, Technical notes at the end of the report. The Patient Record 

a was conducted annually from 1973 through 1981 and again in form is shown in figure 2. 

Patient characteristics 

6 Physiotherapy office visit data according to patient dem~ 

graphic characteristics are presented in tables 1 and 2 and 

figure 3. From January 1980 through December 1981, am- 5	 bulatory patients made 1.2 billion visits to non-Federal, ofticebased physicians practicing in the coterminous United States. 

Of this total, 56,023,000 (4.8 percent) had physiotherapy 4 services ordered or provided. This amounted to an average of 

48 physiotherapy visits per 1,000 ofllce visits. Physiotherapy 

visits were most frequent among patients in age groups 15–64 

3	 years, and male rates substantially exceeded those for female 

patients in the age interval from the 15th to the 44th year. 

Variations in physiotherapy oflice visit rates as they occurred 

2	 among selected racial or ethnic groups are examined in table 2. 

White persons, accounting for 90.7 percent of all physiotherapy 

visits, did not significantly differ from black persons and those 

1	 of other races in physiotherapy visit rate. However, physio 

therapy visit rates were more frequent among Hispanic patients. 

0 I I I I I I I 

1975 1976 1977 1978 1979 1980 1981 Physician characteristics 

9 Year Among oflice-based physicians, the general and family 

— practice specialty (37.7 percent) led all other specialties in 

igure 1. The percent of physiotherapy visits from 1975-81 volume of physiotherapy ofllce visits (table 3). However, when 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service 
2 adwncedata 

i.SSURANCE OF CONF80ENTALITY-A1! $nlo,ma,,.n wh,, h rm.td Pam,, ,d, nt,l, catam Decamma!t of Health. Ed.catm% and welfare 

I m ,nd,.,d.,1, , w,.,, <,, m m Wablnmmmt w,!! bc held . .. f.de. tl*l. WL1lb, u=d onh Pubhc Health SePJt- ANo. 003937 vPersons enc+ed m and fcx the mJ,rIOSM.1 !he survey and w!ll n.! be dmdmed m 

?a$ed10 o!hw Pwm. $ .x .Xd 10, my other LI.vmw 

1. DATE OF VISIT 

* NATIONAL 

2.	 ::;HOF 3mSEX 4mCOLOR OR RACE 

I � WHITE 

2 � BLAcK 

& ::::LE 3 Qfl&:’” 

Da, ‘f-r 

. •A:;:;~ ~:;fl 

re- Otl,Ce.1 Health Re=wch, S1a6tlcs, and Techn.1.aw 

Na,om! CaXer for Hcdlth StmMt8Cs 

PATlENT RECORD 

AMBULATORY MEDICAL CARE SURVEY 

5= ETHNICITY & PATl ENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER 

REASON(S) FOR~VISIT /kparient’s own words/ 

I � HISPANl C ,, MOST IMPORTANT 

ORIGIN 

2 � NOT 

HISPANIC b. OTHER 

9, PHYSICIAN’S DIAGNOSES 

“’s’T 

8 � EKG ,, PRf NCtpAL DIAGNOSISIPROBLEM ASSOCIATEO WITH ITEM a. 

9 � VISION TEST 

10 � ENOOSCOPY 

II � MEJ;$LSTATUS 

b, OTHER SIGNIFICANT CURRENT O! AGNOSES 

,2 jJoTHER ,Sp,c,,y, 

7. ::~[~:k:e~R THJS 8- ?;;e?;;~r~e~~o~[~r~;e~y 

1 � ACUTE PROBLEM 

2 � cHRONIC PROBLEM, ROUT’INE 

3 � CHFIONIC PROBLEM. FI.ARELIP 

4 � POsTsURGERY/POST INJURY 

5 � NON.ILLN ESS CARE IROUTINE 

PRENATAL, GENERAL EXAM,, 

WELL BABY, ETC.) 

10=	 HAVE YOU SEEN 

PATIENT �EFORE? 

I � YES 20.0 

I 

IF YES. FOR THE 

COND{TION IN 

ITEM 9,? 

, � YES 2 � NO 

, � NONE 

2 � LIMITED HISTORY/EXAM, 

3 � GENERAL HISTORYIEXAM. 

~ � pAp ,E,T 

5 � CLINICAL LAB TEST 

6 � XRAY 

7 � BLOOD PRESSURE CHECK 

11. MEDICATION THERAPY THIS VISIT � NONE 

[Using brand or generic names, record all new and continued rneazcatimrs ordered, injected, admlnisz%red, or otherwise 

provided at this vist. Include immunizing and de=m”tizing agen B! 

a.	 FOR Pflt NCtPAL DIAGNOSES IN ITEM 9a. b. FOR ALL OTHER REASONS. 

1 1, 

2, 2. 

3. 3. 

4, 4. 

12. NON-MEDICATION THERAPY 13, WAS PATIENT 14. ;:SPWJICI:;CI;;ISIT 15. OU:;ON 

[Chsck .11 semi... Ordered or provided this vi.rit/	 REFERREO 

FOR THIS VISIT VISIT 

BY A~HER 1 � NO FOLLOVLUP PLANNED [Time actually 

I � NONE E.DDIETCOUNSELING PHYSICIAN? 2 � RETURN ATspEciFIEO TIME	 spent w.th 

physician/ 

2DPHYSIOTHERAPY 7 � FAMILY/SOCIAL 

cOUNSELING 

3 � OFFICE SURGERY 

8 � MEDICAL COUNSELING , � ,,s 

4 lJFAMILy PLANNING 

9 � OTHER (.S,<,,,,, 

5 � PSYCHOTHEFIAPY/ 

THERAPEUTIC LISTENING ,DNO 

UC.G, IILA 1Q17C)1 ,.---.--,. .. . 

Figure 2. Patient record 

stratified by age of the patient general and family practitioners’ 

volume of physiotherapy oftlce visits did not differ significantly 

from that of pediatric specialists for patients under 15 years of 

age and orthopedic surgery and dermatology specialists for patients 15–24 years of age. 

Visit characteristics 

Reason for visit 

The principal reason for visiting the physician’s office as 

expressed in the patient’s own words is listed first in item 6 of 

the Patient Record. The patient’s problem or complaint was 

classified and coded according to the Reason for Visit Classifi3 � RETUFINIF NEEOEO,P.R.N. 

. � TELEPHONE FOLLOW.UPPUNNEO 

5 � REFERREOTOOTHER PHYSICIAN 

6 � 17ETURNEOTOREFER*ING PHyslclAtd 

, � AOMITTO HOSPITAL 

Wn”t” 

8 � OT”ER ,Speclfy, 

OMB NO. 6S-R14’ 

cation for Ambulatory Care (RVC),l and divided into eight 

modules or groups of reasons, as shown in table 4. Reasons for 

visit classified as “symptoms” (symptom module) accounted 

for 72.3 percent of all physiotherapy office visits. As might be 

expected, symptoms of the musculoskeletal system accounted 

for 65.8 percent of all physiotherapy visita. Symptoms referable 

to the musculoskeletal system make up a large proportion of 

lNa~iOnalcenter for Health statistics, D. s&neider, L. Appleton, and T. 

McLemore A reason for visit classificationfor ambulatorycare. Vital and 

Health Statistics. Series 2, No. 78. DHEW Pub. No. (PHS) 79–1352. Public 

Health Service.Washington.U.S. GovernmentPrintingOfllce,Feb. 1979. 
---

adwmdaa3 

Tabla 1. Numbar of office visits, number and parcent distribution 

of physiotherapy visits, and physiotherapy visit rate, by patients age 

nd sex-age group. United States, 1980 and 1981 

Patient age and sex 

Both sexes 

Alleges . . . . . . . . . . . . 

Less than 15 years. . . 

15-24 years . . . . . . . . 

25-44 years . . . . . . . . 

45-64 years . . . . . . . . 

65 years and over. . . . 

Female 

Alleges . . . . . . . . . . . . 

Less than 15 years . . . 

15-24 years . . . . . . . . 

25-44 years . . . . . . . . 

45-64 years . . . . . . . . 

65 years and over. . . . 

Male 

Alleges . . . . . . . . . . . . 

Less than 15 years. . . 

15-24 years . . . . . . . . 

25-44 yeara . . . . . . . . 

45-64 years . . . . . . . . 

65 years and over. . . . 

All office 

visits Ph ysiotherep y office visits 

Percent Visit 

Number in thousands distribution rate! 

1,160,922 56,023 100.0 48 

216,129 4.370 7.8 20 

160,795 8,653 15.4 54 

310,384 17,998 32.1 58 

265,700 16,173 28.9 61 

207.914 8,830 15.8 42 

699,718 30,958 55.3 44 

102,633 2,384 4.3 23 

107,276 4,421 7.9 41 

206,395 9.044 16.1 44 

157,031 9,332 16.7 59 

126,383 5,777 10.3 46 

461,204 25,065 44.7 54 

113,495 1,986 3.5 17 

53,519 4,232 7.6 79 

103,990 8,954 16.0 86 

108,668 6,840 12.2 63 

81,532 3.052 5.4 37 

1Number of physiotherapy office visits per 1,000 office visits. 

�Table 2. Number of office visits, number and percent distribution 

of physiotherapy visits, and physiotherapy visit-rate by patientfs rata 

and Hispanic origin of patient United States, 1980 and 1981 

Patient race and All office 

Hispanic origin visits Physiotherapy office visits 

Percent Visit 

Number in thousands distribution rate I 

All patients . . . . . . . . . 1,160,922 56,023 100.0 48 

Race 

White . . . . . . . . . . . . . . 1,037,590 50,803 90.7 49 

Black . . . . . . . . . . . . . . 110,546 4,565 8.1 41 

Other . . . . . . . . . . . . . 12,786 655 1.2 51 

Hispanic origin 

Hispanic . . . . . . . . . . . 53,337 3,455 6.2 65 

Non-Hispanic . . . . . . . 1,107,585 52,568 93.8 47 

1Number of physiotherapy office visits per 1,000 offke visits.


‘Includes Asian, Pacific Islander, American Indian, and Alaskan Indian.


the 20 most common principal reasons for visit with 18.8 percent 

being classified as some type of “back” symptom (table 5). For 

general and family practice and orthopedic surgezy specialties, 

the top 10 principal reasons for visit are presented in table 6. 

he reader is cautioned that the rankings presented may be 

e	 somewhat artificial because some estimates may not be statistically dtierent from other near estimates due to sampling 

variability. Detailed tabulations of reasons for visit data have 

been published.l 

90 r


1’ 8oth sexes 

_ _ Female 

10
 — Male 

t


Less 15-24 25-44 45-64 65 

than years years years years 

15 and 

years over 

Age of patient 

Figure 3. Physiotherapy visit rate by sex and age of patient 

United States, 1980 and 1981 

Principal diagnosis 

The principal diagnosis, the first-listed diagnosis in item 9 

on the Patient Record, was classiiled according to the International Class#ication ofDiseases, 9th Revisioq Clinical iWodzficalion (ICD–9–CM).2 As can be seen from tables 7 and 8, 

the principal diagnoses for physiotherapy oflice visits are primarily from two ICD–9–CM major classifications Diseases 

of the musculoskeletal system and connective tissue (7 10–739) 

and Injury and poisoning (800–899). 

Major reason for visit 

Item 7 of the Patient Record represents the major reason 

for visit as determined by the physician. Data in table 9 show 

that a greater proportion of physiotherapy visits were made for 

acute problems. 

2Comis~ion on professional and Hospital Activities International CkJSSification of Drkeases, 9th Revision, Clinical Modification Ann Arbor. Edwarda 

Brothers, Inc., 1978. 
1

2

3

4

5

6

7

8

9

10

4 ackncedata 

Table 3. Distribution of physiotherapy office visits by selected specialties and patient’s age United States, 1980 and 1981 

Patient age 

All Less than 15-24 25-44 45-64 

Physician specialty patients 15 years 

Allphysiotherapy office visits ..,, 56,023 4,370 

years years 

Number in thousands 

8,653 17,998 

Percent distribution 

100.0 100.0 

32.9 39.3 

*4.3 7.0 

*2.3 “0.5 

*4.5 5.7 

“3.7 5.5 

22,3 23.3 

“0.5 “0.3 

23.1 7.5 

“0.3 “0.8 

“0.1 “0.3 

“0.2 “0.3 

*1.3 ‘1.1 

“1.0 ‘0.7 

years and ov 

16,173 8,830 

100.0 100.0 

39.8 38.9 

12.8 24.8 

4.5 *2.8 

“1.1 “0.3 

23.6 16.2 

“0.8 *1.1 

4.0 *3.9 

*1,3 “1.2 

*0.5 “0.3 

“0.4 “0.2 

‘1.1 ‘3.0 

“0.3 *0.8 

Allphysiotherapy office visits . . . . . . . . .


General and family practice . . . . . . . . . . . . . . . . . . . . . . .


Internal medicine . . . . . . . . . . . . . . . . .


Pediatrics . . . . . . . . . . . . . . . . . . . . . .


General aurgery . . . . . . . . . . . . . . . . . . .


Obstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . . . . .


Orthopedic surgery . . . . . . . . . . . . . . .


Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . .


Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Psychiatry . . . . . . . . . . . . . . . . . . . . .


Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Otolaryngology . . . . . . . . . . . . . . . . . . . . .


100.0 100.0 

37.7 30.4 

10.7 “2.3 

3.1 32.9 

4.4 *1.4 

2.7 

21.4 14.8 

“0.6 

8.5 “10.0 

“0.9 

‘0.3 ‘0.3 

“0.3 “0,7 

1.6 “3,6 

‘0.6 “0.1 

Table 4. Number and percent distribution of physiotherapy office 

visits by patientis reason for visit United States, 1980 and 1981 

Table 5. Number and percent distribution of physiotherapy office 

visits by the 20 most common principal reasons for visit 

United States, 1980 and 1981 

Reason for visit 

All physiotherapy office visits . . . . . . . . . 

General reason for visit 

Symptom module . . . . . . . . . . . . . . . . . . . . 

Disease module . . . . . . . . . . . . . . . . . . . . . 

Diagnostic screen/preventive module. . . . 

Treatment module . . . . . . . . . . . . . . 

Injury/adverse effect module. . . . . . . . 

Test result module . . . . . . . . . . . . . . 

Administrative module . . . . . . . . 

Uncodable . . . . . . . . . . . . . . . . . . . . . . . 

Residual . . . . . . . . . . . . . . . . . . . . . . . 

Symptom module and RVCl code 

All physiotherapy office 

visits, . . . . . . . . . . . . . . . . . . (s001 -s999) 

General symptoms . . . . (s001 -s099) 

Psychological-mental . . . . . . (s1 00-al 99) 

Nervous . . . . . . . . . . . . . . . . . (s200-s259) 

Cardiovascular-lymphatic . . . (s260-s299) 

Eyes and ears . . . . . . . . . . (s300-s399) 

Respiratory . . . . . . . . . . . . (s400–s499) 

Digestive . . . . . . . . . . . . . . . . (s500-s639) 

Genitourinary. . . . . . . . . . . . (s640-s829) 

Skin, nails, and hair . . . . . . (s830-s899) 

Musculoskeletal . . . . . (s900-s999) 

Physiotherapy 

office visits 

Number in Percent 

thousands distribution 

56,023 100.0 

40,483 72.3 

3,290 5.9 

1,698 3.0 

3,199 5.7 

6,458 11.5 

*63 “0.1 

“78 “0.1 

683 1.2 

*7 I “0.1 

40,483 100,0 

2.722 6.7 

*169 “0.4 

1,438 3.6 

*162 “0.4 

1,054 2.6 

1,820 4.5 

1,072 2.6 

1,242 3.1 

4,158 10.3 

26,645 65.8 

Rank 

. . . 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

Most common principal reason 

for visit and RVCT code 

All physiotherapy visits . . . . . . . . 

Back symptoms . . . . . . . . . (s905) 

Low back symptoms . . . . . (s91 O) 

Neck symptoms. . . . . . . . . (s900) 

Knee symptoms. . . . . . . . (s925) 

Shoulder symptoms. . . . . . (s940) 

Acne or pimples. . . . . . . (s830) 

Postoperative visit . . . . . . . (t205) 

Leg symptoms . . . . . . . . (s920) 

Foot and toe symptoms. . (s935) 

Hand and finger 

symptoms. . . . . . . . .(s960) 

Hip symptoms . . . . . . . . . (s915) 

Skin rash . . . . . . . . . . . . . . (s860) 

Headache . . . . . . . . . . . . . . (s210) 

Arm symptoms. . . . . . . . . . (s945) 

Ankle symptoms . . . . . . . . (s930) 

Psoriasis . . . . . . . . . . . . . . . (d820) 

pain, site not referable to e 

specific body system. . . . (s055) 

Skin lesion . . . . . . . . . . . ..(s865) 

injury/back . . . . . . . . . . . ..(j5l5) 

Symptoms of unspecific 

joints . . . . . . . . . . . . . . . ..(s97O) 

“o 

Physiotherapy 

office visits 

Number in Percent 

thousands distribution 

56,023 100.0 

6,110 10.9 ‘ 

4,408 7.9 

3,416 6.1 

3,047 5.4 

2,408 4,3 

1,388 2.5 

1,301 2.3 

1,192 2.1 

1,043 1,9 

903 1.6 

802 1.4 

798 1,4 

797 1.4 

734 1.3 

685 1.2 

645 1.2 

610 1.1 

601 1.1 

591 1.1 

575 1.0 

lBased on National Center for Health Statistics, D. Schneider, L Appleton, and 

T. McLemore A reason for visit classification for ambulato~ care. Vital and 

Health Statistics. Series 2, No. 78. DHEW Pub. No, (PHS) 79-1352. Public 

Health Servics, Washington. U.S. Government Printing Office, Feb. 1979, 

lBased on National Centar for Health Statistics, D. Schneider, L. Appleton, an 

T. McLemore: A reason for visit claaaifkation for ambulatory cara. Vita/ arrd 

Haa/th Statistics. Series 2, No. 78. DHEW Pub. No. (PHS) 79-1352. Public 

Haalth Sewice. Washington. U.S. Government Printing O%ce, Feb. 1979. 
1

2

3

4

5

6

7

8

9

1

2

3

4

5

6

7

8

9

10

Table 6. Number and percent distribution of physiotherapy office 

visits by the 10 most common principal reasons for visit for selectad 

specialties United States, 1980 and 1981 

Most common principal reason Physiotherapy 

for visit and RVC1 code office visits 

Number in Percent 

General and family practice thousands distribution 

. . . All physiotherapy visits . . . . . . . . 21,115 100.0 

Back symptoms . . . . . . . . . [s905) 3,227 15.3 

Low back symptoms . . . . . (s910) 1,966 9.3 

Neck symptoms. . . . . . . . . (s900) 1,351 6.4 

Shoulder symptoms. . . . . . (s940) 1,016 4.8 

Knee symptoms. . . . . . . . . (s925) 766 3.6 

Leg symptoms . . . . . ., . . . (s920) “430 “2.0 

Foot and toe symptoms. . . (s935) *4 I 6 “2.0 

Headache . . . . . . . . . . . . ..(s210) *398 *1.9 

Physical medicine and 

rehabilitation. . , . . . . . . . . (t400) *396 *1.9 

10 Hip symptoms . . . . . . . . . .(s915) *355 *1.8 

Orthopedic surgery 

. . . All physiotherapy visits . . . . . . . . 12,004 100.0 

Knee symptoms. . . . . . . . . (s925) 1.774 14.8 

Back symptoms . . . . . . . . . (s905) 1,222 10.2 

Low back symptoms . . . ., (s91 O) 1,212 10.1 

Neck symptoms. . . . . . . . . (s900) 994 8.3 

Shoulder symptoms. . . . . . (s940) 768 6.4 

Postoperative visit . . . . . . . (t205) 655 5.5 

Hip symptoms . . . . . . . . . . (s915) *297 *2.5 

Wrist symptoms. . . . . . . . . (s955) “280 *2.3 

Elbow symptoms . . . . . . . . (s950) *279 *2.3 

Ankle symptoms . . . . . . . . (s930) *275 “2.3 

aaed on National Center for Health Stattstms, D. Schneider, L Appleton, and 

. McLemore: A reason for vmit classlflcatlon for ambulatory care. Vital and 

Hea/th Statistics. Ser!es 2, No. 78. DHEW Pub. No, (PHS) 79-1352. Public 

Health Service. Washington. U.S. Government Printi’ng Office, Feb. 1979, 

Prior visit status 

More than 60 percent of all physiotherapy visits to offlcebssed physicians were by patients who had seen the physician 

before for problems that had previously been treated by the 

physician (“old patients” with an “old problem”). This was 

true for all age groups except for patients less than 15 years old 

who had a majority of visits classified as “old patients” with 

“new problem.” 

Disposition 

Data on disposition show that the majorhy of physiotherapy 

office visits involved some type of followup, with “return at 

specific time” being the most frequent disposition decision 

(table 10). 

,/. -

7 

acklncedata 5 

Table 7. Number and parcent distribution of physiotherapy office 

viaits by major diagnostic groups: United States, 1980 and 1981 

principal diagnosis and Physiotherapy 

ICD-9-CM7 code office visits 

Number in Percent 

thousands distribution 

All physiotherapy office visits . . . . . . . . . . 56,023 100.0 

Infectious and parasitic 

diseases . . . . . . . . . . . . . . . . . (001–139) 865 1.5 

Neoplasms . . . . . . . . . . . . . . . .(140-239) *292 “0.5 

Endocrine, nutritional, and metabolic 

diseases and immunity 

disorders . . . . . . . . . . . . . . . . . (240-279) “333 “0.6 

Mental disorders. . . . . . . . . . . . (290-31 9) 548 1.0 

Diseases of nervous system and 

sense organs . . . . . . . . . . . . . . (320-389) 2,203 3.9 

Diseases of circulato~ 

system . . . . . . . . . . . . . . . . . . . (390-459) 2,404 4.3 

Diseases of reapirato~ 

system . . . . . . . . . . . . . . . . . . . (460-51 9) 1,801 3.2 

Diseases of digastive 

system . . . . . . . . . . . . . . . . . . . (520-579) 695 1.2 

Diseases of genitourinary 

system . . . . . . . . . . . . . . . . . . . (580-629) 1,390 2.5 

Diseases of skin and subcutaneous 

tissue . . . . . . . . . . . . . . . . . . . . (680-709) 5)435 9.7 

Diseases of musculoskeletal system 

and connective tissue . . . . . . (710-739) 17,801 31.8 

Symptoms, signs, and ill-defined 

conditions . . . . . . . . . . . . . . . . (780-799) 844 1.5 

Injury and poisoning. . . . . . . . . (800-999) 17,456 31.2 

Supplementary 

classification. . . . . . . . . . . . . . (VO1 -V82) 2,691 4.8 

Other diagnosisz . . . . . . . . . . . . . . . . . . . . . 535 1.0 

Unknown diagnosis3 . . . . . . . . . . . . . . . . . 730 1.3 

‘ Based on Public Health Service and Health Care Financing Administration: 

international Classification of Diseases, 9th Revision, Clinical Modification


(ICD–9–CM). DHHS Pub. No. (PHS] 80-1260. Public Health Service.


Washington. U.S. Government Printing Office, Sept. 1980.


‘Includes diseases of the blood and blood-forming organs (280-289);


complication of pregnancy, childbirth, and the puerperium (630-676);


congenital anomalies [740-759); and certain conditions originating in the


perinatal period (760-779).


31ncludes blank diagnosis, noncodable diagnosis, and illegible diagnosis,


Duration of visit 

Duration of visit is that amount of time spent in face-to 

face contact between physician and patient. It does not include 

time spent waiting to see the physicim, time spent receiving 

care from sources other than the physician without the presence 

of the physici~ or time spent reviewing patient records, test 

results, and so forth. Data in table 10 indicate that the duration 

of more than 60 percent of the physiotherapy oftlce visits were 

between 6 and 15 minutes with a mean duration of 15 minutes. 

-— 
6 aclmncedata 

Table 8. Number and percent of physiotherapy office viaits by the Table 10. Number and percent distribution of physiotherapy office 

20 most common principal diagnoses United States, 1980 and 1981 visits by prior visit status, disposition, and duration of visit 

United States, 1980 and 1981 

Most common principal diagnosis Physiotherapy 

Rank and ICD-9-CM1 code office visits Prior visit status, disposition, and Physiotherapy 

duration of visit office visits � 

Number in Percent 

thousands distribution Number in Percent 

. . All physiotherapy visits . . . . . . . . 56,023 100.0 thouaanda distribution 

1 Sprains and strains of other All physiotherapy office visits . . . . . . . . . 56,023 100.0 

and unspecific perts 

of back . . . . . . . . . . . . . . . . (847) 4,281 7.6 Prior visit status 

2 Sprains and strains of sacroiliac New patient . . . . . . . . . . . . . . . . . . . . . . . . 8,863 15.8 

region . . . . . . . . . . . . . . . .. (846) 3,221 5.7 Old patient . . . . . . . . . . . . . . . . . . . . . . . . . 47,161 84.2 

3 Other and unspecific disorders New problem . . . . . . . . . . . . . . . . . . . . . 12,449 22.2 

of back . . . . . . . . . . . . . . . . (724) 2,889 5.2 Old problem . . . . . . . . . . . . . . . . . . . . . . 34,712 62.0 

4 Diseases of sebaceous 

glands . . . . . . . . . . . . . . . ..(7O6) 2,244 4.0 Disposition 

5 Other disorders of sotl No followup planned . . . . . . . . . . . . . . . . . 3,696 6.6 tissues . . . . . . . . . . . . . . . . (729) 2,105 3.8 Return at specific time . . . . . . . . . . . . . . . 37,007 66.1 6 Peripheral enthesopathies and Return if needed . . . . . . . . . . . . . . . . . . . . . 13,374 23.9 allied syndromes . . . (726) 1,706 3.0 Telephone followup planned. . . . . . . . . . 1,924 3.4 7 Osteoarthrosis and allied Referred to other physician . . . . . . . . . 944 1.7 disorders . . . . . . . . . . . . ..(715) 1,653 3.0 Return to referring physician . . . . . . . . . . . *355 “0.6 8 Intervertebral disc 

9 

disorders . . . . . . . . . . . . . . (722) 

Spondylosis and allied 

1,418 2.5 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *47 *0.1 

10 

disorders . . . . . . . . . . . . . . (721) 

Other and unspecified 

1,324 2.4 Duration 

arthropathies . . . . . . . . . (716) 976 1.7 0minute2 . . . . . . . . . . . . . . . . . . . . . . . . . . 1,058 1.9 

11 Other disorders of synovium, l-5 minutes . . . . . . . . . . . . . . . . . . . . . . . . 6,016 10.7 

tendon, and bursa . . . (727) 960 1.7 6–10 minutes . . . . . . . . . . . . . . . . . . . . . . . 16,822 30.0 

12 Sprains and strains of 11-15 minutes . . . . . . . . . . . . . . . . . . . . . . 18,011 32.2 

knee andleg . . . . . . . . . .. (844) 940 1.7 16–30 minutea . . . . . . . . . . . . . . . . . . . . . . 12,001 21.4 

13 Psoriasis and similar 30minutes or more . . . . . . . . . . . . . . . . . . 2,115 3.8 

disorders . . . . . . . . . . . . .. (696) 930 1.7 

14 Other disorders of cervical 1 May not add to 100.0 because more than 1 disposition was possible. 

region, . . . . . . . . . . . . . . .. (723) 855 1.5 ‘Represents office visits in which there wss no face-to-face contsct between 

15 Sprains and strains of the patient and the physician. 

ankle and foot . . . . . . . . . . (845) 736 1.3 

16 Contusion of lower limb and of 

other unspecific site . . . . . (924) 665 1.2 

17 Rheumatoid arthritis and 

other inflammatory 

polyarthropathies. . . . . . . (714) 66? 1.2 

18 Disorders of muscle, ligament, 

and fasci . . . . . . . . . . . . . . . (728) 635 1.1 

19 Essential hypertension . . . (401) 634 1.1 

20 Other and unspecified 

disorders of joint . . . . . . . . (719) 593 1.1 

Admit tohoapital . . . . . . . . . . . . . . . . . . “301 “0.5 

1Bassd on Public Health Sewice and Heslth Care Financing Administration: 

international Classification of Diseases, 9th Revision, Clinical Modification 

(ICD-9-CM). DHHS Pub. No. (PHS) BO–I 260. Public Health Setvica. 

Washington. U.S. Government Printing Office, Sept. 1980. 

Table 9. Number and percent distribution of physiotherapy office 

visits by major reason for visit United States, 1980 and 1981 

Physiotherapy 

Major reason for visit office visits 

8 adwncedata 

Recent issues of Advance Data From Vital and Health Statistics 

No. 119. Health Promotion and Disease Prevention Provisional Data No. 116. Aging in the Eighties: Age 65 and Older and Lking Alone— —


From the National Health Interview Survey United States, January- Contact with Family, Friends, and Neighbors Preliminary Dat;


June 1985 (In preparation) From the Supplement on Aging to the National Health Interview Sur- _


No. 118. Trends in Smoking, Alcohol Consumption, and Other Health vey United States, January-June 1984 (Issued May 9, 1986)


Practices Amonrz U. S. Adults. 1977 and 1983 (In preparation) No. 115. Aging in the Eiehtiex Preliminary Data From the Su?wle-


No. 117. Office Visits to Orthopedic Surgeons, National Ambulatory ment on Aging to the Nati&al Health Interview Survey United S&es,


.-, :,- lT > 10 r-l 1(T ‘~f 9 1OQ-) JanuarwJune 1984 (Issued May 1, 1986)

Mmced#a7 

Technical notes 

n 

kmrce of data and sample design I 

The estimates presented in this report are based on the 

findings of the National Ambulatory Medical Care Survey 

(NAMCS), a sample survey of otlice-based care conducted 

annually from 1973 through 1981 and again in 1985 by the 

National Center for Health Statistics. The target universe of 

NAMCS is composed of office visits made by ambulatory patients to non-Federal and noninstitutional physicians who are 

primarily engaged in off]ce-based, patient-care practice. Excluded from the survey are visits to physicians practicing in 

Alaska and Hawaii, as are visits to anesthesiologists, pathol~ 

gists, and radiologists. 

NAMCS uses a multistage probability sample design that 

involves a step sampling of primary sampling units (PSUs), 

physicians’ practices within PSUS, and patient visits within 

physicians’ practices. The physician sample (5,805 physicians 

for 1980 and 198 1) was selected from master files maintained by the American Medical Association and the American 

Osteopathic Association. Those members of the sample who 

proved to be in scope and eligible participated at a rate of 77.3 

percent. Responding physicians completed visit records for a 

systematic random sample of office visits made during a randomly assigned weekly reporting period. Telephone contacts 

were excluded. During 1980 and 1981 responding physicians 

c- completed 89,447 visit records on which they recorded 97,796 

h-ug mentions. Characteristics of the physician’s practice, such 

as primary specialty and type of practice, were obtained during 

an induction interview. The National Opinion Research Center, 

under contract to the National Center for Health Statistics, 

was responsible for the field operations of the survey. 

Sampling errors and rounding 

The standard error is a measure of the sampling variability 

that occurs by chance because only a sample, rather than the 

entire universe, is surveyed. The relative standard error of an 

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. In this 

report, any estimate that exceeds a relative standard error of 

30 percent is marked with an asterisk. Approximate relative 

standard errors of selected aggregate statistics are shown in 

tables I and II. 

The determination of statistical inference is based on a 

twosided t-test with a critical value of 1.960 (0.05 level of 

confidence). Terms relating to differences, such as “exceeded” 

or “fell below” indicate that the differences are statistically 

significant. Terms such as “similar” or “roughly equal” mean 

that no statistical significance exists between the estimates 

being compared. In the tables of the report, estimates have 

,— been rounded to the nearest thousand. For this reason, detailed 

1 ?stimates do not always add to totals. 

Tabla 1. Approximate relative standard errors of estimated number 

of office visits basad on all physician speciakiea: NAMCS, 1980 

and 1981 

Relative 

Estimated number of office visits standard error 

Number in thousands Percent 

*44.8 

*31 .7 

“30.0 

20,2 

14.5 

9.5 

7.1 

5.6 

4,4 

3.9 

3.6 

3.5 

EXAMPLE OF USE OF TABLE An aggregate of 30,000,000 visits has a relative 

standard error of 5.0 percent or a standard error of 1,500,000 visits (5.0 

percent of 30,000,000). 

Tabla 11. Approximate relative standard errors of estimated number 

of office visits basad on an individual physician spacialty: NAMCS, 

1980 and 1981 

Relative 

Estimated number of office visits standard error 

Number in thousands Percent 

200” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *46.7 

450” . . . . . . . . . . . . . . . . . . . . . . . . . . . . �31 ,5 

500” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “30.0 

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.5 

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.0 

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.1 

10,000 . . . . . . . . . . . . . . . . . . . . . . . . 9.0 

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 

EXAMPLE OF USE OF TABLE: An aggregate of 7,000,000 visits has a relatwe 

standard error of 10.0 percent or a standard error of 700,000 vmits (1 0.0 

percent of 7,000,000). 

DefinWlons 

An ofice is a place that physicians identify as a location 

for their ambulatory practice. Responsibility for patient care 

and professional services rendered in an office resides with the 

individual physician rather than with an institution. 

A visit is a direct personal exchange between an ambulatory patient seeking health care and a physician, or staff 

member working under the physician’s supervision, who provides the health services. 

An acute problem is a morbid condition with a relatively 

sudden or recent onset (within 3 months of the visit). 

A chronic problem is a morbid condition that existed for 3 

months or longer before the visit. 
8


Recent Issues of Advance Data 

No. 119. Health Promotion and Disease Prevention Provisional Data 

From the National Health Interview Survey: United States, Januaty– 

June 1985 (In preparation) 

No. 118. Trends in Smoking Alcohol Consumption, and Other Health 

Practices Among U.S. Adults, 1977 and 1983 (In preparation) 

No. 117. Ot?ice Visits to Orthopedic Surgeons, National Ambulatory 

Medical Care Survey: United States 1980-81 (Issued May 2, 1986) 

From Vital and Heafth Statistics 

No. 116.Aging in the Eighties Age 65 and Older and Living Alone—. 

Contact with Family, Friends, and Neighbors: Preliminary Dat, 

From the Supplement on Aging to the National Health Interview Sur- T 

vey United States, January-June 1984 (Issued May 9, 1986) 

No. 115. Aging in the Eighties: Preliminary Data From the Supplement on Aging to the National Health Interview Survey United States, 

January-June 1984 (Issued May 1, 1986) 

Symbols 

. . . Data not available 

. . . Catego~ not applicable 

0.0 

z


* 

# 

Suggested citstion 

National Center for Health Statistics, C. Nelson: 

Physiotherapy office visits: National Ambulatoy 

Medical Care Suwey: United States, 1980-81. 

Advance Data From Vital and Health Statistics. 

No, 120. DHHS Pub, No. (PHS) 86-1250. Public 

Health Service. Hyattsville, Md,, July 11, 1986, 

U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

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Hyattsville, Maryland 20782 

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Quantity more than zero but less than 

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Figure does not meet standard of 

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