1
|
Dickson C, de Zoete RMJ, Berryman C, Weinstein P, Chen KK, Rothmore P. Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:104-115. [PMID: 37769242 PMCID: PMC10833081 DOI: 10.1093/pm/pnad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy. METHODS We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. RESULTS Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient's understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls. CONCLUSION Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain. STUDY REGISTRATION Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV).
Collapse
Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Carolyn Berryman
- Allied Health and Human Performance Unit, IIMPACT in Health, The University of South Australia, Adelaide, 5001, Australia
- Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
- Brain Stimulation, Imaging and Cognition Group, The University of Adelaide, Adelaide, 5000, Australia
| | - Philip Weinstein
- School of Public Health, The University of Adelaide, Adelaide, 5000, Australia
- South Australian Museum, Adelaide, 5000, Australia
| | - Kexun Kenneth Chen
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Paul Rothmore
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| |
Collapse
|
2
|
Schroeder H, Israeli A, Liebergall M, Or O, Abu Ahmad W, Paltiel O, Justo D, Zimlichman E. Utilising patient-reported outcomes for goal-directed therapy of hip fracture patients: a sequential controlled trial. BMJ Open Qual 2023; 12:e002402. [PMID: 38154820 PMCID: PMC10759100 DOI: 10.1136/bmjoq-2023-002402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/02/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Hip fracture patients (HFPs) frequently have multiple underlying conditions, necessitating that agreed-upon goals take these complications into consideration. Communication regarding goals between medical-personnel and patients is not always effective. Patient-reported outcomes (PROs) can outline personal goals and help promote quality health care in HFPs. Few studies have been published on this topic. The study's aim was to outline the process of using PROs for goal-directed therapy among HFPs. METHODS This sequential controlled trial was conducted among HFPs from two medical centres. The control and the intervention group received integrative rehabilitation. PROs were measured in both groups using the SF36 questionnaire three times postsurgery: 24-48 hours, 2 weeks and 3 months. During the first round of questioning, only the intervention group was asked 'what matters most to you?' during the rehabilitative process. Accordingly, agreed-upon goals that were determined by the SF36's eight topics and were incorporated into the HFP's rehabilitative process. A Likert scale of 1-5, '1' indicating no-achievement and '5' full-achievement, was used to assess the goal achievement 4-6 months post-fracture. RESULTS 84 HFPs participated in the study: 40 and 44 in the intervention and control group, respectively. In both groups, PROs declined after the HF, then improved somewhat 3 months later, but did not return to prefracture scores. Among the intervention group, 39% reached their specific goals (Likert level 5). Patients who achieved their goals had better PROs in comparison to others. The intervention group indicated PROs helped them articulate their desires and introduced them to new areas of care. CONCLUSIONS Shifting from asking 'what's the matter?' to 'what matters most to you?' can improve the understanding of HFPs' own priorities, promote quality outcomes and enhance patient-centred care. Using PROs as a guide for goal-directed therapy can create a more inclusive process that includes the patients' most important health determinants and needs.
Collapse
Affiliation(s)
- Hanna Schroeder
- School of Nursing in the Faculty of Medicine, Henrietta Szold Hadassah, Hebrew University of Jerusalem, Jerusalem, Israel
- Strategic and Economic Planning Administration, Israel Ministry of Health, Jerusalem, Israel
| | - Avi Israeli
- Dr. Julien Rozan Professor of Healthcare, Hebrew University - Hadassah Medical School, Jerusalem, Israel
- Office of the Chief Scientist, Israel Ministry of Health, Jerusalem, Israel
- Hadassah University Medical Center, Jerusalem, Israel
| | - Meir Liebergall
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Or
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Geriatrics Division, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| |
Collapse
|
3
|
Granviken F, Meisingset I, Vasseljen O, Bach K, Bones AF, Klevanger NE. Acceptance and use of a clinical decision support system in musculoskeletal pain disorders - the SupportPrim project. BMC Med Inform Decis Mak 2023; 23:293. [PMID: 38114970 PMCID: PMC10731802 DOI: 10.1186/s12911-023-02399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND We have developed a clinical decision support system (CDSS) based on methods from artificial intelligence to support physiotherapists and patients in the decision-making process of managing musculoskeletal (MSK) pain disorders in primary care. The CDSS finds the most similar successful patients from the past to give treatment recommendations for a new patient. Using previous similar patients with successful outcomes to advise treatment moves management of MSK pain patients from one-size fits all recommendations to more individually tailored treatment. This study aimed to summarise the development and explore the acceptance and use of the CDSS for MSK pain patients. METHODS This qualitative study was carried out in the Norwegian physiotherapy primary healthcare sector between October and November 2020, ahead of a randomised controlled trial. We included four physiotherapists and three of their patients, in total 12 patients, with musculoskeletal pain in the neck, shoulder, back, hip, knee or complex pain. We conducted semi-structured telephone interviews with all participants. The interviews were analysed using the Framework Method. RESULTS Overall, both the physiotherapists and patients found the system acceptable and usable. Important findings from the analysis of the interviews were that the CDSS was valued as a preparatory and exploratory tool, facilitating the therapeutic relationship. However, the physiotherapists used the system mainly to support their previous and current practice rather than involving patients to a greater extent in decisions and learning from previous successful patients. CONCLUSIONS The CDSS was acceptable and usable to both the patients and physiotherapists. However, the system appeared not to considerably influence the physiotherapists' clinical reasoning and choice of treatment based on information from most similar successful patients. This could be due to a smaller than optimal number of previous patients in the CDSS or insufficient clinical implementation. Extensive training of physiotherapists should not be underestimated to build understanding and trust in CDSSs.
Collapse
Affiliation(s)
- Fredrik Granviken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim, 7491, Norway.
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim, Norway.
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim, 7491, Norway
- Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
| | - Ottar Vasseljen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim, 7491, Norway
| | - Kerstin Bach
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anita Formo Bones
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim, 7491, Norway
| | - Nina Elisabeth Klevanger
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim, 7491, Norway
| |
Collapse
|
4
|
Hernández-Lázaro H, Jiménez-Del Barrio S, Ceballos-Laita L, Lahuerta-Martin S, Medrano-de-la-Fuente R, Hernando-Garijo I, Mingo-Gómez MT. Multicentre cross-sectional study assessing content validity of the International Classification of Functioning, disability and health core set for post-acute musculoskeletal conditions in primary care physiotherapy services. J Rehabil Med 2023; 55:jrm11950. [PMID: 37974517 PMCID: PMC10666063 DOI: 10.2340/jrm.v55.11950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/20/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To assess content validity of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for post-acute musculoskeletal conditions in primary care physiotherapy services. DESIGN Multicentre cross-sectional study. SUBJECTS Patients with musculoskeletal disorders referred to primary care physiotherapy services. METHODS Structured interviews were conducted using categories from the ICF Core Set, and their relevance was assessed using a visual analogue scale. An ICF category had to represent a problem for at least 5% of the sample in order to be validated. RESULTS The study sample comprised 274 patients. All categories in the ICF Core Set were confirmed. Body functions related to pain and movement were the most commonly impaired, with ICF categories "b280 Sensation of pain" and "b710 Mobility of joint functions" having the highest prevalence (87.2% and 84.7%, respectively). Activity limitations and participation restrictions were concentrated in chapters "d4 Mobility" (63.5% for "d430 Lifting and carrying objects") and "d2 General tasks and demands" (59.5% for "d240 Handling stress and other psychological demands"). The most relevant environmental factors were "e225 Climate" (55.8%) and "e580 Health services, systems and policies" (39.4%). CONCLUSION The ICF Core Set for post-acute musculoskeletal conditions shows appropriate content validity for primary care physiotherapy services.
Collapse
Affiliation(s)
- Héctor Hernández-Lázaro
- Ólvega Primary Care Physiotherapy Unit, Soria Health Care Management, Castilla y León Regional Health Administration (SACYL), Ólvega (Soria), Spain
| | | | | | | | | | | | | |
Collapse
|
5
|
Pathak A, Abbott JH, Bajracharya N, Gurung G, Nepal GM, Sharma S. Barriers and facilitators to implementation of outcome measures among physiotherapists in Nepal: A mixed-methods study. Musculoskelet Sci Pract 2023; 68:102859. [PMID: 37844424 DOI: 10.1016/j.msksp.2023.102859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Standardised outcome measures are essential to evidence-based practice but their implementation remains a significant challenge in low- and middle-income countries. The barriers and enablers for implementation of outcome measures are likely different in these settings. OBJECTIVES We sought to understand barriers and facilitators to use of standardised outcome measures (e.g. patient-reported, performance-based, clinician-reported) in clinical practice among physiotherapists in Nepal. DESIGN Exploratory sequential mixed-method study. METHODS We conducted focus groups with physiotherapists in Nepal to understand factors contributing to standardised outcome measure use/non-use in depth and thematically analysed the data using Consolidated Framework for Implementation Research (CFIR). To triangulate the findings, we used an online survey which was distributed to practicing physiotherapists in Nepal using social media. RESULTS We interviewed 26 physiotherapists for the qualitative phase and 125 physiotherapists responded to our online survey. The most endorsed facilitator was mandating outcome measure use through regulations at organisational or national level, for example, submission of patient-level outcome measures to an insurance system. Major barriers were lack of time, lack of outcome measures in local languages, inability to follow-up with patients and perceived inability of patients to understand outcome measures. Challenges that had not yet been identified in previous studies were inability to follow-up with patients and organisational culture (e.g., cultural hierarchy within an institution). CONCLUSION The findings of our study provide an understanding of the contextual needs, and potential way forward for implementation of outcome measures in developing countries like Nepal. Future studies should focus on establishing consensus on which measures to use, the cross-cultural adaptation of these measures, and developing pathways for regulation.
Collapse
Affiliation(s)
- Anupa Pathak
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, New Zealand; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, New Zealand
| | - Nibha Bajracharya
- Department of Physiotherapy, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Gagan Gurung
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Govinda Mani Nepal
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Saurab Sharma
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia
| |
Collapse
|
6
|
Adje M, Steinhäuser J, Stevenson K, Mbada CE, Karstens S. Patients' and physiotherapists' perspectives on implementing a tailored stratified treatment approach for low back pain in Nigeria: a qualitative study. BMJ Open 2022; 12:e059736. [PMID: 35725255 PMCID: PMC9214370 DOI: 10.1136/bmjopen-2021-059736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Stratified care has the potential to be efficient in addressing the physical and psychosocial components of low back pain (LBP) and optimise treatment outcomes essential in low-income countries. This study aimed to investigate the perceptions of physiotherapists and patients in Nigeria towards stratified care for the treatment of LBP, exploring barriers and enablers to implementation. METHODS A qualitative design with semistructured individual telephone interviews for physiotherapists and patients with LBP comprising research evidence and information on stratified care was adopted. Preceding the interviews, patients completed the Subgroups for Targeted Treatment tool. The interviews were recorded, transcribed and analysed following grounded theory methodology. RESULTS Twelve physiotherapists and 13 patients with LBP participated in the study (11 female, mean age 42.8 (SD 11.47) years). Seven key categories emerged: recognising the need for change, acceptance of innovation, resistance to change, adapting practice, patient's learning journey, trusting the therapist and needing conviction. Physiotherapists perceived stratified care to be a familiar approach based on their background training. The prevalent treatment tradition and the patient expectations were seen as major barriers to implementation of stratified care by the physiotherapists. Patients see themselves as more informed than therapists realise, yet they need conviction through communication and education to cooperate with their therapist using this approach. Viable facilitators were also identified as patients' trust in the physiotherapist and adaptations in terms of training and modification of the approach to enhance its use. CONCLUSION Key barriers identified are the patients' treatment expectations and physiotherapists' adherence to the tradition of practice. Physiotherapists might facilitate implementation of the stratified care by communication, hierarchical implementation and utilisation of patients' trust. Possibilities to develop a consensus on key strategies to overcome barriers and on utilisation of facilitators should be tested in future research.
Collapse
Affiliation(s)
- Mishael Adje
- Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany
- Institute of Family Medicine, University of Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University of Lübeck, Lübeck, Germany
| | - Kay Stevenson
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK
| | | | - Sven Karstens
- Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany
| |
Collapse
|
7
|
Hofstetter L, Häusler M, Mühlemann M, Nyirö L, Mühlemann D, Hincapié CA. Musculoskeletal healthcare at a Swiss university hospital chiropractic medicine outpatient clinic in 2019: a health services research study. Chiropr Man Therap 2022; 30:7. [PMID: 35148792 PMCID: PMC8832828 DOI: 10.1186/s12998-022-00417-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Balgrist University Hospital in Zurich, Switzerland, is an academic hospital focused on musculoskeletal disorders. An integrated chiropractic medicine clinic provides chiropractic care to a broad patient population. This health services research study aims to advance understanding of chiropractic healthcare service for quality assurance and healthcare quality improvement. METHODS We performed an observational clinical cohort study at the Balgrist chiropractic medicine outpatient clinic in 2019. The records of all patients with initial visits or returning initial visits (> 3 months since last visit) and their subsequent visits from January 1, 2019, to December 31, 2019, were used to create the study dataset. Data collected included demographic characteristics, diagnoses, imaging data, conservative treatments, surgeries, and other clinical care data. Descriptive statistics were used to summarize data. RESULTS 1844 distinct patients (52% female, mean age 48 ± 17 years) were eligible and included in the study. 1742 patients had a single initial visit, 101 had 2 initial visits, and 1 patient had 3 initial visits during the study period (total of 1947 initial visit records). The most common main diagnoses were low back pain (42%; 95% CI 40-46%), neck pain (22%; 20-24%), and thoracic pain (8%; 7-9%). 32% of patients presented with acute (< 4 weeks) symptoms, 11% subacute (4-12 weeks), and 57% chronic (> 12 weeks). Patients had a median of 5 chiropractic visits during their episode of care within a median of 28 days duration. Only 49% (95% CI 47-52%) of patient records had a clinical outcome that was extractable from routine clinical documentation in the hospital information system. CONCLUSION This health services study provides an initial understanding of patient characteristics and healthcare delivered in a Swiss academic hospital chiropractic outpatient setting and areas for improved clinical data quality assurance. A more concerted effort to systematically collect patient reported outcome measures would be a worthwhile healthcare quality improvement initiative.
Collapse
Affiliation(s)
- Léonie Hofstetter
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Melanie Häusler
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Malin Mühlemann
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Luana Nyirö
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Daniel Mühlemann
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Cesar A Hincapié
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Department of Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
| |
Collapse
|
8
|
Anbupriya M, Gayathri K, Hariharan S. Prior experience of physiotherapy treatment among the general public: A qualitative analysis. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_51_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
9
|
Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Patient-Reported Outcome-Based Quality Indicators in Dutch Primary Care Physical Therapy for Patients With Nonspecific Low Back Pain: A Cohort Study. Phys Ther 2021; 101:6258995. [PMID: 33929546 PMCID: PMC8336590 DOI: 10.1093/ptj/pzab118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/13/2021] [Accepted: 04/07/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to define and select a core set of outcome-based quality indicators, accepted by stakeholders on usability and perceived added value as a quality improvement tool, and to formulate recommendations for the next implementation step. METHODS In phase 1, 15 potential quality indicators were defined for patient-reported outcome measures and associated domains, namely the Numeric Pain Rating Scale (NPRS) for pain intensity, the Patient Specific Functioning Scale (PSFS) for physical activity, the Quebec Back Pain Disability Scale for physical functioning, and the Global Perceived Effect-Dutch Version for perceived effect. Their comparability and discriminatory characteristics were described using cohort data. In phase 2, a core set of quality indicators was selected based on consensus among stakeholders in focus group meetings. RESULTS In total, 65,815 completed treatment episodes for patients with nonspecific low back pain were provided by 1009 physical therapists from 219 physical therapist practices. The discriminability between physical therapists of all potential 15 quality indicators was adequate, with intraclass correlation coefficients between 0.08 and 0.30. Stakeholders selected a final core set of 6 quality indicators: 2 process indicators (the routine measurement of NPRS and the PSFS) and 4 outcome indicators (pretreatment and posttreatment change scores for the NPRS, PSFS, Quebec Back Pain Disability Scale, and the minimal clinically important difference of the Global Perceived Effect-Dutch Version). CONCLUSION This study described and selected a core set of outcome-based quality indicators for physical therapy in patients with nonspecific low back pain. The set was accepted by stakeholders for having added value for daily practice in physical therapy primary care and was found useful for quality improvement initiatives. Further studies need to focus on improvement of using the core set of outcome-based quality indicators as a quality monitoring and evaluation instrument. IMPACT Patient-reported outcome-based quality indicators developed from routinely collected clinical data are promising for use in quality improvement in daily practice.
Collapse
Affiliation(s)
- Arie C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,Address all correspondence to Dr Verburg at:
| | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Henri Kiers
- Institute of Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands,Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|