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Oostendorp RAB, Elvers H, van Trijffel E, Rutten GM, Scholten-Peeters GGM, De Kooning M, Laekeman M, Nijs J, Roussel N, Samwel H. Improved quality of physiotherapy care in patients with Whiplash-Associated Disorders: Results based on 16 years of routinely collected data. FRONTIERS IN PAIN RESEARCH 2022; 3:929385. [PMID: 36110289 PMCID: PMC9468444 DOI: 10.3389/fpain.2022.929385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/05/2022] [Indexed: 12/04/2022] Open
Abstract
Quality improvement is now a central tenet in physiotherapy care, and quality indicators (QIs), as measurable elements of care, have been applied to analyze and evaluate the quality of physiotherapy care over the past two decades. QIs, based on Donabedian's model of quality of care, provide a foundation for measuring (improvements in) quality of physiotherapy care, providing insight into the many remaining evidentiary gaps concerning diagnostics, prognostics and treatment, as well as patient-related outcome measures. In this overview we provide a synthesis of four recently published articles from our project group on the topic of quantitative measures of quality improvement in physiotherapy care, in this context specifically focused on patients with WAD in primary care physiotherapy. A set of process and outcome QIs (n = 28) was developed for patients with WAD and linked to a database consisting of routinely collected data (RCD) on patients with WAD collected over a 16-year period. The QIs were then embedded per step of the clinical reasoning process: (a) administration (n = 2); (b) history taking (n = 7); (c) objectives of examination (n = 1); (d) clinical examination (n = 5); (e) analysis and conclusion (n = 1); (f) treatment plan (n = 3); (g) treatment (n = 2); (h) evaluation (n = 5); and (i) discharge (n = 2). QIs were expressed as percentages, allowing target performance levels to be defined ≥70% or ≤30%, depending on whether the desired performance required an initially high or low QI score. Using RCD data on primary care patients with WAD (N = 810) and a set of QIs, we found that the quality of physiotherapy care has improved substantially over a 16-year period. This conclusion was based on QIs meeting predetermined performance targets of ≥70% or ≤30%. Twenty-three indicators met the target criterium of ≥70% and three indicators ≤30%. Our recommended set of QIs, embedded in a clinical reasoning process for patients with WAD, can now be used as a basis for the development of a validated QI set that effectively measures quality (improvement) of primary care physiotherapy in patients with WAD.
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Affiliation(s)
- Rob A. B. Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, Netherlands
- *Correspondence: Rob A. B. Oostendorp
| | - Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
- Methodological Health-Skilled Institute, Beuningen, Netherlands
| | - Emiel van Trijffel
- SOMT University of Physiotherapy, Amersfoort, Netherlands
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Ziekenhuisgroep Twente, ZGT Academy, Almelo, Netherlands
| | - Geert M. Rutten
- Research Program of Organization of Healthcare and Social Services, School of Health Studies, HAN University of Applied Science, Nijmegen, Netherlands
| | - Gwendolyne G. M. Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Margot De Kooning
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Marjan Laekeman
- Department of Physiological Psychology, Otto-Friedrich University of Bamberg, Bamberg, Germany
| | - Jo Nijs
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Nathalie Roussel
- Department of Physiotherapy and Rehabilitation Sciences (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Han Samwel
- Integrated Health Care Clinics (IHC), 's-Hertogenbosch, Netherlands
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Oostendorp RAB, Elvers H, van Trijffel E. Letter to the Editor: Adherence to clinical practice guidelines for low back pain from a Dutch perspective. Physiother Theory Pract 2020; 37:1-5. [PMID: 33302750 DOI: 10.1080/09593985.2020.1858933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Rob A B Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre , Nijmegen, Netherlands.,Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel , Brussels, Belgium.,Department of Physiotherapy, International Research Group - Pain in Motion-, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel , Brussels, Belgium.,Practice Physiotherapy and Manual Therapy , Heeswijk-Dinther, Netherlands,
| | - Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre , Nijmegen, Netherlands
| | - Emiel van Trijffel
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel , Brussels, Belgium.,SOMT University of Physiotherapy , Amersfoort, Netherlands.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel , Brussels, Belgium
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Oostendorp RAB, Elvers JWH, Trijffel EV. We are missing more. An international measurable model of clinical reasoning using quality indicators and routinely collected data. J Man Manip Ther 2020; 27:253-257. [PMID: 31671045 DOI: 10.1080/10669817.2019.1648714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Rob A B Oostendorp
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Brussels, Belgium.,Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, The Netherlands
| | - J W Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Amersfoort, The Netherlands
| | - Emiel Van Trijffel
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,SOMT University of Physiotherapy, Amersfoort, The Netherlands
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Oostendorp RAB, Elvers JWH, Trijffel van E. Concept Analysis of Clinical Reasoning in Physical Therapist Practice. Phys Ther 2020; 100:1353-1356. [PMID: 32302388 PMCID: PMC7439222 DOI: 10.1093/ptj/pzaa065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 04/06/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Rob A B Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Brussels, Belgium; and Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, The Netherlands,Address all correspondence to Dr Oostendorp at
| | - J W Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Emiel Trijffel van
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; SOMT University of Physiotherapy, Amersfoort, The Netherlands; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. [Oostendorp RAB, Elvers JWH, van Trijffel E. Concept analysis of clinical reasoning in physical therapist practice Phys Ther. 2020;100:1–4.]
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Oostendorp RAB, Elvers JWH, van Trijffel E, Rutten GM, Scholten–Peeters GGM, Heijmans M, Hendriks E, Mikolajewska E, De Kooning M, Laekeman M, Nijs J, Roussel N, Samwel H. Relationships Between Context, Process, and Outcome Indicators to Assess Quality of Physiotherapy Care in Patients with Whiplash-Associated Disorders: Applying Donabedian's Model of Care. Patient Prefer Adherence 2020; 14:425-442. [PMID: 32184572 PMCID: PMC7060032 DOI: 10.2147/ppa.s234800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Quality indicators (QIs) are measurable elements of practice performance and may relate to context, process, outcome and structure. A valid set of QIs have been developed, reflecting the clinical reasoning used in primary care physiotherapy for patients with whiplash-associated disorders (WAD). Donabedian's model postulates relationships between the constructs of quality of care, acting in a virtuous circle. AIM To explore the relative strengths of the relationships between context, process, and outcome indicators in the assessment of primary care physiotherapy in patients with WAD. MATERIALS AND METHODS Data on WAD patients (N=810) were collected over a period of 16 years in primary care physiotherapy practices by means of patients records. This routinely collected dataset (RCD-WAD) was classified in context, process, and outcome variables and analyzed retrospectively. Clinically relevant variables were selected based on expert consensus. Associations were expressed, using zero-order, as Spearman rank correlation coefficients (criterion: rs >0.25 [minimum: fair]; α-value = 0.05). RESULTS In round 1, 62 of 85 (72.9%) variables were selected by an expert panel as relevant for clinical reasoning; in round 2, 34 of 62 (54.8%) (context variables 9 of 18 [50.0%]; process variables 18 of 34 [52.9]; outcome variables 8 of 10 [90.0%]) as highly relevant. Associations between the selected context and process variables ranged from 0.27 to 0.53 (p≤0.00), between selected context and outcome variables from 0.26 to 0.55 (p≤0.00), and between selected process and outcome variables from 0.29 to 0.59 (p≤0.00). Moderate associations (rs >0.50; p≤0.00) were found between "pain coping" and "fear avoidance" as process variables, and "pain intensity" and "functioning" as outcome variables. CONCLUSION The identified associations between selected context, process, and outcome variables were fair to moderate. Ongoing work may clarify some of these associations and provide guidance to physiotherapists on how best to improve the quality of clinical reasoning in terms of relationships between context, process, and outcome in the management of patients with WAD.
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Affiliation(s)
- Rob A B Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands
| | - J W Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Methodological Health-Skilled Institute, Beuningen, the Netherlands
| | - Emiel van Trijffel
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Geert M Rutten
- Institute of Health Studies, Faculty of Health and Social Studies, HAN University of Applied Science, Nijmegen, the Netherlands
- Faculty of Science and Engineering, Maastricht University, Maastricht, the Netherlands
| | - Gwendolyne G M Scholten–Peeters
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Free University Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marcel Heijmans
- Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Center of Evidence Based Physiotherapy, Maastricht University, Maastricht, the Netherlands
- Practice Physiotherapy ‘Klepperheide’, Druten, the Netherlands
| | - Emilia Mikolajewska
- Department of Physiotherapy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus Univerisity, Toruń, Poland
- Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń, Poland
| | - Margot De Kooning
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Marjan Laekeman
- Department of Nursing Sciences, Ph.D.-Kolleg, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Nathalie Roussel
- Department of Physiotherapy and Rehabilitation Sciences (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Han Samwel
- Revalis Pain Rehabilitation Centre, ‘s Hertogenbosch, the Netherlands
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Oostendorp RAB, Elvers JWH, van Trijffel E, Rutten GM, Scholten-Peeters GGM, Heijmans M, Hendriks E, Mikolajewska E, De Kooning M, Laekeman M, Nijs J, Roussel N, Samwel H. Clinical Characteristics and Patient-Reported Outcomes of Primary Care Physiotherapy in Patients with Whiplash-Associated Disorders: A Longitudinal Observational Study. Patient Prefer Adherence 2020; 14:1733-1750. [PMID: 33061316 PMCID: PMC7532902 DOI: 10.2147/ppa.s262578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/22/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Whiplash-associated disorders (WADs) constitute a state of health characterized by a wide diversity of symptoms as a result of impairments of functions, activity limitations, and participation restrictions. Patient-reported outcome measurements (PROMs) and patient-reported outcomes (PROs) seem appropriate when describing and evaluating the health status of patients with WAD. AIM To measure the use of PROMs and PROs as quality indicators in clinical reasoning, and to analyze and evaluate pre- and post-treatment 'pain intensity' and 'functioning', and for 'perceived improvement' in patients with WAD in primary care physiotherapy practice by year of referral, with the phase after accident and prognostic health profile embedded in the clinical reasoning process. MATERIALS AND METHODS Data were collected over a period of 10 years. Pain intensity, functioning, and perceived improvement were measured using the Visual Analogue Scale for Pain (VAS-P), the Neck Disability Index (NDI) and the Global Perceived Effect scale (GPE). Pre- and post-treatment mean differences were tested for statistical significance and compared to minimal clinically important differences (MCID). Effect sizes were expressed as Cohen's d. Multivariable regression analysis was performed to explore independent associations of year of referral, phase after the accident, and the patient's prognostic health profile with post-treatment pain intensity and functioning. RESULTS A consecutive sample of 523 patients was included. Pre- and post-treatment mean differences on VAS-P and NDI were statistically significant (P<0.000) and clinically relevant, with 'large' effect sizes for pain intensity and functioning. MCIDs were achieved by 80% for VAS-P and for 60% for NDI. Year of referral and phase after the accident were independently associated with worse post-treatment functioning. About half of the patients (n=241 [46.1%]) perceived themselves as improved. CONCLUSION The PROMs and PROs pain intensity, functioning and perceived improvement were integrated as quality indicators in the physiotherapy clinical reasoning process for patients with WAD. Significant differences in pain intensity and functioning were found but were unrelated to year of referral, phase after whiplash-related injury or prognostic health profile. The MCID VAS-P scores did not differ depending on experienced pain.
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Affiliation(s)
- Rob A B Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands
- Correspondence: Rob AB Oostendorp Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, p/a Oude Kleefsebaan 325, AT Berg En Dal6572, Nijmegen, the NetherlandsTel +31 246423419 Email
| | - J W Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Allied Health Care, Methodological Health-Skilled Institute, Beuningen, the Netherlands
| | - Emiel van Trijffel
- Department of Master Education, SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Geert M Rutten
- Institute of Health Studies, Faculty of Health and Social Studies, HAN University of Applied Science, Nijmegen, the Netherlands
- Campus Venlo, Faculty of Science and Engineering, Maastricht University, Maastricht, the Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marcel Heijmans
- Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Center of Evidence Based Physiotherapy, Maastricht University, Maastricht, the Netherlands
- Practice Physiotherapy ‘Maasstaete, Druten, the Netherlands
| | - Emilia Mikolajewska
- Department of Physiotherapy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń, Poland
| | - Margot De Kooning
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Marjan Laekeman
- Department of Nursing Sciences, Ph.D.-Kolleg, Faculty of Health, University Witten/Herdecke, Witten, Germany
- Department of Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Nathalie Roussel
- Department of Physiotherapy and Rehabilitation Sciences (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Han Samwel
- Revalis Pain Rehabilitation Centre, S Hertogenbosch, the Netherlands
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van Trijffel E, A B Oostendorp R, Elvers JWH. Routinely collected data as real-world evidence for physiotherapy practice. Physiother Theory Pract 2019; 35:805-809. [PMID: 31218943 DOI: 10.1080/09593985.2019.1615678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Evidence-based practice is the current undisputed predominant paradigm within medicine and allied health care, particularly in physiotherapy. Despite its potential benefits, over the years various points of criticism have been formulated one of which is the overreliance on randomized clinical trials as the highest level of evidence for treatment effectiveness. In the current era, where the availability of large amounts of clinical data gathered during the course of care delivery is rapidly increasing as well as our ability to access, process, link, and analyze these data in fairly efficient ways, alternative sources to supplement rather than replace evidence from RCTs look promising. In this Editorial, we discuss the opportunities and limitations of these routinely collected data in physiotherapy research and provide several examples from the literature. We conclude that the use of routinely collected data in physiotherapy research has the potential to increasingly contribute to real-world evidence, particularly in musculoskeletal primary care physiotherapy, provided that researchers are aware of methodological limitations and adhere to reporting standards.
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Affiliation(s)
- Emiel van Trijffel
- a Department of Master Education and Research , SOMT University of Physiotherapy , Amersfoort , Netherlands.,b Department of Manual Therapy, Faculty of Medicine and Pharmacy , Vrije Universiteit Brussel , Brussels , Belgium.,c Experimental Anatomy Research Department, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Rob A B Oostendorp
- b Department of Manual Therapy, Faculty of Medicine and Pharmacy , Vrije Universiteit Brussel , Brussels , Belgium.,d Scientific Institute for Quality of Healthcare , Radboud University Nijmegen Medical Centre , Nijmegen , Netherlands.,e Pain in Motion International Research Group , Vrije Universiteit Brussel , Brussels , Belgium.,f Practice for Physiotherapy and Manual Therapy , Heeswijk-Dinther , Netherlands
| | - J W Hans Elvers
- g Department of Public Health and Research , Radboud University Nijmegen Medical Centre , Nijmegen , Netherlands
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Oostendorp RA, Hans Elvers J, van Trijffel E. The quality of physiotherapy care: the development and application of quality indicators using scientific evidence and routinely collected data embedded in the process of clinical reasoning. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_4_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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