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Gaid D, Eilayyan O, Ahmed S, Bussières A. Enrollment, adherence and retention rates among musculoskeletal disorders rehabilitation practitioners in knowledge translation studies: a systematic review and meta-regression. Implement Sci Commun 2024; 5:51. [PMID: 38702833 PMCID: PMC11069130 DOI: 10.1186/s43058-024-00585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/10/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Practitioners' enrollment, adherence, and retention rates influence estimates of effectiveness in knowledge translation (KT) studies and remain important concerns for implementation researchers. This review aimed to systematically summarize the current evidence on feasibility measures as gauged by enrollment, adherence, and retention rates in KT evaluation studies targeting rehabilitation practitioners treating musculoskeletal disorders (MSDs). METHODS We searched five electronic databases from the inception to October 2022. We included KT studies that 1) had designs recommended by the Effective Practice and Organisation of Care, 2) targeted rehabilitation practitioners managing patients with MSDs, 3) delivered KT interventions according to the Expert Recommendations for Implementing Change classification, and 4) reported on the feasibility measures (e.g., enrollment, adherence, and retention). Descriptive statistics were conducted to report on study-, practitioners- and intervention-related factors influencing enrollment, adherence, and retention rates. Meta-regression weighted by the sample size of included studies was used to estimate the effect of factors on overall enrollment, adherence, and retention rates. RESULTS Findings from 33 KT studies reported weighted enrolment, adherence, and retention rate of 82% (range: 32%-100%), 74% (range: 44%-100%), and 65% (range: 36%-100%) respectively for both intervention and control groups. Factors positively influencing enrollment, adherence, and retention rates included designing short study period with short duration intervention. CONCLUSIONS Intense (e.g., high frequency, short duration) single KT intervention was more appealing for practitioners. Future evaluation studies should clearly report follow-up data, and practitioners' prior training, Results may not apply to non-MSD healthcare providers.
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Affiliation(s)
- D Gaid
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
| | - O Eilayyan
- Department of Physical Therapy, Al-Ahliyya Amman University, Amman, Jordan
| | - S Ahmed
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
| | - A Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Département Chiropratique, Université du Québec à Trois Rivières (UQTR), Trois-Rivières, QC, Canada
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De Hert S, Paula-Garcia WND. Implementation of guidelines in clinical practice; barriers and strategies. Curr Opin Anaesthesiol 2024; 37:155-162. [PMID: 38390877 DOI: 10.1097/aco.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW Published clinical practice guidelines frequently have difficulties for implementation of the recommendations and adherence in daily clinical practice. The present review summarizes the current knowledge on the barriers encountered when implementing clinical practice guideline and the strategies proposed to address these barriers. RECENT FINDINGS Studies on strategies for implementation of clinical guidelines are scarce. Evidence indicates that a multidisciplinary policy is necessary in order to address the barriers at various levels. Continuous education and motivation of the stakeholders, together with structural adaptations are key elements in the process. SUMMARY The barriers for implementation of guidelines involve different levels, including the healthcare system, organizational, societal and cultural specificities, and individual attitudes. All of these should be addressed with policy-driven strategies. Such strategies could include optimization of resources allocations, and establishing well coordinated multidisciplinary networks, finally, future studies should also evaluate the effectiveness of the potential strategies.
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Affiliation(s)
- Stefan De Hert
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital and Department of Basic and Applied Medical Sciences Ghent University, Ghent, Belgium
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Vullings N, Maas M, Adriaansen M, Vermeulen H, van der Wees P, Heinen M. Developing and testing a reflection method for implementation of the informal care guideline in community nursing: Design-based research. J Adv Nurs 2024. [PMID: 38515159 DOI: 10.1111/jan.16156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/20/2024] [Accepted: 03/02/2024] [Indexed: 03/23/2024]
Abstract
AIM To develop a reflection method for community nurses and certified nursing assistants to support the implementation of the Dutch Informal Care guideline in daily care. DESIGN Design-based research. METHODS A design group and four test groups of community nurses and nursing assistants were formed to develop a reflection method that aligns with the needs and preferences of its end-users. The design and test group meetings were video recorded. The video data were iteratively discussed and analysed thematically to adapt and refine the method and to identify its key features. RESULTS A final reflection method was developed. Five main themes were identified from the analysis: the group, reflective triggers, knowledge about the guidelines, the coach and preconditions. The themes are linked to nine key features representing the building blocks of the reflection method. The key features are group size, participants with different (educational) backgrounds, pairs of participants, expressing thoughts, video feedback, reflection game, making the connection with the guideline, coaching as a process facilitator and meeting organizational and contextual conditions for implementation. CONCLUSION An evidence- and practice-based reflection method for community nurses and certified nursing assistants is developed to support the implementation. By involving community nurses and certified nursing assistants, the method closely matches their needs and preferences. Critical elements of the reflection method are a game element, video feedback and working in pairs in a group of participants from different (educational) backgrounds. Guidance is needed to make the transfer from theory to practice. IMPACT A reflection method for community nurses and certified nursing assistants was developed to enhance care work according to guideline recommendations, aiming to improve the care provided by informal caregivers. REPORT METHOD The COREQ guideline was used. PATIENT OR PUBLIC CONTRIBUTION This reflection method was developed in close collaboration with all stakeholders during the entire study.
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Affiliation(s)
- Nicole Vullings
- Institute of Nursing Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marjo Maas
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marian Adriaansen
- Institute of Nursing Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Hester Vermeulen
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip van der Wees
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
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Alotaibi MA, Alhowimel AS, Alodaibi FA, Aloraifi M. The Practice of Shared Decision-Making Among Physiotherapists and Patients with Musculoskeletal Conditions. J Multidiscip Healthc 2023; 16:2655-2665. [PMID: 37706183 PMCID: PMC10496844 DOI: 10.2147/jmdh.s425315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose Shared decision-making (SDM) may be interpreted as a set of core values rather than as a consensus definition. This study aimed to explore how SDM between patients and physiotherapists may lead to patient satisfaction. Patients and Methods A cross-sectional study was conducted to examine the relationship between SDM and patient satisfaction. The study targeted physiotherapists and patients with musculoskeletal pain or disorders. A structured questionnaire (the nine-item Shared Decision-Making Questionnaire) was developed to show the extent to which patients felt involved in the process by scoring nine items from 0 to 5 on a six-point scale. t-tests were performed to estimate differences in SDM perceptions between patients and physiotherapists, and regression analyses were performed to estimate the best predictors of SDM. Results The questionnaire was completed by a total of 106 patients and nine physiotherapists. The demographic information of the samples was presented with frequency analysis. This study's findings demonstrate no variations in the final SDM perceptions between patients and physiotherapists, but when SDM was contrasted step-by-step (as items), many variances were discovered. These distinctions reinforce the notion that regardless of the end outcome, the process of reaching a consensus has a distinct profile depending on the type of medical care. Therapists emphasize the first steps, possibly because there is sufficient evidence to make a therapeutic decision. However, patients highlight the final steps, perhaps because the moment for a decision based on the consultation's nature is approaching. Conclusion This study demonstrates that SDM is a complex process that must be examined in multiple stages. However, in physiotherapy contexts, this process exhibits extremely different patterns, reflecting a significantly different perspective of the decision-making process.
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Affiliation(s)
- Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Faris A Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Aloraifi
- Salamat Medical Hospital, Department of Physiotherapy, Hail, Saudi Arabia
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Gleadhill C, Dooley K, Kamper SJ, Manvell N, Corrigan M, Cashin A, Birchill N, Donald B, Leyland M, Delbridge A, Barnett C, Renfrew D, Lamond S, Boettcher CE, Chambers L, Maude T, Davis J, Hodgson S, Makaroff A, Wallace JB, Kotrick K, Mullen N, Gallagher R, Zelinski S, Watson T, Davidson S, Viana Da Silva P, Mahon B, Delore C, Manvell J, Gibbs B, Hook C, Stoddard C, Meers E, Byrne M, Schneider T, Bolsewicz K, Williams CM. What does high value care for musculoskeletal conditions mean and how do you apply it in practice? A consensus statement from a research network of physiotherapists in New South Wales, Australia. BMJ Open 2023; 13:e071489. [PMID: 37328182 PMCID: PMC10277099 DOI: 10.1136/bmjopen-2022-071489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/24/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES To develop a physiotherapist-led consensus statement on the definition and provision of high-value care for people with musculoskeletal conditions. DESIGN We performed a three-stage study using Research And Development/University of California Los Angeles Appropriateness Method methodology. We reviewed evidence about current definitions through a rapid literature review and then performed a survey and interviews with network members to gather consensus. Consensus was finalised in a face-to-face meeting. SETTING Australian primary care. PARTICIPANTS Registered physiotherapists who are members of a practice-based research network (n=31). RESULTS The rapid review revealed two definitions, four domains of high value care and seven themes of high-quality care. Online survey responses (n=26) and interviews (n=9) generated two additional high-quality care themes, a definition of low-value care, and 21 statements on the application of high value care. Consensus was reached for three working definitions (high value, high-quality and low value care), a final model of four high value care domains (high-quality care, patient values, cost-effectiveness, reducing waste), nine high-quality care themes and 15 statements on application. CONCLUSION High value care for musculoskeletal conditions delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care. High-quality care is evidence based, effective and safe care that is patient-centred, consistent, accountable, timely, equitable and allows easy interaction with healthcare providers and healthcare systems.
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Affiliation(s)
- Connor Gleadhill
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- New South Wales Regional Health Partners, Newcastle, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Katherine Dooley
- School of Health Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Steven J Kamper
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Allied Health Department, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
| | - Nicole Manvell
- NUmoves Physiotherapy, Callaghan, New South Wales, Australia
| | | | - Aidan Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Noah Birchill
- Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Bruce Donald
- John Hunter Hospital Physiotherapy, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Murray Leyland
- Thornton Physiotherapy, Maitland, New South Wales, Australia
| | - Andrew Delbridge
- Regent Street Physiotherapy, New Lambton, New South Wales, Australia
| | | | - David Renfrew
- Newcastle Performance Physiotherapy, Newcastle, New South Wales, Australia
| | - Steven Lamond
- Newcastle Knights, Newcastle, New South Wales, Australia
| | - Craig Edward Boettcher
- Regent Street Physiotherapy, New Lambton, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Newcastle, New South Wales, Australia
| | - Lucia Chambers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Travis Maude
- Advanced Physiotherapy, Warners Bay, New South Wales, Australia
| | - Jon Davis
- PhysioStudio, Maitland, New South Wales, Australia
| | - Stephanie Hodgson
- Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Andrew Makaroff
- Employers Mutual Limited, Newcastle, New South Wales, Australia
| | | | - Kelly Kotrick
- Newcastle Performance Physiotherapy, Newcastle, New South Wales, Australia
| | | | - Ryan Gallagher
- Honeysuckle Health, Newcastle, New South Wales, Australia
| | - Samuel Zelinski
- NUmoves Physiotherapy, Callaghan, New South Wales, Australia
| | - Toby Watson
- The Good Physio, Newcastle, New South Wales, Australia
| | - Simon Davidson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Priscilla Viana Da Silva
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | | | - Caitlin Delore
- Regent Street Physiotherapy, New Lambton, New South Wales, Australia
| | - Joshua Manvell
- Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | | | - Chris Hook
- Advanced Physiotherapy, Warners Bay, New South Wales, Australia
| | - Chris Stoddard
- Terrace Physio Plus, Raymond Terrace, New South Wales, Australia
| | - Elliot Meers
- Kinetic Sports Physiotherapy, Newcastle, New South Wales, Australia
| | - Michael Byrne
- Recovery Partners, Newcastle, New South Wales, Australia
| | | | - Katarzyna Bolsewicz
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Christopher Michael Williams
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
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Windfeld-Lund C, Sturt R, Pham C, Lannin NA, Graco M. Systematic Review of the Effectiveness of Allied Health Clinical Education Programs. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:109-116. [PMID: 36988438 DOI: 10.1097/ceh.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Continuing allied health professional (AHP) clinical education is essential to ensure high-quality patient care; however, the effectiveness of current education programs is unclear. This review aimed to determine whether AHP education programs improve the knowledge of AHPs, change their clinical practice behavior, and/or improve patient-related clinical outcome and to identify important components of these programs. METHODS Four electronic databases were searched. Controlled clinical trials investigating the effectiveness of clinical education programs were included. Education programs were diverse, varying in design, delivery mode, and intensity. Only therapy-specific AHPs were included. Effectiveness was determined by differences in group outcomes in the domains of AHP knowledge, AHP clinical practice behavior, and patient-related clinical outcomes. RESULTS Forty-four studies were identified, of which 26 included physiotherapists only. Most control groups were waitlist, passive dissemination of information, or usual care, limiting comparisons between programs. Changes in AHP knowledge was investigated in 20 trials, with 13 showing an improvement. Thirty studies investigated changes in AHP clinical practice behavior, with half demonstrating a difference between groups. Seventeen studies investigated a patient-related clinical outcome, with five finding a difference between groups. Where improvements in outcomes were demonstrated, programs tended to incorporate self-selection and cater to the learner's contextual needs. DISCUSSION AHP knowledge is effectively improved through targeted education programs. To change AHP behavior and patient outcomes, it seems important to incorporate self-selection for the program and consider the learner's individual needs and contexts through mentoring, outreach visits, reflection, and incorporating patient participation in the learning.
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Affiliation(s)
- Cristie Windfeld-Lund
- Ms Windfeld-Lund: Senior Physiotherapist, Alfred Health, Melbourne, Australia, Mr Sturt : Allied Health Clinical Education Lead, Alfred Health, Melbourne, Australia. Ms Pham: Senior Physiotherapist, Alfred Health, Melbourne, Australia. Dr. Lannin: Professor, Department of Neuroscience, Monash University, Melbourne, Australia; and Clinical Chair (Occupational Therapy), Alfred Health, Melbourne, Australia. Dr Graco: Implementation Scientist, Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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Steenbruggen RA, Maas MJM, Hoogeboom TJ, Brand PLP, van der Wees PJ. A framework to improve quality of hospital-based physiotherapy: a design-based research study. BMC Health Serv Res 2023; 23:34. [PMID: 36641465 PMCID: PMC9840522 DOI: 10.1186/s12913-023-09062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/11/2023] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A quality framework for hospital-based physiotherapy is lacking. This study aims to design a framework, building on the currently available literature, to improve the quality of hospital-based physiotherapy. METHODS A multidisciplinary panel of six representatives of hospital-based physiotherapy and their key stakeholders (patients, medical specialists, hospital management and professional association) was set up. We used brainwriting to sample ideas and the 'decision-matrix' to select the best ideas. RESULTS The first round of brainwriting with an online panel of six experienced participants yielded consensus on seven possible methods for quality improvement of hospital-based physiotherapy [1]: continuing education [2] ,feedback on patient reported experience measures and patient reported outcome measures [3] ,a quality portfolio [4] ,peer observation and feedback [5] ,360 degree feedback [6] ,a management information system, and [7] intervision with intercollegiate evaluation. Placing these methods in a decision matrix against four criteria (measurability, acceptability, impact, accessibility) resulted in a slight preference for a management information system, with almost equal preference for five other methods immediately thereafter. The least preference was given to a 360-degree feedback. CONCLUSIONS In the design of a framework for improving the quality of hospital-based physiotherapy, all seven suggested methods were perceived as relevant but differed in terms of advantages and disadvantages. This suggests that, within the framework, a mixture of these methods may be desirable to even out respective advantages and disadvantages.
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Affiliation(s)
- Rudi A. Steenbruggen
- grid.5477.10000000120346234School of Health, Physiotherapy, Saxion University of Applied Sciences, Enschede, the Netherlands, Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands, p/a Saxion, University of Applied Sciences, Postbus 70.000, 7500 KB Enschede, the Netherlands
| | - Marjo J. M. Maas
- grid.10417.330000 0004 0444 9382Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands Nijmegen, the Netherlands, Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands
| | - Thomas J. Hoogeboom
- grid.10417.330000 0004 0444 9382Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands
| | - Paul L. P. Brand
- grid.4494.d0000 0000 9558 4598Isala Hospital, Zwolle, the Netherlands, University of Groningen and University Medical Centre, Groningen, the Netherlands
| | - Philip J. van der Wees
- grid.10417.330000 0004 0444 9382Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands
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Lemmers GPG, Bier JD, van Lankveld W, Westert GP, Staal JB, van der Wees PJ. Guideline adherence of physiotherapists in the treatment of patients with low back pain: A qualitative study. J Eval Clin Pract 2022; 28:1147-1156. [PMID: 35615965 PMCID: PMC9796459 DOI: 10.1111/jep.13703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 01/01/2023]
Abstract
RATIONALE Adherence rates to guidelines show room for improvement, and increase in adherence to guidelines may potentially lead to better outcomes and reduced costs of treatment. To improve adherence, it is essential to understand the considerations of physiotherapists regarding the assessment and management of low back pain (LBP). The purpose of this study is to gain insight in the considerations of Dutch physiotherapists on adherence to the national physiotherapy guideline in the treatment of patients with LBP. METHODS This is a qualitative study, using an interpretive approach of semi-structured interviews with 14 physiotherapists who regularly treat patients with LBP. Thematic analysis was conducted with open coding using an existing framework. This framework distinguishes five components to adherence based on patient factors, provider factors, guideline characteristics, institutional factors and the implementation process. RESULTS Participating physiotherapists mentioned that the guideline should provide more information about psychosocial prognostic factors and psychosocial treatment options. The participants experienced difficulties in addressing patient expectations that conflict with guideline recommendations. The implementation process of the guideline was considered insufficient. Physiotherapists might rely too much on their experience, and knowledge of evidence-based treatment might be improved. In general, the interviewed physiotherapists thought they were mainly non-adherent to the guidelines. However, when comparing their considerations with the actual guideline recommendations they were mainly adherent. CONCLUSION To improve adherence, the guideline should provide more information about addressing psychosocial prognostic factors, and Dutch physiotherapists might be trained in communication skills to better address patient expectations. A more extensive implementation process is warranted for the next guideline to increase the physiotherapists' knowledge of evidence-based treatment.
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Affiliation(s)
- Gijs Petrus Gerardus Lemmers
- Department of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Research & Development, Fysius Back Experts, Nijverdal, The Netherlands.,School for Allied Health, Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Jasper Daniël Bier
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.,Department of Physiotherapy, FS Fysio, Capelle aan den IJssel, The Netherlands
| | - Wim van Lankveld
- School for Allied Health, Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Gerard Pieter Westert
- Department of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jacobus Bart Staal
- Department of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,School for Allied Health, Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Philip Jan van der Wees
- Department of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Schröder K, Öberg B, Enthoven P, Hedevik H, Abbott A. Improved adherence to clinical guidelines for low back pain after implementation of the BetterBack model of care: A stepped cluster randomized controlled trial within a hybrid type 2 trial. Physiother Theory Pract 2022:1-15. [PMID: 35230212 DOI: 10.1080/09593985.2022.2040669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The BetterBack model of care (MoC) for low back pain (LBP) was recently developed in Swedish physiotherapy (PT) primary care. OBJECTIVE To evaluate if PTs' adherence to LBP clinical practice guidelines (CPGs) improves after implementation of the BetterBack MoC (intervention). METHODS This was a stepped, single-blinded cluster randomized controlled trial. Patients nested in the three clusters were allocated to routine care (n = 222) or intervention (n = 278). The primary outcome was referral to specialist consultation. This was among five best practice recommendations divided into an assessment quality index (no referral to specialist consultation and no medical imaging) and a treatment quality index (use of educational interventions; use of exercise interventions; no use of non-evidence-based physiotherapy). For overall adherence, patients had to be treated with all five recommendations fulfilled. Logistic regression was used for between-group comparisons. RESULTS The proportion of patients receiving referral to specialist consultation during the PT treatment period was low in both groups with no between-group differences. However, patients in the intervention group showed significantly higher assessment quality index, treatment quality index and overall adherence compared to routine care. Adherence to the separate recommendations showed improved stratified number of visits, use of exercise was maintained high, patient educational intervention increased and use of non-evidence-based physiotherapy decreased. A reduction of medical imaging during the physiotherapy treatment period was also observed. CONCLUSIONS The adoption of CPGs could be substantially improved by introducing a MoC through PT training and supportive materials.
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Affiliation(s)
- Karin Schröder
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Paul Enthoven
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Hedevik
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Allan Abbott
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Wibbelink CJM, Arntz A, Grasman RPPP, Sinnaeve R, Boog M, Bremer OMC, Dek ECP, Alkan SG, James C, Koppeschaar AM, Kramer L, Ploegmakers M, Schaling A, Smits FI, Kamphuis JH. Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry 2022; 22:89. [PMID: 35123450 PMCID: PMC8817780 DOI: 10.1186/s12888-021-03670-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
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Affiliation(s)
- Carlijn J. M. Wibbelink
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Raoul P. P. P. Grasman
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Roland Sinnaeve
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michiel Boog
- grid.491189.cDepartment of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, Rotterdam, 3062 MA the Netherlands ,grid.6906.90000000092621349Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Odile M. C. Bremer
- grid.491093.60000 0004 0378 2028Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, Amsterdam, 1093 MB the Netherlands
| | - Eliane C. P. Dek
- grid.491389.ePsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, Rotterdam, 3062 MA the Netherlands
| | | | - Chrissy James
- grid.420193.d0000 0004 0546 0540Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, Amsterdam, 1082 JC the Netherlands
| | | | - Linda Kramer
- grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC Heerhugowaard, the Netherlands
| | - Maria Ploegmakers
- grid.491369.00000 0004 0466 1666Pro Persona, Siependaallaan 3, Tiel, 4003 LE the Netherlands
| | - Arita Schaling
- grid.491369.00000 0004 0466 1666Pro Persona, Willy Brandtlaan 20, Ede, 6716 RR the Netherlands
| | - Faye I. Smits
- grid.468622.c0000 0004 0501 8787GGZ Rivierduinen, Sandifortdreef 19, Leiden, 2333 ZZ the Netherlands
| | - Jan H. Kamphuis
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
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11
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Steenbruggen RA, van Heusden-Scholtalbers LA, Hoogeboom TJ, Maas M, Brand P, Wees PVD. Impact and feasibility of a tailor-made patient communication quality improvement programme for hospital-based physiotherapists: a mixed-methods study. BMJ Open Qual 2021; 10:bmjoq-2020-001286. [PMID: 33888470 PMCID: PMC8070875 DOI: 10.1136/bmjoq-2020-001286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/23/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background In tailoring a quality improvement programme for hospital-based physiotherapy, the original use of video recordings was replaced by using the tracer methodology. Objective To examine the impact of a tailor-made quality improvement programme addressing patient communication on the professional development of hospital-based physiotherapists, and to evaluate barriers and facilitators as determinants of feasibility of the programme. Methods A mixed-methods study was conducted. Participants were clustered in groups per hospital and linked with an equally sized group in a nearby hospital. Within the groups, fixed couples carried out a 2-hour tracer by directly observing each other’s daily work routine. This procedure was repeated 6 months later. Data from feedback forms were analysed quantitatively, and a thematic analysis of transcripts from group interviews was conducted. Results Fifty hospital-based physiotherapists from 16 hospitals participated. They rated the impact of the programme on professional development, on a scale from 1 (much improvement needed) to 5 (no improvement needed), as 3.99 (SD 0.64) after the first tracer and 4.32 (SD 0.63) 6 months later; a mean improvement of 0.33 (95% CI 0.16 to 0.50). Participants scored, on a scale ranging from 1 to 5 on barriers and facilitators (feasibility), a mean of 3.45 (SD 0.95) on determinants of innovation, 3.47 (SD 0.86) on probability to use and 2.63 (SD 1.07) on the user feedback list. All participants emphasised the added value of the tracer methodology and mentioned effects on self-reflection and awareness most. Conclusions The tailor-made quality improvement programme, based on principles of the tracer methodology, was associated with a significant impact on professional development. Barriers and facilitators as determinants of feasibility of the programme showed the programme being feasible.
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Affiliation(s)
- Rudi A Steenbruggen
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands .,School of Health, Saxion University of Applied Sciences, Enschede, The Netherlands
| | | | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marjo Maas
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Paul Brand
- Medical Education, Isala Hospitals, Zwolle, The Netherlands.,Clinical Education, UMCG, Groningen, The Netherlands
| | - Philip van der Wees
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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12
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Romney W, Bellows DM, Tavernite JP, Salbach N, Deutsch JE. Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review. Arch Phys Med Rehabil 2021; 103:S276-S296. [PMID: 33561438 DOI: 10.1016/j.apmr.2021.01.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe knowledge translation (KT) research as a means of changing practice behaviors in rehabilitation. We specifically aimed to explore how theories, models, and frameworks (TMFs) are used to guide KT, guide methods to tailor KT interventions, and evaluate outcomes. We hypothesized these methods would have increased over the past 10 years. DATA SOURCES We identified articles through searches conducted using databases Cumulative Index to Nursing and Allied Health, MEDLINE, PubMed, Academic Search Premier, and previous reviews from January 2000 to April 2020. Search terms included physical therapy, occupational therapy, speech-language pathology, knowledge translation, and knowledge-to-action (KTA). STUDY SELECTION Two authors interpedently screened titles, abstracts, and full-text articles. Studies were included if behavior change of rehabilitation practitioners was measured. Systematic reviews, protocols, and capacity-building interventions were excluded. DATA EXTRACTION Three authors extracted information on study design, theoretical frameworks, intervention strategies, and outcome evaluation. DATA SYNTHESIS Fifty-six studies were included in the review. Sixteen (29%) reported the use of a theoretical framework to guide the KT process. Since 2013, the KTA framework was used 35% of the time. Twenty-two studies (39%) reported barrier assessments to tailor interventions, and 82% were published after 2013. However, barrier assessment in the local context was only conducted 64% of the time. Outcomes of tailored interventions were most frequently measured using chart audits (50%) and questionnaires (41%). Further, the link between KT theory, specific barriers, and selection of intervention strategies was not consistently described. CONCLUSIONS Over the past 7 years, there has been an increase in the use of KT TMFs and tailored interventions. Recommendations for future research include the use of TMFs to guide local barrier assessment, KT strategy selection, intervention development, and overall KT process and mapping barriers to selected intervention strategies.
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Affiliation(s)
- Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT; Department of Rehabilitation and Movement Sciences, RIVERS Lab, Rutgers University, Newark, NJ.
| | | | - Jake P Tavernite
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT
| | - Nancy Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Judith E Deutsch
- Department of Rehabilitation and Movement Sciences, RIVERS Lab, Rutgers University, Newark, NJ
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Kimiaeimehr F, Hosseini SM, Alimohammadzadeh K, Bahadori M, Maher A. Confirmatory factor analysis model of factors affecting the implementation of clinical guidelines in Iran. Med J Islam Repub Iran 2020; 34:122. [PMID: 33437718 PMCID: PMC7787019 DOI: 10.34171/mjiri.34.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Indexed: 11/05/2022] Open
Abstract
Background: Clinical guidelines refer to a developed scientific statement to help physicians and patients for decision-making about the best care for special clinical conditions, which can be an important document to shape evidence-based medicine. This study aimed to identify factors affecting the implementation of clinical guidelines in Iran to enhance the quality of services. Methods: This descriptive analytical study was performed with combined quantitative-qualitative method in the first half of 2019. The statistical population consisted of 400 health managers and experts who were selected through multistage sampling method in 5 regions of Iran (north, south, center, east, and west). Overall, 20 academic experts were selected from each university. For data collection, a researcher-made questionnaire (n = 400) was used. To measure face and content validity, content validity ratio (CVR) and content validity index (CVI) were used. Also, to determine reliability, test-retest method, with Cronbach's alpha coefficient of 0.934 was used. For data analysis, Lisrel 8.8 and SPSS 24 were used. Finally, fitness indices were used to determine the fitness of the model. Results: Six factors, including organizational (9 components), organizational culture (8 components), the clinical guidelines feature (8 components), insurance (7 components), and trusteeship of the health care system (8 components) were identified as the main dimensions. The economic dimension had the maximum effect on implementing clinical guidelines (0.90), while the clinical guidelines feature (0.63) and organizational culture (0.63) showed the minimum extent of effect on implementing clinical guidelines. Conclusion: Evidently, imposing the mentioned interventions with the ultimate goal of sustainable behavior change in providing health care services requires contribution of all practitioners, presentation of suitable facilities for implementing clinical guidelines based on evidence, time and personnel management, training methodology and planning, developing the necessary infrastructure, supervision, and developing professional and legal motivation.
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Affiliation(s)
- Farzaneh Kimiaeimehr
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Khalil Alimohammadzadeh
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
- Health Economics Policy Research Center, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Maher
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
- Department of Health Policy, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Leahy E, Chipchase L, Calo M, Blackstock FC. Which Learning Activities Enhance Physical Therapist Practice? Part 1: Systematic Review and Meta-analysis of Quantitative Studies. Phys Ther 2020; 100:1469-1483. [PMID: 32529249 DOI: 10.1093/ptj/pzaa107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/26/2019] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Following graduation from professional education, the development of clinical expertise requires career-long participation in learning activities. The purpose of this study was to evaluate which learning activities enhanced physical therapist practice. METHODS Eight databases were searched for studies published from inception through December 2018. Articles reporting quantitative data evaluating the effectiveness of learning activities completed by qualified physical therapists were included. Study characteristics and results were extracted from the 26 randomized controlled trials that met the inclusion criteria. Clinician (knowledge, affective attributes, and behavior) and patient-related outcomes were extracted. RESULTS There was limited evidence that professional development courses improved physical therapist knowledge. There was low-level evidence that peer assessment and feedback were more effective than case discussion at improving knowledge (standardized mean difference = 0.35, 95% CI = 0.09-0.62). Results were inconsistent for the effect of learning activities on affective attributes. Courses with active learning components appeared more effective at changing physical therapist behavior. The completion of courses by physical therapists did not improve patient outcomes; however, the addition of a mentored patient interaction appeared impactful. CONCLUSION Current evidence suggests active approaches, such as peer assessment and mentored patient interactions, should be used when designing learning activities for physical therapists. Further high-quality research focused on evaluating the impact of active learning interventions on physical therapist practice and patient outcomes is now needed. IMPACT This study is a first step in determining which learning activities enhance clinical expertise and practice would enable the physical therapy profession to make informed decisions about the allocation of professional development resources.
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Affiliation(s)
- Edmund Leahy
- BPhysio, MPhty(Musc), Department of Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia; Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia; and Physiotherapy Department, Northern Health, Epping, Victoria, Australia
| | - Lucy Chipchase
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Marlena Calo
- BPhysio, PGCert(PFPhysio), Department of Physiotherapy, School of Science and Health, Western Sydney University; and Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, La Trobe University
| | - Felicity C Blackstock
- Department of Physiotherapy, School of Science and Health, Western Sydney University
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15
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Zadro JR, O'Keeffe M, Allison JL, Lembke KA, Forbes JL, Maher CG. Effectiveness of Implementation Strategies to Improve Adherence of Physical Therapist Treatment Choices to Clinical Practice Guidelines for Musculoskeletal Conditions: Systematic Review. Phys Ther 2020; 100:1516-1541. [PMID: 32488264 DOI: 10.1093/ptj/pzaa101] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/26/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of implementation strategies aimed at improving the adherence of physical therapists' treatment choices to clinical practice guidelines for a range of musculoskeletal conditions. METHODS For this review, searches were performed in several databases combining terms synonymous with "practice patterns" and "physical therapy" until August 2019. The review included randomized controlled trials that investigated any intervention to improve the adherence of physical therapists' treatment choices to clinical practice guidelines or research evidence. Treatment choices assessed by surveys, audits of clinical notes, and treatment recording forms were the primary measures of adherence. Self-reported guideline adherence was the secondary measure. Three reviewers independently assessed risk of bias. Because of heterogeneity across studies, only a narrative synthesis of the results was performed. RESULTS Nine studies were included. Four demonstrated a positive effect on at least 1 measure of treatment choices for low back pain and acute whiplash. One involved a comparison with no intervention, and 3 involved a comparison with another active intervention. The interventions that demonstrated a positive effect included dissemination of clinical practice guidelines, with additional elements including interactive educational meetings (3 studies), tailored interventions and monitoring of the performance of health care delivery (1 study), peer assessment (1 study), and local opinion leaders plus educational outreach visits (1 study). CONCLUSIONS Although this review revealed limited trials evaluating interventions to increase physical therapists' use of evidence-based treatments for musculoskeletal conditions compared with no intervention, it highlighted some interventions that may be effective. IMPACT Dissemination of clinical practice guidelines, interactive educational meetings, tailored interventions and monitoring the performance of health care delivery, peer assessment, and use of local opinion leaders plus educational outreach visits should be implemented to improve physical therapists' adherence to clinical practice guidelines for a range of musculoskeletal conditions.
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Affiliation(s)
- Joshua R Zadro
- School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia; and Institute for Musculoskeletal Health, The University of Sydney
| | - Mary O'Keeffe
- School of Public Health, Sydney Medical School, The University of Sydney; and Institute for Musculoskeletal Health, The University of Sydney
| | - Jodie L Allison
- School of Public Health, Sydney Medical School, The University of Sydney
| | - Kirsty A Lembke
- School of Public Health, Sydney Medical School, The University of Sydney
| | - Joanna L Forbes
- School of Public Health, Sydney Medical School, The University of Sydney
| | - Christopher G Maher
- School of Public Health, Sydney Medical School, The University of Sydney; and Institute for Musculoskeletal Health, The University of Sydney
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16
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van de Sant AJW, de Vries NM, Hoogeboom TJ, Nijhuis-van der Sanden MWG. Implementation of a Personalized, Cost-Effective Physical Therapy Approach (Coach2Move) for Older Adults: Barriers and Facilitators. J Geriatr Phys Ther 2020; 42:E1-E16. [PMID: 28753136 PMCID: PMC6687416 DOI: 10.1519/jpt.0000000000000140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background and Purpose: This article reports on a recent randomized clinical trial that showed a personalized approach to physical therapy (Coach2Move) by a physical therapist specialized in geriatrics (PTG) to be more cost-effective than usual physical therapy care in people with mobility problems (n = 130, mean age = 78 years). Methods: We used an explanatory mixed-methods sequential design alongside the randomized clinical trial to gain insight into (a) the contrast between the 2 interventions, (b) the fidelity of the Coach2Move delivery; (c) PTGs' experiences of Coach2Move; and (d) possible barriers and facilitators for future implementation. The study included 13 PTGs educated in the strategy and 13 physical therapists with expertise in geriatrics delivering the usual care. In total, 106 medical records were available for assessment: 57 (85%) Coach2Move, 49 (75%) usual care. Quantitative process indicators were used to analyze electronic medical records to determine contrasts in the phases of clinical reasoning. The fidelity of the delivery was tested using indicator scores focusing on 4 key elements of Coach2Move. In-depth interviews with Coach2Move therapists were thematically analyzed to explore experiences and facilitators/barriers related to implementation. Results and Discussion: Indicator scores showed significant and clinically relevant contrasts in all phases of clinical reasoning, with consistently higher scores among PTGs, except for the treatment plan. Moreover, the fidelity of Coach2Move delivery was more than 70% in all phases, except the evaluation phase (53%). Experiences of Coach2Move were positive. In particular, extended intake allowing motivational interviewing, physical examination and an in-depth problem analysis, and shared goal setting were considered valuable. Facilitators for implementation were the addition of a Coach2Move medical record, frequent coaching by the researcher, and readiness to change in the therapist. Barriers were (1) having to use 2 parallel electronic medical record systems, (2) having to clear the calendar to schedule an intake of 90 minutes, (3) fear of losing income, (4) the sense that patients do not want to change their lifestyle, and (5) not acknowledging that increasing physical activity is an important goal for older adults with mobility problems. Conclusions: Physical therapy based on the Coach2Move strategy is substantially different from usual care. Future implementation should focus on increasing regular evaluation and feedback, taking into account individuals' contextual factors, and improving organizational facilities while mitigating income loss.
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Affiliation(s)
| | - Nienke M de Vries
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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17
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Zadro JR, Ferreira G. Has physical therapists' management of musculoskeletal conditions improved over time? Braz J Phys Ther 2020; 24:458-462. [PMID: 32387047 DOI: 10.1016/j.bjpt.2020.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Our 2019 systematic review found that up to 63% of physical therapists provided recommended care for musculoskeletal conditions, up to 43% provided non-recommended care, and up to 81% provided care of unknown value. We included studies published as early as 1993 and as recent as 2017. OBJECTIVE To determine whether physical therapists' treatment choices for musculoskeletal conditions have improved over time. METHODS For the original review, we included studies (until April 2018) that quantified physical therapy treatment choices for musculoskeletal conditions through surveys of physical therapists, audits of clinical notes, and other methods (e.g. clinical observation). Using medians and interquartile ranges, we summarised the percentage of physical therapists who provided treatments that were recommended, not recommended, and of unknown value. For this analysis, we stratified the findings from the above systematic review by decade (1990-1999, 2000-2009, 2010-2018). RESULTS The median percentage of physical therapists who provided recommended treatments (40% from 1990 to 1999, 50% from 2000 to 2009, and 35% from 2010 to 2018) and non-recommended treatments (41%, 28%, and 39% respectively) has not changed over time. However, more physical therapists seem to be providing treatments of unknown value (41% from 1990 to 1999, 55% from 2000 to 2009, and 70% from 2010 to 2018). CONCLUSION Possible explanations for this trend include the growing need for clinical innovation, challenge of keeping up to date with evidence, increased exposure to treatments of unknown value, belief that evidence is not relevant to practice, and possible limitations of the data. Strategies to help physical therapists replace non-recommended care with recommended care are discussed.
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Affiliation(s)
- Joshua R Zadro
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
| | - Giovanni Ferreira
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
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18
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Lanhers C, Poizat S, Pereira B, Auclair C, Perrier C, Schmidt J, Gerbaud L, Coudeyre E. Measuring the impact of the French version of The Whiplash Book on both treatment approach and fear-avoidance beliefs among emergency physicians. A cluster randomized controlled trial. PLoS One 2020; 15:e0229849. [PMID: 32187610 PMCID: PMC7080520 DOI: 10.1371/journal.pone.0229849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Whiplash-associated disorders have been the subject of much attention in the scientific literature and remain a major public health problem. Objective Measure the impact of a validated information booklet on the fear-avoidance beliefs of emergency physicians and their approach to management regarding the treatment of whiplash-associated disorders. Methods A prospective cluster randomized controlled study conducted with a sample of emergency medicine physicians. Fear-avoidance beliefs were measured using The Whiplash Belief Questionnaire (WBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ). We assessed the approach to management based on the prescription of pharmacological and non-pharmacological treatments based on the advice given to patients. The validated information booklet was the French version of The Whiplash Book. A set of questionnaires was sent to participants pre- and post-intervention. The experimental intervention was the provision of The Whiplash Book. The control arm did not receive any training or information. Results Mean fears and beliefs scores on inclusion were high: WBQ = 19.09 (± 4.06); physical activity FABQ = 11.45 (± 4.73); work FABQ = 13.85 (± 6.70). Improvement in fear-avoidance beliefs scores being greater in the intervention group was further confirmed by the variation in WBQ (-20 [-32; -6] vs. -6 [-16; 9]; p = 0.06), physical activity FABQ (-70 [-86; -50] vs. -15 [-40; 11]; p < 0.001), and work FABQ (-40 [-71; 0] vs. 0 [-31; 50]; p = 0.02). The emergency physicians' initial approach to management was not consistent with current guidelines. Reading the French version of The Whiplash Book could contribute to changing their approach to management in several areas on intra-group analysis. Conclusion The French version of The Whiplash Book positively influenced fear-avoidance beliefs among emergency physicians.
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Affiliation(s)
- Charlotte Lanhers
- Department of Physical Medicine and Rehabilitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Clermont-Ferrand Auvergne University, Clermont-Ferrand, France
- * E-mail:
| | - Stéphane Poizat
- Department of Physical Medicine and Rehabilitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Clermont-Ferrand Auvergne University, Clermont-Ferrand, France
| | - Bruno Pereira
- Innovation and Clinical Research, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Candy Auclair
- Department of Public Health, Biostatistics Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Christophe Perrier
- Emergency Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jeannot Schmidt
- Clermont-Ferrand Auvergne University, Clermont-Ferrand, France
- Emergency Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laurent Gerbaud
- Clermont-Ferrand Auvergne University, Clermont-Ferrand, France
- Department of Public Health, Biostatistics Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Department of Physical Medicine and Rehabilitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Clermont-Ferrand Auvergne University, Clermont-Ferrand, France
- INRA, Unity of Human Nutrition (UNH, UMR 1019), CRNH Auvergne, Clermont-Ferrand, France
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de Rooij M, van der Leeden M, van der Esch M, Lems WF, Meesters JJL, Peter WF, Roorda LD, Terbraak MS, Vredeveld T, Vliet Vlieland TPM, Dekker J. Evaluation of an educational course for primary care physiotherapists on comorbidity-adapted exercise therapy in knee osteoarthritis: an observational study. Musculoskeletal Care 2020; 18:122-133. [PMID: 31985164 PMCID: PMC7318645 DOI: 10.1002/msc.1439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/13/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022]
Abstract
Objective The objectives of the present study were to: (1) evaluate the effect of an educational course on competence (knowledge and clinical reasoning) of primary care physical therapists (PTs) in treating patients with knee osteoarthritis (KOA) and comorbidity according to the developed strategy; and (2) identify facilitators and barriers for usage. Method The present research was an observational study with a pretest‐posttest design using mixed methods. PTs were offered a postgraduate course consisting of e‐learning and two workshops (blended education) on the application of a strategy for exercise prescription in patients with KOA and comorbidity. Competences were measured by questionnaire on knowledge (administered before and 2 weeks after the course), and a patient vignette to measure clinical reasoning (administered before the course and after a 6 month period of treating patients). Facilitators and barriers for using the strategy were assessed by a questionnaire and semi‐structured interviews. Results Thirty‐four PTs were included. Competence (knowledge and clinical reasoning) improved significantly (p < 0.01). Fourteen out of 34 PTs had actually treated patients with KOA and comorbidity, during a 6‐month period. The strategy was found to be feasible in daily practice. The main barriers included the limited number of (self‐) referrals of patients, limited number of reimbursed treatment sessions by insurance companies and a suboptimal collaboration with (referring) physicians. Conclusion A blended course on exercise therapy for patients with KOA and comorbidity seems to improve PTs' competence through increasing knowledge and clinical reasoning skills. Identified barriers should be solved before large‐scale implementation of exercise therapy can take place in these complex patients.
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Affiliation(s)
- Mariëtte de Rooij
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands
| | - Marike van der Leeden
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin van der Esch
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Willem F Lems
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jorit J L Meesters
- Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Wilfred F Peter
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands.,Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Leo D Roorda
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, the Netherlands
| | - Michel S Terbraak
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Tom Vredeveld
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopedics, Rehabilitation, and Physiotherapy, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences research institute, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Heij W, Teerenstra S, Sweerts L, Staal JB, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Implementation of a Cost-Effective Physical Therapy Approach (Coach2Move) to Improve Physical Activity in Community-Dwelling Older Adults With Mobility Problems: Protocol for a Cluster-Randomized, Stepped Wedge Trial. Phys Ther 2019; 100:653-661. [PMID: 31846501 PMCID: PMC7297439 DOI: 10.1093/ptj/pzz183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/08/2019] [Accepted: 08/23/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Coach2Move is a personalized treatment strategy by physical therapists to elicit physical activity in community-dwelling older adults with mobility problems. OBJECTIVE The primary objective of this study is to assess the effectiveness and cost-effectiveness of the implementation of Coach2Move compared with regular care physical therapy in daily clinical practice. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION A multicenter cluster-randomized stepped wedge trial is being implemented in 16 physical therapist practices (4 clusters of 4 practices in 4 steps) in the Netherlands. The study aims to include 400 older adults (≥70 years) living independently with mobility problems and/or physically inactive lifestyles. The intervention group receives physical therapy conforming to the Coach2Move strategy; the usual care group receives typical physical therapist care. MEASUREMENTS Measurements are taken at baseline and 3, 6, and 12 months after the start of treatment. The primary outcomes for effectiveness are the amount of physical activity (LASA Physical Activity Questionnaire) and functional mobility (Timed Up and Go test). Trial success can be declared if at least 1 parameter improves while another does not deteriorate. Secondary outcomes are level of frailty (Evaluative Frailty Index for Physical Activity), perceived effect (Global Perceived Effect and Patient Specific Complaints questionnaire), quality of life (EQ-5D-5 L), and health care expenditures. Multilevel linear regression analyses are used to compare the outcomes between treatment groups according to an intention-to-treat approach. Alongside the trial, a mixed-methods process evaluation is performed to understand the outcomes, evaluate therapist fidelity to the strategy, and detect barriers and facilitators in implementation. LIMITATIONS An important limitation of the study design is the inability to blind treating therapists to study allocation. DISCUSSION The trial provides insight into the effectiveness and cost-effectiveness of the Coach2Move strategy compared with usual care. The process evaluation provides insight into influencing factors related to outcomes and implementation.
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Affiliation(s)
- Ward Heij
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, the Netherlands,Address all correspondence to Mr Heij at:
| | - Steven Teerenstra
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Health Evidence, Section Biostatistics
| | - Lieke Sweerts
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare; Radboud university medical center, Radboud Institute for Health Sciences, Department of Orthopaedics
| | - J Bart Staal
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare; and HAN University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, Nijmegen, the Netherlands
| | | | - Thomas J Hoogeboom
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare
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21
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Abstract
: Clinical nurses develop a program to strengthen professional relationships and practice.
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Williams JC, Ireland T, Warman S, Cake MA, Dymock D, Fowler E, Baillie S. Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:389-404. [PMID: 31108006 DOI: 10.1111/eje.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/16/2019] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care. MATERIALS AND METHODS A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost. RESULTS A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour. CONCLUSIONS Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.
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Affiliation(s)
- Julie C Williams
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Tony Ireland
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Sheena Warman
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Martin A Cake
- School of Veterinary and Biomedical Sciences, Murdoch University, Perth, Western Australia, Australia
| | - David Dymock
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Ellayne Fowler
- Centre for Medical Education, University of Bristol, Bristol, UK
| | - Sarah Baillie
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, UK
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Dobia A, Ryan K, Abutaleb M, Edwards A. Perceptions of physicians in Saudi Arabia on the use of international clinical guidelines for managing primary insomnia. PLoS One 2019; 14:e0220960. [PMID: 31398230 PMCID: PMC6688835 DOI: 10.1371/journal.pone.0220960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/26/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION While there are no national clinical guidelines for managing primary insomnia in Saudi Arabia, there are also no published studies of physicians' perceptions of and attitudes towards using international guidelines. The objective of this study was to explore the knowledge, perceptions, and attitudes of physicians practising in Saudi Arabia about using international guidelines for managing insomnia. METHODS A qualitative study using in-depth, face-to-face, and semi-structured interviews with 15 physicians held in July 2017 at a tertiary care hospital in Jazan, the distal south-western province in Saudi Arabia. Interviews were audio-recorded, transcribed verbatim, coded using the qualitative software NVivo11 and analysed thematically. Data saturation was assumed as no new understandings of the broad thematic issues were produced by the last three interviews. RESULTS Themes identified were: Knowledge, Resistance, Barriers and Facilitators. Participants acknowledged their lack of awareness of available guidelines and their lack of training and education about Cognitive Behavioural Therapy for Insomnia (CBT-I). They highlighted a lack of education for patients about insomnia and its treatment. Beliefs about dependence on hypnotics and the inappropriateness of international guidelines for Saudi Arabia inclined many to resist using them. Inability to document diagnosis and consultations due to limited time and lack of suitable electronic systems, lack of suitably trained practitioners for referral for CBT-I, and lack of accountability for practice were identified as key barriers to following international guidelines. Development of national guidelines was the most important facilitator suggested by participants. CONCLUSIONS The health authorities in the government of the Kingdom of Saudi Arabia (KSA) should improve general public awareness about sleep disorders and provide focused training for specialists and technologists. Above all, KSA needs its own nationwide guidelines for treating sleep-disorders based on evidence-based clinical trials, consistent with its history, culture, socioeconomic conditions and traditions.
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Affiliation(s)
- Ali Dobia
- Reading School of Pharmacy, University of Reading, Reading, United Kingdom
- General Directorate of Medical Services, Riyadh, Saudi Arabia
| | - Kath Ryan
- Reading School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | - Alexander Edwards
- Reading School of Pharmacy, University of Reading, Reading, United Kingdom
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24
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Maric J, Childs J, Esterman A. Barriers and facilitators to the implementation of clinical practice guidelines in sonography. SONOGRAPHY 2019. [DOI: 10.1002/sono.12179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jovana Maric
- School of Health SciencesUniversity of South Australia Adelaide South Australia Australia
| | - Jessie Childs
- SANSOM Research InstituteUniversity of South Australia Adelaide South Australia Australia
| | - Adrian Esterman
- UniSA Cancer Research InstituteUniversity of South Australia Adelaide South Australia Australia
- Australian Institute of Tropical Health and MedicineJames Cook University Townsville Queensland Australia
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25
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Al Zoubi FM, Menon A, Mayo NE, Bussières AE. The effectiveness of interventions designed to increase the uptake of clinical practice guidelines and best practices among musculoskeletal professionals: a systematic review. BMC Health Serv Res 2018; 18:435. [PMID: 29884165 PMCID: PMC5994025 DOI: 10.1186/s12913-018-3253-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/29/2018] [Indexed: 12/27/2022] Open
Abstract
Background The objective of this systematic review was to summarize and evaluate evidence about the effectiveness of knowledge translation (KT) interventions to improve the uptake and application of clinical practice guidelines and best practices for a wide range of musculoskeletal (MSK) disorders and health care professionals. Methods A search for relevant randomized controlled trials (RCTs) published in English was conducted in MEDLINE (Ovid interface), EMBASE, CINAHL, and CENTRAL (Cochrane library). Two independent reviewers selected studies, assessed risk of bias, and extracted data. All MSK disorders were included except MSK injuries, fractures, trauma, or inflammatory disorders. Results A total of 7904 citations yielded 11 eligible RCTs. The targeted MSK disorders included: low back pain (n = 5), neck pain (n = 2), whiplash (1), spinal disorders (n = 1), and osteoarthritis of the hip and knee (n = 2). Studies primarily involved physiotherapists, chiropractors, and a mix of physiotherapists, chiropractors and osteopaths. Results were reported using effect sizes (Cohen’s d). Interactive educational meetings were the most commonly used KT strategy. For professional outcomes, 3 studies using single-component interventions had a small effect (d ranges from 0.14 to 0.28) and 7 studies used multifaceted interventions (3 were effective (d ranges from 0.824 to 2.27). For patient outcomes, 4 studies were ineffective (d ranges from 0.06 to 0.31). The majority of the included RCTs had moderate-to-high risk of bias. About half of the studies used theory-based interventions, but the elements of the interventions and theoretical frameworks were often poorly described. Furthermore, there were no comparable outcome measures to evaluate the impact of the interventions on a similar scale. Conclusions The findings suggested that multifaceted educational KT interventions appear to be effective for improving professional outcomes, although effects were inconsistent. The KT strategies were generally not effective on patient outcomes. In general, studies were of low quality, interventions were poorly described, and only half had theoretical underpinning. Researchers are encouraged to use validated professional and patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-018-3253-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fadi M Al Zoubi
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, 16 Room 205, Montreal, QC, H3G 1Y5, Canada.,Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC, Canada
| | - Anita Menon
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, 16 Room 205, Montreal, QC, H3G 1Y5, Canada
| | - Nancy E Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, 16 Room 205, Montreal, QC, H3G 1Y5, Canada
| | - André E Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, 16 Room 205, Montreal, QC, H3G 1Y5, Canada. .,Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC, Canada. .,Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
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Olde Rikkert MGM, van der Wees PJ, Schoon Y, Westert GP. Using Patient Reported Outcomes Measures to Promote Integrated Care. Int J Integr Care 2018; 18:8. [PMID: 30127692 PMCID: PMC6095063 DOI: 10.5334/ijic.3961] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/04/2018] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Patient reported outcome measures (PROMs) have been introduced as standardised outcomes, but have not been implemented widely for disease targeted pathways of care, nor for geriatric patients who prefer functional performance and quality of life. DISCUSSION We describe innovative multipurpose implementation of PROMs as evidenced by two best practices of PROMs application in geriatric and physiotherapy practice. We show that PROMs can show meaningful outcomes in older subjects' patient journeys, which can at the same time serve individuals and groups of both patients and professionals. KEY LESSON PROMs can deliver generic outcomes relevant for older patients, may improve patient-physician relationship, quality of care and prediction of future outcomes in geriatric care, if they are valid, reliable and responsive, but still short and simple. A precondition to make the hard tip from research to practice is that PROMs are carefully positioned in the clinical encounters and in electronic health records.
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Affiliation(s)
- Marcel G. M. Olde Rikkert
- Chair Dept Geriatrics and Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, NL
| | | | - Yvonne Schoon
- Department Geriatrics and Chair Emergency Department, Radboud University Medical Center, Nijmegen, NL
| | - Gert P. Westert
- Chair IQ healthcare and Theme leader Health care Improvement Science, Radboud University Medical Center, Nijmegen, NL
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Stander J, Grimmer K, Brink Y. Training programmes to improve evidence uptake and utilisation by physiotherapists: a systematic scoping review. BMC MEDICAL EDUCATION 2018; 18:14. [PMID: 29334943 PMCID: PMC5769325 DOI: 10.1186/s12909-018-1121-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/09/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Research training programmes are a knowledge translation (KT) intervention which aim to improve research evidence uptake by clinicians. Whilst KT training programmes have been reported to significantly improve evidence uptake by physiotherapists, it is unclear which aspects of training optimally assist KT into physiotherapy practice. The purpose of the review was to establish the body of evidence regarding KT training programmes to improve physiotherapists' use of evidence-based practice (EBP) and clinical practice guidelines (CPG). METHODS A systematic scoping review was undertaken in line with the adapted Arksey and O'Malley framework. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PUBMED, OTseeker, Scopus, ERIC) were searched. Targeted keywords identified primary research articles of any hierarchy, that described the nature and impact of KT training programmes for physiotherapists. Where systematic reviews were identified, the component primary studies were considered individually for relevance. Critical appraisal was not undertaken due to the nature of a scoping review, and data was reported descriptively. RESULTS Ten systematic reviews were identified (yielding four relevant primary studies). Five additional primary studies were identified (two randomised controlled trials, two non-randomised controlled trials and one pre-post study) which were not included in the original systematic reviews. This provided nine eligible primary research studies for review. The KT strategies were all multi-faceted. Interactive sessions, didactic sessions, printed material and discussion and feedback were consistently associated with effective outcomes. When KT strategies addressed local barriers to EBP utilisation, there were better success rates for EBP and CPG uptake, irrespective of the outcome measures used. There were no consistent ways of measuring outcome. CONCLUSION Multi-faceted KT strategies designed to address local barriers to knowledge translation were most effective in improving EBP/ CPG uptake among physiotherapists.
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Affiliation(s)
- Jessica Stander
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - Karen Grimmer
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- International Centre for Allied Health Evidence (iCAHE), City East Campus, P4-18 North Terrace, University of South Australia, Adelaide, 5000 Australia
| | - Yolandi Brink
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
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Maas MJ, Driehuis F, Meerhoff GA, Heerkens YF, van der Vleuten CP, Nijhuis-van der Sanden MW, van der Wees PJ. Impact of Self- and Peer Assessment on the Clinical Performance of Physiotherapists in Primary Care: A Cohort Study. Physiother Can 2018; 70:393-401. [PMID: 30745725 PMCID: PMC6361404 DOI: 10.3138/ptc.2017-40.pc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study evaluated the impact of a quality improvement programme based on self- and peer assessment to justify nationwide implementation. Method: Four professional networks of physiotherapists in The Netherlands (n = 379) participated in the programme, which consisted of two cycles of online self-assessment and peer assessment using video recordings of client communication and clinical records. Assessment was based on performance indicators that could be scored on a 5-point Likert scale, and online assessment was followed by face-to-face feedback discussions. After cycle 1, participants developed personal learning goals. These goals were analyzed thematically, and goal attainment was measured using a questionnaire. Improvement in performance was tested with multilevel regression analyses, comparing the self-assessment and peer-assessment scores in cycles 1 and 2. Results: In total, 364 (96%) of the participants were active in online self-assessment and peer assessment. However, online activities varied between cycle 1 and cycle 2 and between client communication and recordkeeping. Personal goals addressed client-centred communication (54%), recordkeeping (24%), performance and outcome measurement (15%), and other (7%). Goals were completely attained (29%), partly attained (64%), or not attained at all (7%). Self-assessment and peer-assessment scores improved significantly for both client communication (self-assessment = 11%; peer assessment = 8%) and recordkeeping (self-assessment = 7%; peer assessment = 4%). Conclusions: Self-assessment and peer assessment are effective in enhancing commitment to change and improving clinical performance. Nationwide implementation of the programme is justified. Future studies should address the impact on client outcomes.
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Affiliation(s)
- Marjo J.M. Maas
- Institute of Health Studies, HAN University of Applied Sciences
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Femke Driehuis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Guus A. Meerhoff
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Yvonne F. Heerkens
- Institute of Health Studies, HAN University of Applied Sciences
- Dutch Institute of Allied Healthcare, Amersfoort
| | - Cees P.M. van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Philip J. van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
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Facilitating peer based learning through summative assessment – An adaptation of the Objective Structured Clinical Assessment tool for the blended learning environment. Nurse Educ Pract 2018; 28:40-45. [DOI: 10.1016/j.nepr.2017.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022]
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30
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Stevens A, Köke A, van der Weijden T, Beurskens A. Ready for goal setting? Process evaluation of a patient-specific goal-setting method in physiotherapy. BMC Health Serv Res 2017; 17:618. [PMID: 28859652 PMCID: PMC5579955 DOI: 10.1186/s12913-017-2557-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 08/17/2017] [Indexed: 11/23/2022] Open
Abstract
Background Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. Methods We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Results Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the ‘setting goals’ and ‘planning treatment’ steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. Conclusion The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2557-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anita Stevens
- Zuyd University of Applied Sciences, Faculty of Health, P.O. Box 550, 6400 AN, Heerlen, the Netherlands. .,Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
| | - Albère Köke
- Zuyd University of Applied Sciences, Faculty of Health, P.O. Box 550, 6400 AN, Heerlen, the Netherlands.,Adelante Centre of Research in Rehabilitation, Hoensbroek, the Netherlands.,Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Anna Beurskens
- Zuyd University of Applied Sciences, Faculty of Health, P.O. Box 550, 6400 AN, Heerlen, the Netherlands.,Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
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31
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Meerhoff GA, van Dulmen SA, Maas MJM, Heijblom K, Nijhuis-van der Sanden MWG, Van der Wees PJ. Development and Evaluation of an Implementation Strategy for Collecting Data in a National Registry and the Use of Patient-Reported Outcome Measures in Physical Therapist Practices: Quality Improvement Study. Phys Ther 2017; 97:837-851. [PMID: 28789466 DOI: 10.1093/ptj/pzx051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 05/03/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND In 2013, the Royal Dutch Society for Physical Therapy launched the program "Quality in Motion." This program aims to collect data from electronic health record systems in a registry that is fed back to physical therapists, facilitating quality improvement. PURPOSE The purpose of this study was to describe the development of an implementation strategy for the program and to evaluate the feasibility of building a registry and implementing patient-reported outcome measures (PROMs) in physical therapist practices. METHODS A stepwise approach using mixed methods was established in 3 consecutive pilots with 355 physical therapists from 66 practices. Interim results were evaluated using quantitative data from a self-assessment questionnaire and the registry and qualitative data from 21 semistructured interviews with physical therapists. Descriptive statistics and McNemar's symmetry chi-squared test were used to summarize the feasibility of implementing PROMs. RESULTS PROMs were selected for the 5 most prevalent musculoskeletal conditions in Dutch physical therapist practices. A core component of the implementation strategy was the introduction of knowledge brokers to support physical therapists in establishing the routine use of PROMs in clinical practice and to assist in executing peer assessment workshops. In February 2013, 30.3% of the physical therapist practices delivered 4.4 completed treatment episodes per physical therapist to the registry; this increased to 92.4% in November 2014, delivering 54.1 completed patient episodes per physical therapist. Pre- and posttreatment PROM use increased from 12.2% to 39.5%. LIMITATIONS It is unclear if the participating physical therapists reflect a representative sample of Dutch therapists. CONCLUSION Building a registry and implementing PROMs in physical therapist practices are feasible. The routine use of PROMs needs to increase to ensure valid feedback of outcomes. Using knowledge brokers is promising for implementing the program via peer assessment workshops.
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Affiliation(s)
- Guus A Meerhoff
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands and Strategy and Development Department, Royal Dutch Society for Physical Therapy, Amersfoort, The Netherlands
| | - Simone A van Dulmen
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center and Strategy and Development Department, Royal Dutch Society for Physical Therapy
| | - Marjo J M Maas
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center and Institute of Health Studies, HAN University of Applied Sciences
| | - Karin Heijblom
- Strategy and Development Department, Royal Dutch Society for Physical Therapy
| | | | - Philip J Van der Wees
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center
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Strategies to translate knowledge related to common musculoskeletal conditions into physiotherapy practice: a systematic review. Physiotherapy 2017; 104:1-8. [PMID: 28942899 DOI: 10.1016/j.physio.2017.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/19/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many physiotherapists underuse evidence-based practice guidelines or recommendations when treating patients with musculoskeletal disorders, yet synthesis of knowledge translation interventions used within the field of physiotherapy fails to offer clear conclusions to guide the implementation of clinical practice guidelines. OBJECTIVES To evaluate the effectiveness of various knowledge translation interventions used to implement changes in the practice of current physiotherapists treating common musculoskeletal issues. DATA SOURCES A computerized literature search of MEDLINE, CINHAL and ProQuest of systematic reviews (from inception until May 2016) and primary research studies (from January 2010 until June 2016). STUDY SELECTION AND ELIGIBILITY CRITERIA Eligibility criteria specified articles evaluating interventions for translating knowledge into physiotherapy practice. DATA EXTRACTION AND DATA SYNTHESIS Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Of a total of 13014 articles located and titles and abstracts screened, 34 studies met the inclusion criteria, including three overlapping publications, resulting in 31 individual studies. RESULTS Knowledge translation interventions appear to have resulted in a positive change in physiotherapist beliefs, attitudes, skills and guideline awareness. However, no consistent improvement in clinical practice, patient and economic outcomes were observed. LIMITATIONS The studies included had small sample sizes and low methodological quality. The heterogeneity of the studies was not conducive to pooling the data. CONCLUSIONS AND IMPLICATION OF KEY FINDINGS The intensity and type of knowledge translation intervention seem to have an effect on practice change. More research targeting financial, organizational and regulatory knowledge translation interventions is needed.
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Stevens A, Köke A, van der Weijden T, Beurskens A. The development of a patient-specific method for physiotherapy goal setting: a user-centered design. Disabil Rehabil 2017; 40:2048-2055. [PMID: 28504014 DOI: 10.1080/09638288.2017.1325943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To deliver client-centered care, physiotherapists need to identify the patients' individual treatment goals. However, practical tools for involving patients in goal setting are lacking. The purpose of this study was to improve the frequently used Patient-Specific Complaints instrument in Dutch physiotherapy, and to develop it into a feasible method to improve physiotherapy goal setting. METHODS An iterative user-centered design was conducted in co-creation with the physiotherapists and patients, in three phases. Their needs and preferences were identified by means of group meetings and questionnaires. The new method was tested in several field tests in physiotherapy practices. RESULTS Four main objectives for improvement were formulated: clear instructions for the administration procedure, targeted use across the physiotherapy process, client-activating communication skills, and a client-centered attitude of the physiotherapist. A theoretical goal-setting framework and elements of shared decision making were integrated into the new-called, Patient-Specific Goal-setting method, together with a practical training course. CONCLUSIONS The user-centered approach resulted in a goal-setting method that is fully integrated in the physiotherapy process. The new goal-setting method contributes to a more structured approach to goal setting and enables patient participation and goal-oriented physiotherapy. Before large-scale implementation, its feasibility in physiotherapy practice needs to be investigated. Implications for rehabilitation Involving patients and physiotherapists in the development and testing of a goal-setting method, increases the likelihood of its feasibility in practice. The integration of a goal-setting method into the physiotherapy process offers the opportunity to focus more fully on the patient's goals. Patients should be informed about the aim of every step of the goal-setting process in order to increase their awareness and involvement. Training physiotherapists to use a patient-specific method for goal setting is crucial for a correct application.
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Affiliation(s)
- Anita Stevens
- a Faculty of Health , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,b Department of Family Medicine , Maastricht University, CAPHRI School for Public Health and Primary Care , Maastricht , The Netherlands
| | - Albère Köke
- a Faculty of Health , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,c Adelante Centre of Research in Rehabilitation , Hoensbroek , The Netherlands.,d Department of Rehabilitation Medicine , Maastricht University , Maastricht , The Netherlands
| | - Trudy van der Weijden
- b Department of Family Medicine , Maastricht University, CAPHRI School for Public Health and Primary Care , Maastricht , The Netherlands
| | - Anna Beurskens
- a Faculty of Health , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,b Department of Family Medicine , Maastricht University, CAPHRI School for Public Health and Primary Care , Maastricht , The Netherlands
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Suman A, Dikkers MF, Schaafsma FG, van Tulder MW, Anema JR. Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care: a systematic review. Implement Sci 2016; 11:126. [PMID: 27647000 PMCID: PMC5029102 DOI: 10.1186/s13012-016-0482-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care. METHODS The following electronic databases were searched from inception to June 1, 2015: MEDLINE, Embase, PsycInfo, the Cochrane Library, and CINAHL. The search strategy was restricted to low back pain, neck pain, and implementation research. Studies were included if their design was a randomized controlled trial, reporting on patients (age ≥18 years) with non-specific low back pain or neck pain (with or without radiating pain). Trials were eligible if they reported patient outcomes, measures of healthcare professional behaviour, and/or outcomes on healthcare level. The primary outcome was professional behaviour. Guidelines that were evaluated in the studies had to be implemented in a healthcare setting. No language restrictions were applied, and studies had to be published full-text in peer-reviewed journals, thus excluding abstract only publications, conference abstracts, and dissertation articles. Two researchers independently screened titles and abstract, extracted data from included studies, and performed risk of bias assessments. RESULTS After removal of duplicates, the search resulted in 4750 abstracts to be screened. Of 43 full-text articles assessed for eligibility, 12 were included in this review, reporting on 9 individual studies, and separate cost-effectiveness analyses of 3 included studies. Implementation strategies varied between studies. Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls. CONCLUSION This review showed that multifaceted strategies for the implementation of neck and/or back pain guidelines in health care do not significantly improve professional behaviour outcomes. No effects on patient outcomes or cost of care could be found. More research is necessary to determine whether multifaceted implementation strategies are conducted as planned and whether these strategies are effective in changing professional behaviour and thereby clinical practice.
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Affiliation(s)
- Arnela Suman
- Department of Public and Occupational Health, VU University medical centre and the EMGO+ Institute for Health and Care Research, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Marije F Dikkers
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Frederieke G Schaafsma
- Department of Public and Occupational Health, VU University medical centre and the EMGO+ Institute for Health and Care Research, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
- Research Centre for Insurance Medicine, Collaboration between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, VU University medical centre and the EMGO+ Institute for Health and Care Research, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Research Centre for Insurance Medicine, Collaboration between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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Moreno EM, Moriana JA. User involvement in the implementation of clinical guidelines for common mental health disorders: a review and compilation of strategies and resources. Health Res Policy Syst 2016; 14:61. [PMID: 27507569 PMCID: PMC4979121 DOI: 10.1186/s12961-016-0135-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is now broad consensus regarding the importance of involving users in the process of implementing guidelines. Few studies, however, have addressed this issue, let alone the implementation of guidelines for common mental health disorders. The aim of this study is to compile and describe implementation strategies and resources related to common clinical mental health disorders targeted at service users. METHODS The literature was reviewed and resources for the implementation of clinical guidelines were compiled using the PRISMA model. A mixed qualitative and quantitative analysis was performed based on a series of categories developed ad hoc. RESULTS A total of 263 items were included in the preliminary analysis and 64 implementation resources aimed at users were analysed in depth. A wide variety of types, sources and formats were identified, including guides (40%), websites (29%), videos and leaflets, as well as instruments for the implementation of strategies regarding information and education (64%), self-care, or users' assessment of service quality. CONCLUSIONS The results reveal the need to establish clear criteria for assessing the quality of implementation materials in general and standardising systems to classify user-targeted strategies. The compilation and description of key elements of strategies and resources for users can be of interest in designing materials and specific actions for this target audience, as well as improving the implementation of clinical guidelines.
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Affiliation(s)
- Eliana M Moreno
- Department of Psychology, University of Cordoba, Calle San Alberto Magno S/N, 14071, Cordoba, Spain. .,Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, Avda Menéndez Pidal s/n, 14004, Cordoba, Spain.
| | - Juan Antonio Moriana
- Department of Psychology, University of Cordoba, Calle San Alberto Magno S/N, 14071, Cordoba, Spain.,Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, Avda Menéndez Pidal s/n, 14004, Cordoba, Spain
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Fischer F, Lange K, Klose K, Greiner W, Kraemer A. Barriers and Strategies in Guideline Implementation-A Scoping Review. Healthcare (Basel) 2016; 4:healthcare4030036. [PMID: 27417624 PMCID: PMC5041037 DOI: 10.3390/healthcare4030036] [Citation(s) in RCA: 470] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/20/2016] [Accepted: 06/24/2016] [Indexed: 01/11/2023] Open
Abstract
Research indicates that clinical guidelines are often not applied. The success of their implementation depends on the consideration of a variety of barriers and the use of adequate strategies to overcome them. Therefore, this scoping review aims to describe and categorize the most important barriers to guideline implementation. Furthermore, it provides an overview of different kinds of suitable strategies that are tailored to overcome these barriers. The search algorithm led to the identification of 1659 articles in PubMed. Overall, 69 articles were included in the data synthesis. The content of these articles was analysed by using a qualitative synthesis approach, to extract the most important information on barriers and strategies. The barriers to guideline implementation can be differentiated into personal factors, guideline-related factors, and external factors. The scoping review revealed the following aspects as central elements of successful strategies for guideline implementation: dissemination, education and training, social interaction, decision support systems and standing orders. Available evidence indicates that a structured implementation can improve adherence to guidelines. Therefore, the barriers to guideline implementation and adherence need to be analysed in advance so that strategies that are tailored to the specific setting and target groups can be developed.
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Affiliation(s)
- Florian Fischer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany.
| | - Kerstin Lange
- Department of Public Health Medicine, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany.
| | - Kristina Klose
- Department of Health Care Management, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany.
| | - Wolfgang Greiner
- Department of Health Care Management, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany.
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany.
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Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report. Phys Ther 2015; 95:1712-21. [PMID: 26381807 DOI: 10.2522/ptj.20150035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/09/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The current state of health care demands higher-value care. Due to many barriers, clinicians routinely do not implement evidence-based care even though it is known to improve quality and reduce cost of care. The purpose of this case report is to describe a theory-based, multitactic implementation of a quality improvement process aimed to deliver higher-value physical therapy for patients with low back pain. CASE DESCRIPTION Patients were treated from January 2010 through December 2014 in 1 of 32 outpatient physical therapy clinics within an academic health care system. Data were examined from 47,755 patients (mean age=50.3 years) entering outpatient physical therapy for management of nonspecific low back pain, with or without radicular pain. Development and implementation tactics were constructed from adult learning and change management theory to enhance adherence to best practice care among 130 physical therapists. A quality improvement team implemented 4 tactics: establish care delivery expectations, facilitate peer-led clinical and operational teams, foster a learning environment focused on meeting a population's needs, and continuously collect and analyze outcomes data. Physical therapy utilization and change in functional disability were measured to assess relative cost and quality of care. Secondarily, charge data assessed change in physical therapists' application of evidence-based care. OUTCOMES Implementation of a quality improvement process was measured by year-over-year improved clinical outcomes, decreased utilization, and increased adherence to evidence-based physical therapy, which was associated with higher-value care. DISCUSSION When adult learning and change management theory are combined in quality improvement efforts, common barriers to implementing evidence-based care can be overcome, creating an environment supportive of delivering higher-value physical therapy for patients with low back pain.
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Maas MJM, van Dulmen SA, Sagasser MH, Heerkens YF, van der Vleuten CPM, Nijhuis-van der Sanden MWG, van der Wees PJ. Critical features of peer assessment of clinical performance to enhance adherence to a low back pain guideline for physical therapists: a mixed methods design. BMC MEDICAL EDUCATION 2015; 15:203. [PMID: 26563246 PMCID: PMC4643538 DOI: 10.1186/s12909-015-0484-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 11/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously published randomized controlled trial showed that PA was more effective than the usual strategy "case discussion" in improving adherence to a low back pain guideline. Peer assessment aims to enhance knowledge, communication, and hands-on clinical skills consistent with guideline recommendations. Participants observed and evaluated clinical performance on the spot in a role-play simulating clinical practice. Participants performed three roles: physical therapist, assessor, and patient. This study explored the critical features of the PA program that contributed to improved guideline adherence in the perception of participants. METHODS Dutch physical therapists working in primary care (n = 49) organized in communities of practice (n = 6) participated in the PA program. By unpacking the program we identified three main tasks and eleven subtasks. After the program was finished, a questionnaire was administered in which participants were asked to rank the program tasks from high to low learning value and to describe their impact on performance improvement. Overall ranking results were calculated. Additional semi-structured interviews were conducted to elaborate on the questionnaires results and were transcribed verbatim. Questionnaires comments and interview transcripts were analyzed using template analysis. RESULTS Program tasks related to performance in the therapist role were perceived to have the highest impact on learning, although task perceptions varied from challenging to threatening. Perceptions were affected by the role-play format and the time schedule. Learning outcomes were awareness of performance, improved attitudes towards the guideline, and increased self-efficacy beliefs in managing patients with low back pain. Learning was facilitated by psychological safety and the quality of feedback. CONCLUSION The effectiveness of PA can be attributed to the structured and performance-based design of the program. Participants showed a strong cognitive and emotional commitment to performing the physical therapist role. That might have contributed to an increased awareness of strength and weakness in clinical performance and a motivation to change routine practice.
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Affiliation(s)
- Marjo J M Maas
- HAN University of Applied Sciences, Institute for Health Studies, Kapittelweg 33, 5425 EN, Nijmegen, The Netherlands.
- Radboud University Medical Center, Institute for Health Sciences, IQ healthcare, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands.
| | - Simone A van Dulmen
- Radboud University Medical Center, Institute for Health Sciences, IQ healthcare, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands.
| | - Margaretha H Sagasser
- Radboud University Medical Center Department of Primary and Community Care, Nijmegen, The Netherlands.
| | - Yvonne F Heerkens
- HAN University of Applied Sciences, Institute for Health Studies, Kapittelweg 33, 5425 EN, Nijmegen, The Netherlands.
- Dutch Institute of Allied Health Care, Amersfoort, The Netherlands.
| | - Cees P M van der Vleuten
- Maastricht University, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands.
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Institute for Health Sciences, IQ healthcare, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands.
| | - Philip J van der Wees
- Radboud University Medical Center, Institute for Health Sciences, IQ healthcare, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands.
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Manual physical therapists' use of biopsychosocial history taking in the management of patients with back or neck pain in clinical practice. ScientificWorldJournal 2015; 2015:170463. [PMID: 25945358 PMCID: PMC4402195 DOI: 10.1155/2015/170463] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/09/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To develop and evaluate process indicators relevant to biopsychosocial history taking in patients with chronic back and neck pain. METHODS The SCEBS method, covering the Somatic, Psychological (Cognition, Emotion, and Behavior), and Social dimensions of chronic pain, was used to evaluate biopsychosocial history taking by manual physical therapists (MPTs). In Phase I, process indicators were developed while in Phase II indicators were tested in practice. RESULTS Literature-based recommendations were transformed into 51 process indicators. Twenty MTPs contributed 108 patient audio recordings. History taking was excellent (98.3%) for the Somatic dimension, very inadequate for Cognition (43.1%) and Behavior (38.3%), weak (27.8%) for Emotion, and low (18.2%) for the Social dimension. MTPs estimated their coverage of the Somatic dimension as excellent (100%), as adequate for Cognition, Emotion, and Behavior (60.1%), and as very inadequate for the Social dimension (39.8%). CONCLUSION MTPs perform screening for musculoskeletal pain mainly through the use of somatic dimension of (chronic) pain. Psychological and social dimensions of chronic pain were inadequately covered by MPTs. Furthermore, a substantial discrepancy between actual and self-estimated use of biopsychosocial history taking was noted. We strongly recommend full implementation of the SCEBS method in educational programs in manual physical therapy.
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An innovative peer assessment approach to enhance guideline adherence in physical therapy: single-masked, cluster-randomized controlled trial. Phys Ther 2015; 95:600-12. [PMID: 25234274 DOI: 10.2522/ptj.20130469] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 08/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are not readily implemented in clinical practice. One of the impeding factors is that physical therapists do not hold realistic perceptions of their adherence to CPGs. Peer assessment (PA) is an implementation strategy that aims at improving guideline adherence by enhancing reflective practice, awareness of professional performance, and attainment of personal goals. OBJECTIVE The purpose of this study was to compare the effectiveness of PA with the usual case discussion (CD) strategy on adherence to CPGs for physical therapist management of upper extremity complaints. DESIGN A single-masked, cluster-randomized controlled trial with pretest-posttest design was conducted. INTERVENTION Twenty communities of practice (n=149 physical therapists) were randomly assigned to groups receiving PA or CD, with both interventions consisting of 4 sessions over 6 months. Both PA and CD groups worked on identical clinical cases relevant to the guidelines. Peer assessment focused on individual performance observed and evaluated by peers; CD focused on discussion. OUTCOMES Guideline adherence was measured with clinical vignettes, reflective practice was measured with the Self-Reflection and Insight Scale (SRIS), awareness of performance was measured via the correlation between perceived and assessed improvement, and attainment of personal goals was measured with written commitments to change. RESULTS The PA groups improved more on guideline adherence compared with the CD groups (effect=22.52; 95% confidence interval [95% CI]=2.38, 42.66; P=.03). The SRIS scores did not differ between PA and CD groups. Awareness of performance was greater for the PA groups (r=.36) than for the CD groups (r=.08) (effect=14.73; 95% CI=2.78, 26.68; P=.01). The PA strategy was more effective than the CD strategy in attaining personal goals (effect=0.50; 95% CI=0.04, 0.96; P=.03). LIMITATIONS Limited validity of clinical vignettes as a proxy measure of clinical practice was a limitation of the study. CONCLUSIONS Peer assessment was more effective than CD in improving adherence to CPGs. Personal feedback may have contributed to its effectiveness. Future research should address the role of the group coach.
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