Concurrent validity of physical therapist performed musculo-skeletal (MSK) diagnostic ultrasound imaging (DUI) vs MRI in detecting shoulder RTC tears

Abstract

satisfaction, physiotherapists’ knowledge of and adherence to the CPG-LBP, as well as to compare the results of the two cycles. Methods: All physiotherapists (n= 9) in the Medical Cente participated. The Focus-PDCA (Plan-Do-Check-Act) cycle was selected as a tool for multi-faceted and continuous quality improvement. Physiotherapists were educated focusing on guideline recommendations and patient education, and receivedmonthly reminders. A competency test was conducted to test the therapists’ knowledge and ability in clinical decision-making. Patient files were audited to evaluate physiotherapists’ adherence to guideline recommendations based on thirteen quality indicators. Outcome of care in the second cycle was measured by assessing patients’ health status with the Quebec Back Pain Disability Scale (QBPDS) and Numeric Rating Scale for Pain (NRS-P). Adherence was calculated using descriptive statistics. Results of the second cycle and differences between the two cycles were analyzed with Chi-square statistics and Fisher’s exact test (p value = 0.05). Results: The competency test in the second cycle resulted in an average score of 73% in correct definitions and 60% in clinical decision–making. Adherence to guideline recommendations was derived from 44 patient files. For the diagnostic process, the overall percentages of adherencewere high (90% and 93% in first and second cycle respectively). Overall percentage of adherence in the treatment process improved significantly in the second cycle (42% and 64% for first and second cycle respectively). Health status of patients after treatment during the second cycle was improved significantly for the QBPDS and NRS-P. In the second cycle patients reported 85% agreement with the therapists’ education, 72% satisfaction with the outcome of care, and 70% in overall satisfaction with their recovery. Conclusion(s): A multi-faceted implementation strategy based on identifying barriers to change and continuous evaluation was effective in improving therapists’ adherence to CPG-LBP and patient satisfaction with care. Checking the feasibility of such an implementation strategy nationally is needed. Implications: To the knowledge of the authors this is the first study reporting compared results from two consecutive implementation cycles. Checking the feasibility of such an implementation strategy nationally is needed. Countries like Lebanon, where resources are scarce, can benefit from adopting foreign guidelines to stimulate evidence-based practice.