Abstract
Quality improvement has become a central tenet of physiotherapy care. Quality indicators (QIs) as measurable elements of care have been used over the past 25 years to analyze and evaluate the quality of physiotherapy care. The aim of this article is to describe the state of the art regarding the development and application of QIs in physiotherapy primary care when embedded in a clinical reasoning process. In contrast to international clinical practice guidelines, Dutch physiotherapy clinical practice guidelines are generally based on the clinical reasoning process in combination with best available evidence. Information required to develop QIs is preferably derived by combining available systematic review-based scientific evidence, guideline-based recommendations, and routinely collected data with clinical evidence, professional expertise and standards, and patient perspectives. A set of QIs (n=28) in patients with whiplash-associated disorders was developed and embedded per step of the clinical reasoning process in physiotherapy care: (a) administration (n=2); (b) history taking (n=7); (c) objectives of examination (n=1); (d) clinical examination (n=4); (e) analysis and conclusion (n=2); (f) treatment plan (n=3); (g) treatment (n=2); (h) evaluation (n=5); and (i) discharge (n=2). The use of QIs represents a useful tool for measuring the (improvement of) quality of physiotherapy primary care, as many evidentiary gaps still exist in terms of diagnostics, prognostics, and treatment, and concerning patient-related outcome measurements in different patient groups such as patients with musculoskeletal pain. The recommended set of QIs embedded in the clinical reasoning process for patients with whiplash-associated disorders can be used as a starting point for the development of a general set of QIs that measure the (improvement of) quality of primary care physiotherapy.
Highlights
Quality improvement has become a central tenet of physiotherapy care and a statutory obligation in many countries [1]
There are numerous reasons why it is important to improve the quality of physiotherapy care, and these include enhancing the clinical reasoning process and making best use of clinical practice guidelines (CPG) and scientific evidence, improving patient-related outcomes and safety, and aligning care to what patients want in addition to what they need
Individual health profile addressed to the whiplash injury since accident, an indication of treatment prognosis, and an indication for physiotherapy have been established and are noted
Summary
Quality improvement has become a central tenet of physiotherapy care and a statutory obligation in many countries [1]. CPGs, patient-related outcome measurements, and literature, systematic reviews; (b) transformation of recommendations into QIs by phrasing them as the average degree (in %) to which patients were subjected to a methodically performed clinical reasoning process, including the level of evidence supporting the formulated QIs graded from levels I–IV, based on a national consensus document [25]; (c) appraisal by an expert and user panel, including scoring of the set of QIs on a five-point Likert scale (1=not at all to 5=completely) based on acceptability, feasibility, clarity, and relevancy to the physiotherapy care process; (d) classification of process indicators into the nine steps of the clinical reasoning process; and (e) classification of outcome indicators in accordance with the International Classification of Functioning, Disability and Health (ICF) [26] such as body functions, activity and participation, and personal and environmental factors. Dizziness test, positional testing, eyes movement test in agreement with objectives of oto-neurological examination
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