Acceptance of the 'Assessment of Physiotherapy Practice (Chinese)' as a standardised evaluation of professional competency in Chinese physiotherapy students: an observational study.

BACKGROUND: Development of an entry-level physiotherapy curriculum in China currently follows the World Confederation for Physical Therapy (WCPT) guidelines, however there is no standard, validated, assessment tool for physiotherapy practice in use in China. This article reports the process of translation of the "Assessment of Physiotherapy Practice" (APP), a validated assessment instrument adopted by all universities in Australia and New Zealand, into Chinese (APP-Chinese) and its implementation by Chinese physiotherapy clinical educators (CEs) and students during clinical placements. METHODS: The process of forward and backward translation of the APP was undertaken by a team of academics from universities in Shanghai, Hong Kong, United States and Australia. An APP-Chinese version was produced and used for assessment of the clinical performance of 4th year students at a university in Shanghai. Feedback on the implementation of the APP-Chinese was solicited from students and CEs using the same two questionnaires employed to assess implementation of the original APP. RESULTS: All CEs agreed that the rules used to score the APP-Chinese were helpful in assessing student performance. Over 90% of the CEs considered the APP-Chinese was pragmatic for use in the clinical environment in China. All students agreed with the rating of their performance on the APP-Chinese marked by their educators, and that the performance indicators were useful in guiding their expected performance behaviour. CONCLUSION: The APP-Chinese is the first standardised assessment tool for evaluation of clinical performance of physiotherapy students in China and was shown to be well accepted by both students and CEs in the clinical education unit and university involved in this study.

Contemporary Practice as a Board-Certified Pediatric Clinical Specialist: A Practice Analysis.

PURPOSE: The purpose of the 2019 practice analysis was to identify the elements of contemporary practice as a board-certified pediatric clinical specialist. METHODS: Consistent with the processes of the American Board of Physical Therapy Specialties (ABPTS), a subject matter expert panel used consensus-based processes to develop a survey to gather information concerning the knowledge areas, professional roles and responsibilities, practice expectations, and practice demographics of board-certified pediatric clinical specialists. The web-based survey was divided into 3 parts and administered to 3 separate groups of board-certified pediatric clinical specialists. RESULTS: Survey responses from 323 clinical specialists provided data to support confirmation and revision of the Description of Specialty Practice (DSP) for pediatrics. CONCLUSIONS: The revised DSP will provide contemporary practice information to inform the ABPTS specialist examination blueprint and the curricula of credentialed residency programs in pediatric physical therapy.

An interdisciplinary statement of scientific societies for the advancement of delirium care across Europe (EDA, EANS, EUGMS, COTEC, IPTOP/WCPT).

BACKGROUND: Delirium is a geriatric syndrome that presents in 1 out of 5 hospitalized older patients. It is also common in the community, in hospices, and in nursing homes. Delirium prevalence varies according to clinical setting, with rates of under 5% in minor elective surgery but up to 80% in intensive care unit patients. Delirium has severe adverse consequences, but despite this and its high prevalence, it remains undetected in the majority of cases. Optimal delirium care requires an interdisciplinary, multi-dimensional diagnostic and therapeutic approach involving doctors, nurses, physiotherapists, and occupational therapists. However, there are still important gaps in the knowledge and management of this syndrome. MAIN BODY: The objective of this paper is to promote the interdisciplinary approach in the prevention and management of delirium as endorsed by a delirium society (European Delirium Association, EDA), a geriatrics society (European Geriatric Medicine Society, EuGMS), a nursing society (European Academy of Nursing Science, EANS), an occupational therapy society (Council of Occupational Therapists for European Countries, COTEC), and a physiotherapy society (International Association of Physical Therapists working with Older People of the World Confederation for Physical Therapy, IPTOP/WCPT). SHORT CONCLUSION: In this paper we have strongly promoted and supported interdisciplinary collaboration underlying the necessity of increasing communication among scientific societies. We have also provided suggestions on how to fill the current gaps via improvements in undergraduate and postgraduate delirium education among European Countries.

GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence.

BACKGROUND: Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for 'GLA:D Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain. METHODS: GLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created. RESULTS: Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual's capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions. CONCLUSION: From current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.

Validity and reproducibility of a tool for assessing clinical competencies in physical therapy students.

BACKGROUND: The evaluation of competencies in the clinical field is essential for health professionals, as it allows the acquisition of these competencies to be tracked. The objective of this study was to create and evaluate the validity and reliability of a tool for measuring clinical competencies in physical therapy (PT) students to assess the quality of their performance in a professional context. METHODS: A descriptive study was designed. The Measurement Tool for Clinical Competencies in PT (MTCCP) was developed based on the evaluation of 39 experts: 15 clinicians and 24 instructors. The content validity was evaluated using the Content Validity Index (CVI). Three professors were invited to apply the tool to 10 students. Cronbach's alpha, exploratory factor analysis, and the intraclass correlation coefficient were used to determine the reliability and validity of the scale. RESULTS: The CVI was positive-higher than 0.8. Principal component analysis confirmed the construct validity of the tool for two main factors: clinical reasoning (first factor) and professional behavior (second factor). With regard to reliability, the MTCCP achieved an internal congruence of 0.982. The inter-evaluator reproducibility for clinical reasoning, professional behavior, and the total MTCCP score was almost perfect; the ICCs were 0.984, 0.930, and 0.983, respectively. CONCLUSIONS: The MTCCP is a valid and reliable instrument for assessing the performance of PT students in hospital settings and can be used to determine what skills students feel less confident using and what additional training/learning opportunities could be provided. Further research is needed to determine whether the MTCCP has similar validity and reproducibility in other Spanish-speaking national and international PT programs.

The characteristics of stroke units in Ontario: a pan-provincial survey.

BACKGROUND: Previous studies have demonstrated that organized, multidisciplinary care is the cornerstone of current strategies to reduce the death and disability caused by stroke. Identification of stroke units and an understanding of their composition and operation would provide insight for the further actions required to improve stroke care. The objective of this study was to identify and survey stroke units in Canada's largest province, Ontario (population of 13 million) in order to describe availability, structure, staffing, processes of care, and type of population stroke units serve. METHODS: The Ontario Stroke Network (2011) list of stroke units and snowball sampling was used to identify all stroke units. During 2013 - 2014 an interviewer conducted telephone surveys with the stroke unit managers using closed and semi-open ended questions. Descriptive statistics were used to summarize survey responses. RESULTS: The survey identified 32 stroke units, and a respondent from every stroke unit (100% response rate) was interviewed. Twenty one were acute stroke units, 10 were integrated stroke units and one was classified as a rehabilitation stroke unit. Stroke units were available in all 14 Local Health Integration Networks except Central West. The estimated average number of stroke patients served per stroke unit was 604 with six-fold variation (242 to 1480) across the province. The typical population served in stroke units were patients with either ischemic or hemorrhagic stroke. Data consistently reported on the processes of stroke care, including the availability of multidisciplinary staff, specific diagnostic imaging, use of validated assessment tools, and the delivery of patient education. Details about the core components of stoke care were provided by 16 stroke units (50%). CONCLUSIONS: This study demonstrates the heterogeneous structure of stroke units in Ontario and signaled potential disparity in access to stroke units. Many core components are in place, but half of the stroke units in Ontario do not meet all criteria. Areas for potential improvement include stroke care training for the multidisciplinary team, provision of individualized rehabilitation plans, and early discharge assessment.

Reconsidering inherent requirements: a contribution to the debate from the clinical placement experience of a physiotherapy student with vision impairment.

BACKGROUND: Clinical placements in acute hospitals present challenges for students with vision impairment who are being educated as health care professionals. Legislation in Australia supports reasonable adjustments to education, thus students with vision impairment have completed accredited courses and gained professional registration. However the implementation of inherent requirement statements suggesting that adequate visual acuity is required to complete a physiotherapy program may create barriers to access for such students. METHODS: We describe features that contributed to a successful physiotherapy clinical placement in an acute hospital setting for a student with vision impairment and use this experience to prompt debate about the use of inherent requirement statements. FINDINGS: Planning, consultation, collaboration and problem solving commencing from the time of program entry were integral to clinical placement preparation for this student. Individualised adjustments (including a support worker for reading screens and medical records) and the student's specific qualities (professionalism, communication, problem solving, memory, kinaesthetic abilities) contributed to a successful outcome. DISCUSSION: Reflecting on this experience and published inherent requirements, there is an apparent lack of involvement of people with disability in the development of inherent requirement statements; we question the need for this level of regulation; and discuss the potential impact of inherent requirement statements on the health workforce. This experience demonstrated that an individualised approach to reasonable adjustments for a student with a disability was successful in an acute hospital setting. The implementation of inherent requirement statements may systemically reduce the capacity of education providers to develop such bespoke solutions and deserves further debate.

The 'Best Practice Guide to Conservative Management of Patellofemoral Pain': incorporating level 1 evidence with expert clinical reasoning.

IMPORTANCE: Patellofemoral pain (PFP) is both chronic and prevalent; it has complex aetiology and many conservative treatment options. OBJECTIVE: Develop a comprehensive contemporary guide to conservative management of PFP outlining key considerations for clinicians to follow. DESIGN: Mixed methods. METHODS: We synthesised the findings from six high-quality systematic reviews to September 2013 with the opinions of 17 experts obtained via semistructured interviews. Experts had at least 5 years clinical experience with PFP as a specialist focus, were actively involved in PFP research and contributed to specialist international meetings. The interviews covered clinical reasoning, perception of current evidence and research priorities. RESULTS: Multimodal intervention including exercise to strengthen the gluteal and quadriceps musculature, manual therapy and taping possessed the strongest evidence. Evidence also supports use of foot orthoses and acupuncture. Interview transcript analysis identified 23 themes and 58 subthemes. Four key over-arching principles to ensure effective management included-(1) PFP is a multifactorial condition requiring an individually tailored multimodal approach. (2) Immediate pain relief should be a priority to gain patient trust. (3) Patient empowerment by emphasising active over passive interventions is important. (4) Good patient education and activity modification is essential. Future research priorities include identifying risk factors, testing effective prevention, developing education strategies, evaluating the influence of psychosocial factors on treatment outcomes and how to address them, evaluating the efficacy of movement pattern retraining and improving clinicians' assessment skills to facilitate optimal individual prescription. CONCLUSIONS AND RELEVANCE: Effective management of PFP requires consideration of a number of proven conservative interventions. An individually tailored multimodal intervention programme including gluteal and quadriceps strengthening, patellar taping and an emphasis on education and activity modification should be prescribed for patients with PFP. We provide a 'Best Practice Guide to Conservative Management of Patellofemoral Pain' outlining key considerations.

Scholarly research productivity is not related to higher three-year licensure pass rates for physical therapy academic programs.

BACKGROUND: In the domain of academia, the scholarship of research may include, but not limited to, peer-reviewed publications, presentations, or grant submissions. Programmatic research productivity is one of many measures of academic program reputation and ranking. Another measure or tool for quantifying learning success among physical therapists education programs in the USA is 100 % three year pass rates of graduates on the standardized National Physical Therapy Examination (NPTE). In this study, we endeavored to determine if there was an association between research productivity through artifacts and 100 % three year pass rates on the NPTE. METHODS: This observational study involved using pre-approved database exploration representing all accredited programs in the USA who graduated physical therapists during 2009, 2010 and 2011. Descriptive variables captured included raw research productivity artifacts such as peer reviewed publications and books, number of professional presentations, number of scholarly submissions, total grant dollars, and numbers of grants submitted. Descriptive statistics and comparisons (using chi square and t-tests) among program characteristics and research artifacts were calculated. Univariate logistic regression analyses, with appropriate control variables were used to determine associations between research artifacts and 100 % pass rates. RESULTS: Number of scholarly artifacts submitted, faculty with grants, and grant proposals submitted were significantly higher in programs with 100 % three year pass rates. However, after controlling for program characteristics such as grade point average, diversity percentage of cohort, public/private institution, and number of faculty, there were no significant associations between scholarly artifacts and 100 % three year pass rates. CONCLUSIONS: Factors outside of research artifacts are likely better predictors for passing the NPTE.

Honorary authorship: frequency and associated factors in physical medicine and rehabilitation research articles.

OBJECTIVES: To estimate the prevalences of perceived honorary authorship and International Committee of Medical Journal Editors (ICMJE)-defined honorary authorship, and identify factors affecting each rate in the physical medicine and rehabilitation literature. DESIGN: Internet-based survey. SETTING: Not applicable. PARTICIPANTS: First authors of articles published in 3 major physical medicine and rehabilitation journals between January 2009 and December 2011 were surveyed in June and July 2012 (N=1182). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The reported prevalences of perceived and ICMJE-defined honorary authorship were the primary outcome measures, and multiple factors were analyzed to determine whether they were associated with these measures. RESULTS: The response rate was 27.3% (248/908). The prevalences of perceived and ICMJE-defined honorary authorship were 18.0% (44/244) and 55.2% (137/248), respectively. Factors associated with perceived honorary authorship in the multivariate analysis included the suggestion that an honorary author should be included (P<.0001), being a medical resident or fellow (P=.0019), listing "reviewed manuscript" as 1 of the nonauthorship tasks (P=.0013), and the most senior author deciding the authorship order (P=.0469). Living outside North America was independently associated with ICMJE-defined honorary authorship (P=.0079) in the multivariate analysis. In the univariate analysis, indicating that the most senior author decided authorship order was significantly associated with ICMJE-defined honorary authorship (P=<.001). CONCLUSIONS: Our results suggest that honorary authorship does occur in a significant proportion of the physical medicine and rehabilitation literature. Additionally, we found several factors associated with perceived and ICMJE-defined honorary authorship and a discrepancy between the 2 rates. Further studies with larger response rates are recommended to further explore this topic.

Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.

BACKGROUND: Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden. METHODS: An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test. RESULTS: 168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes. CONCLUSIONS: A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.

Evaluating quality indicators for physical therapy in primary care.

OBJECTIVE: To evaluate measurement properties of a set of public quality indicators on physical therapy. DESIGN: An observational study with web-based collected survey data (2009 and 2010). SETTING: Dutch primary care physical therapy practices. PARTICIPANTS: In 3743 physical therapy practices, 11 274 physical therapists reporting on 30 patients each. MAIN OUTCOME MEASURES: Eight quality indicators were constructed: screening and diagnostics (n= 2), setting target aim and subsequent of intervention (n = 2), administrating results (n = 1), global outcome measures (n = 2) and patient's treatment agreement (n = 1). Measurement properties on content and construct validity, reproducibility, floor and ceiling effects and interpretability of the indicators were assessed using comparative statistics and multilevel modeling. RESULTS: Content validity was acceptable. Construct validity (using known group techniques) of two outcome indicators was acceptable; hypotheses on age, gender and chronic vs. acute care were confirmed. For the whole set of indicators reproducibility was approximated by correlation of 2009 and 2010 data and rated moderately positive (Spearman's ρ between 0.3 and 0.42 at practice level) and interpretability as acceptable, as distinguishing between patient groups was possible. Ceiling effects were assessed negative as they were high to extremely high (30% for outcome indicator 6-95% for administrating results). CONCLUSION: Weaknesses in data collection should be dealt with to reduce bias and to reduce ceiling effects by randomly extracting data from electronic medical records. More specificity of the indicators seems to be needed, and can be reached by focusing on most prevalent conditions, thus increasing usability of the indicators to improve quality of care.

Why peer assessment helps to improve clinical performance in undergraduate physical therapy education: a mixed methods design.

BACKGROUND: Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers' performance. We designed a PA task to assess students' clinical skills (including reasoning, communication, physical examination and treatment skills) in a role-play that simulated physical therapy (PT) practice. Students alternately performed in the role of PT, assessor, and patient. Oral face-to-face feedback was provided as well as written feedback and scores.This study aims to explore the impact of PA on the improvement of clinical performance of undergraduate PT students. METHODS: The PA task was analyzed and decomposed into task elements. A qualitative approach was used to explore students' perceptions of the task and the task elements. Semi-structured interviews with second year students were conducted to explore the perceived impact of these task elements on performance improvement. Students were asked to select the elements perceived valuable, to rank them from highest to lowest learning value, and to motivate their choices. Interviews were transcribed verbatim and analyzed, using a phenomenographical approach and following template analysis guidelines. A quantitative approach was used to describe the ranking results. RESULTS: Quantitative analyses showed that the perceived impact on learning varied widely. Performing the clinical task in the PT role, was assigned to the first place (1), followed by receiving expert feedback (2), and observing peer performance (3). Receiving peer feedback was not perceived the most powerful task element.Qualitative analyses resulted in three emerging themes: pre-performance, true-performance, and post-performance triggers for improvement. Each theme contained three categories: learning activities, outcomes, and conditions for learning.Intended learning activities were reported, such as transferring prior learning to a new application context and unintended learning activities, such as modelling a peer's performance. Outcomes related to increased self-confidence, insight in performance standards and awareness of improvement areas. Conditions for learning referred to the quality of peer feedback. CONCLUSIONS: PA may be a powerful tool to improve clinical performance, although peer feedback is not perceived the most powerful element. Peer assessors in undergraduate PT education use idiosyncratic strategies to assess their peers' performance.

Nationwide survey of school-based physical therapy practice.

PURPOSE: The Individuals with Disabilities Education Improvement Act and related literature have implications for school-based physical therapy. This study examined therapists' reports of their actual practice, compared with literature-based recommendations for "ideal" practice, and explored their conceptions of ideal practice. METHODS: Participation in an online survey was requested of school-based physical therapists. Analysis of the results compared the therapists' reports of their actual practice with their views about ideal practice. RESULTS: Among the 561 respondents, there was general agreement that actual practice was always or usually consistent with the literature. However, poor agreement was found between their reported actual practice and their opinions of ideal practice. The majority of service delivery was direct intervention. Ninety percent believed they were "adequately" meeting their students' needs. CONCLUSIONS: Actual reported practice generally met literature descriptions of ideal practice but not to the extent the respondents thought ideal.

Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association.

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials).

Position statement on genuine physiotherapy research at German university hospitals.

In addition to patient care, physiotherapy is increasingly important in research at university hospitals. Genuine physiotherapy research plays a decisive role in this. This position statement describes the opportunities, benefits, framework conditions, challenges, and research priorities of genuine physiotherapy research at German university hospitals.

Systematic Development and Validity Evidence for a Checklist to Assess Bed Mobility Skills Among Physical Therapy Students.

INTRODUCTION: Assessments with strong validity evidence are necessary to accurately assess health professions students' performance of clinical skills. The aim of this study was to develop and validate a checklist assessment of physical therapy students' performance of bed mobility skills. METHODS: A checklist was developed using a 4-step process: 1) evidence review and preliminary checklist development, 2) Delphi review to reach consensus on content, 3) pilot testing and checklist editing, 4) final round of Delphi review. Consensus during Delphi review was defined as 100% of participants rating an item "keep as is" and zero comments in Round 1, and >50% of participants rating each item agree/strongly agree in subsequent Delphi rounds. Interrater reliability (IRR) was measured by two raters scoring 32 recorded exam simulations. RESULTS: All 48 items of the checklist reached consensus after three rounds of Delphi review (12 participants in Round 1, 11 participants in Rounds 2-3). IRR was substantial with 88.5% agreement, Cohen's kappa coefficient=0.61, p<0.001, 95% CI [0.56, 0.66]. DISCUSSION: This checklist has potential to be used to assess student readiness to evaluate and train patients in bed mobility tasks for first-time clinical experiences and to serve as a methodological template for future checklist development.

Maximizing usability of evidence in rehabilitation practice: tips for researchers.

The ultimate goal of rehabilitation research is to improve the lives of people with disabilities; yet, little research is implemented into clinical practice. The objectives of the current article are to serve as a guide for rehabilitation researchers regarding factors that contribute to translation of the evidence base in clinical practice, to highlight some common problems encountered by clinicians when trying to implement evidence-based treatments, and to provide tips that researchers can use to enhance the likelihood of their research products being used in clinical practice. The impact of clinician and environmental factors on use of evidence-based medicine are reviewed. Practical issues encountered by clinicians when attempting to translate evidence-based findings into practice are highlighted by discussing 2 areas of research: compensatory strategies for memory impairment after brain injury and use of electrical stimulation for weakness and paralysis in persons with spinal cord injury. The article closes with a series of tips to assist researchers in translating findings to clinicians.

Evaluation of the theory-based Quality Improvement in Physical Therapy (QUIP) programme: a one-group, pre-test post-test pilot study.

BACKGROUND: Guideline adherence in physical therapy is far from optimal, which has consequences for the effectiveness and efficiency of physical therapy care. Programmes to enhance guideline adherence have, so far, been relatively ineffective. We systematically developed a theory-based Quality Improvement in Physical Therapy (QUIP) programme aimed at the individual performance level (practicing physiotherapists; PTs) and the practice organization level (practice quality manager; PQM). The aim of the study was to pilot test the multilevel QUIP programme's effectiveness and the fidelity, acceptability and feasibility of its implementation. METHODS: A one-group, pre-test, post-test pilot study (N = 8 practices; N = 32 PTs, 8 of whom were also PQMs) done between September and December 2009. Guideline adherence was measured using clinical vignettes that addressed 12 quality indicators reflecting the guidelines' main recommendations. Determinants of adherence were measured using quantitative methods (questionnaires). Delivery of the programme and management changes were assessed using qualitative methods (observations, group interviews, and document analyses). Changes in adherence and determinants were tested in the paired samples T-tests and expressed in effect sizes (Cohen's d). RESULTS: Overall adherence did not change (3.1%; p = .138). Adherence to three quality indicators improved (8%, 24%, 43%; .000 ≤ p ≤ .023). Adherence to one quality indicator decreased (-15.7%; p = .004). Scores on various determinants of individual performance improved and favourable changes at practice organizational level were observed. Improvements were associated with the programme's multilevel approach, collective goal setting, and the application of self-regulation; unfavourable findings with programme deficits. The one-group pre-test post-test design limits the internal validity of the study, the self-selected sample its external validity. CONCLUSIONS: The QUIP programme has the potential to change physical therapy practice but needs considerable revision to induce the ongoing quality improvement process that is required to optimize overall guideline adherence. To assess its value, the programme needs to be tested in a randomized controlled trial.