Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

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

Authors: Geert M Rutten, Janneke Harting, L Kay Bartholomew, Angelique Schlief, Rob AB Oostendorp, Nanne K de Vries

Published in: BMC Health Services Research | Issue 1/2013

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
1.
Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J: Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999, 318 (7182): 527-530. 10.1136/bmj.318.7182.527.CrossRefPubMedPubMedCentral
2.
O’Connor PJ: Adding value to evidence-based clinical guidelines. JAMA. 2005, 294 (6): 741-743. 10.1001/jama.294.6.741.CrossRefPubMed
3.
Grol R: Successes and failures in the implementation of evidence based guidelines for clinical practice. Medical Care. 2001, 39 (8, Supplement II): II46-II54.PubMed
4.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8 (6 iii-iv): 1-72.
5.
Oxman AD, Thomson MA, Davis DA, Haynes RB: No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995, 153 (10): 1423-1431.PubMedPubMedCentral
6.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PC, Rubin HR: Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282 (15): 1458-1465. 10.1001/jama.282.15.1458.CrossRefPubMed
7.
Wensing M, Wollersheim H, Grol R: Organizational interventions to implement improvements in patient care: a structured review of reviews. Implement Sci. 2006, 1: 2-10.1186/1748-5908-1-2.CrossRefPubMedPubMedCentral
8.
Bosch M, Halfens RJ, van der Weijden T, Wensing M, Akkermans R, Grol R: Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers. Worldviews Evid Based Nurs. 2011, 8 (1): 4-14. 10.1111/j.1741-6787.2010.00187.x.CrossRefPubMed
9.
Leentjens AF, Burgers JS: [What factors are important for the successful implementation of guidelines?]. Tijdschr Psychiatr. 2008, 50 (6): 329-335.PubMed
10.
Baiardini I, Braido F, Bonini M, Compalati E, Canonica GW: Why do doctors and patients not follow guidelines?. Curr Opin Allergy Clin Immunol. 2009, 9 (3): 228-233. 10.1097/ACI.0b013e32832b4651.CrossRefPubMed
11.
Grol R, Cluzeau FA, Burgers JS: Clinical practice guidelines: towards better quality guidelines and increased international collaboration. Br J Cancer. 2003, 89 (Suppl 1): S4-S8.CrossRefPubMedPubMedCentral
12.
Hakkennes S, Dodd K: Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care. 2008, 17 (4): 296-300. 10.1136/qshc.2007.023804.CrossRefPubMed
13.
Rebbeck T, Maher CG, Refshauge KM: Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial. Aust J Physiother. 2006, 52 (3): 165-174. 10.1016/S0004-9514(06)70025-3.CrossRefPubMed
14.
Bekkering GE, Hendriks HJM, van Tulder MW, Knol DL, Hoeijenbos M, Oostendorp RAB, Bouter LM: The effect on the process of care of an active strategy to implement the clinical guidelines on physiotherapy for low back pain: a cluster-randomised controlled trial. Qual Saf Health Care. 2005, 14: 107-112. 10.1136/qshc.2003.009357.CrossRefPubMedPubMedCentral
15.
Stevenson K, Lewis M, Hay E: Does physiotherapy management of low back pain change as a result of an evidence-based educational programme?. J Eval Clin Pract. 2006, 12 (3): 365-375. 10.1111/j.1365-2753.2006.00565.x.CrossRefPubMed
16.
Bosch M, Dijkstra R, Wensing M, van der Weijden T, Grol R: Organizational culture, team climate and diabetes care in small office-based practices. BMC Health Serv Res. 2008, 8: 180-10.1186/1472-6963-8-180.CrossRefPubMedPubMedCentral
17.
Michie S, Prestwich A: Are interventions theory-based? Development of a theory coding scheme. Health Psychol. 2010, 29 (1): 1-8.CrossRefPubMed
18.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, and Group, o. b. o. t. P. T.: Making psychological theory usefull for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155.CrossRefPubMedPubMedCentral
19.
Solberg LI, Brekke ML, Fazio CJ, Fowles J, Jacobsen DN, Kottke TE, Mosser G, O’Connor PJ, Ohnsorg KA, Rolnick SJ: Lessons from experienced guideline implementers: attend to many factors and use multiple strategies. Jt Comm J Qual Improv. 2000, 26 (4): 171-188.PubMed
20.
Grol RP, Bosch MC, Hulscher ME, Eccles MP, Wensing M: Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007, 85 (1): 93-138. 10.1111/j.1468-0009.2007.00478.x.CrossRefPubMedPubMedCentral
21.
Hulscher ME, van der Meer JW, Grol RP: Antibiotic use: how to improve it?. Int J Med Microbiol. 2010, 300 (6): 351-356. 10.1016/j.ijmm.2010.04.003.CrossRefPubMed
22.
Bekkering GE, Hendriks HJM, Koes BW, Oostendorp RAB, Ostelo RWJG, Thomassen J, Van Tulder MW: KNGF-richtlijn Lage-rugpijn. Ned Tijdschr Fysiother. 2001, 111 (3 Suppl): 1-24.
23.
Heijmans M, Hendriks E, Van der Esch M, Pool-Goudzwaard A, Scholten Peeters G, Van Tulder M, De Wijer A, Oostendorp R: KNGF-richtlijn manuele therapie bij Lage-rugpijn. Ned Tijdschr Fysiother. 2003, 113 (6 Suppl): 1-40.
24.
25.
Swinkels I, Van den Ende C, Van den Bosch W, Dekker J, Wimmers R: Physiotherapy management of low back pain: does practice match the Dutch guidelines?. Aust J Physiother. 2005, 51 (2): 35-41.CrossRefPubMed
26.
Rutten GM, Degen S, Hendriks EJ, Braspenning JC, Harting J, Oostendorp RA: Adherence to clinical practice guidelines for low back pain in physical therapy: do patients benefit?. Phys Ther. 2010, 90 (8): 1111-1122. 10.2522/ptj.20090173.CrossRefPubMed
27.
Fritz JM, Cleland JA, Brennan GP: Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists?. Med Care. 2007, 45 (10): 973-980. 10.1097/MLR.0b013e318070c6cd.CrossRefPubMed
28.
Green LW, Kreuter MW: Health promotion planning: An educational and ecological approach. 1999, Mountain View, CA: Mayfield Publishing Company
29.
Rogers E: Diffusion of innovations. 1995, New York: The Free Press, 4
30.
Harting J, Rutten GM, Rutten ST, Kremers SP: A qualitative application of the diffusion of innovations theory to examine determinants of guideline adherence among physical therapists. Phys Ther. 2009, 89 (3): 221-232. 10.2522/ptj.20080185.CrossRefPubMed
31.
Rutten G, Kremers S, Rutten S, Harting J: A theory-based cross-sectional survey demonstrated the important role of awareness in guideline implementation. J Clin Epidemiol. 2009, 62 (2): 167-176. 10.1016/j.jclinepi.2008.04.004. e1CrossRefPubMed
32.
WHO: International Classification of Functioning, Disability and Health - ICF. 2001, Geneva: World Health Organization
33.
Bartholomew LK, Parcel GS, Kok G, Gottlieb NH: Planning health promotion programs. An intervention mapping approach. 2006, San Fransisco: Jossey-Bass, 2
34.
Steckler A, Linnan L: Process Evaluation for Public Health Interventions and Research. 2002, San Francisco: Jossey-Bass Publishers
35.
Rutten G: Settting and keeping the professional system in motion. Using intervention mapping to develop a theory-based programme to improve guideline adherence in physical therapy [PhD thesis]. 2012, Nijmegen: Scientific Institute for Quality of Healthcare (IQhealthcare), Radboud University Nijmegen Medical Centre
36.
Polit DF, Beck CT: Nursing Research, Principles and Methods. 2004, Philadelphia: J.B. Lippincott Company, 7
37.
Rutten GMJ, Harting J, Rutten STJ, Bekkering GE, Kremers SPJ: Measuring physiotherapists’ guideline adherence by means of clinical vignettes: a validation study. J Eval Clin Pract. 2006, 12 (5): 491-500. 10.1111/j.1365-2753.2006.00699.x.CrossRefPubMed
38.
Cohen J: Statistical power analysis for the behavioral sciences. 1988, Hillsdale, NJ: Lawrence Erlbaum Associates
39.
40.
Lawrence M, Olesen F: Indicators of quality health care. Eur J Gen Pract. 1997, 3: 103-108. 10.3109/13814789709160336.CrossRef
41.
Goel V: Anatomy of deductive reasoning. Trends Cogn Sci. 2007, 11 (10): 435-441. 10.1016/j.tics.2007.09.003.CrossRefPubMed
42.
Dunlop W, Cortina J, Vaslow J, Burke M: Meta analysis of experiments with matched groups or repeated measures designs. Psych Meth. 1996, 1: 170-177.CrossRef
43.
Lipsey M: Design Sensitivity: Statistical Power for Experimental Research. 1990, Newbury Park, CA: Sage Publications
44.
Van Peet AAJ, Van den Wittenboer GLM, Hox JJ: Toegepaste statistiek: Inductieve technieken. 1997, Groningen: Wolters-Noordhoff
45.
Kraemer HC, Mintz J, Noda A, Tinklenberg J, Yesavage JA: Caution regarding the use of pilot studies to guide power calculations for study proposals. Arch Gen Psychiatry. 2006, 63 (5): 484-489. 10.1001/archpsyc.63.5.484.CrossRefPubMed
46.
Field A: Discovering statistics using SPSS. 2005, Londen: Sage Publications Ltd, 2
47.
Adams AS, Soumerai SB, Lomas J, Ross-Degnan D: Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care. 1999, 11: 187-192. 10.1093/intqhc/11.3.187.CrossRefPubMed
48.
Maue SK, Segal R, Kimberlin CL, Lipowski EE: Predicting physician guideline compliance: an assessment of motivators and perceived barriers. Am J Manag Care. 2004, 10 (6): 383-391.PubMed
49.
Luck J, Peabody JW: Using standardised patients to measure physicians’ practice: validation study using audio recordings. BMJ. 2002, 325: 679-683. 10.1136/bmj.325.7366.679.CrossRefPubMedPubMedCentral
50.
Sandvik H: Criterion validity of responses to patient vignettes: an analysis based on management of female urinary incontinency. Fam Med. 1995, 27 (6): 388-392.PubMed
51.
Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M: Comparison of vignettes, standardised patients and chart abstraction. A prospective validation study of 3 methods for measuring quality. JAMA. 2000, 283: 1715-1722. 10.1001/jama.283.13.1715.CrossRefPubMed
52.
Peabody JW, Luck J, Glassman P, Jain S, Hansen J, Spell M, Lee M: Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med. 2004, 141: 771-780. 10.7326/0003-4819-141-10-200411160-00008.CrossRefPubMed
53.
54.
Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003, 362 (9391): 1225-1230. 10.1016/S0140-6736(03)14546-1.CrossRefPubMed
55.
Stevens JG, Beurskens AJ: Implementation of measurement instruments in physical therapist practice: development of a tailored strategy. Phys Ther. 2010, 90 (6): 953-961. 10.2522/ptj.20090105.CrossRefPubMed
56.
Vancouver J: Self-regulation in organizational settings. A tale of two paradigms. Handbook of Self Regulation. Edited by: Boekaerts M, Pintrich P, Zeidner M. 2005, San Diego: Elsevier Academic Press, 303-341.
57.
Francke AL, Smit MC, de Veer AJ, Mistiaen P: Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008, 8: 38-10.1186/1472-6947-8-38.CrossRefPubMedPubMedCentral
58.
Shaw WS, Pransky G, Patterson W, Winters T: Early disability risk factors for low back pain assessed at outpatient occupational health clinics. Spine. 2005, 30 (5): 572-580. 10.1097/01.brs.0000154628.37515.ef.CrossRefPubMed
59.
Heneweer H, Aufdemkampe G, van Tulder MW, Kiers H, Stappaerts KH, Vanhees L: Psychosocial variables in patients with (sub)acute low back pain: an inception cohort in primary care physical therapy in The Netherlands. Spine (Phila Pa 1976). 2007, 32 (5): 586-592. 10.1097/01.brs.0000256447.72623.56.CrossRef
60.
Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM: Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011, 378 (9802): 1560-1571. 10.1016/S0140-6736(11)60937-9.CrossRefPubMedPubMedCentral
61.
Locke EA, Latham GP: Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. Am Psychol. 2002, 57 (9): 705-717.CrossRefPubMed
62.
Evans DW, Foster NE, Underwood M, Vogel S, Breen AC, Pincus T: Testing the effectiveness of an innovative information package on practitioner reported behaviour and beliefs: the UK Chiropractors, Osteopaths and Musculoskeletal Physiotherapists Low back pain ManagemENT (COMPLeMENT) trial [ISRCTN77245761]. BMC Musculoskelet Disord. 2005, 6: 41-10.1186/1471-2474-6-41.CrossRefPubMedPubMedCentral
63.
Grimshaw JM, Zwarenstein M, Tetroe JM, Godin G, Graham ID, Lemyre L, Eccles MP, Johnston M, Francis JJ, Hux J, O’Rourke K, Legare F, Presseau J: Looking inside the black box: a theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM) to improve referral and prescribing practices in primary care in Ontario, Canada. Implement Sci. 2007, 2: 38-10.1186/1748-5908-2-38.CrossRefPubMedPubMedCentral
64.
Ouwens M, Hermens R, Hulscher M, Vonk-Okhuijsen S, Tjan-Heijnen V, Termeer R, Marres H, Wollersheim H, Grol R: Development of indicators for patient-centred cancer care. Support Care Cancer. 2009, 18 (1): 121-130.CrossRefPubMedPubMedCentral
65.
O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis DA, Haynes RB, Harvey EL: Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007, CD000409-4
66.
Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD: Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009, CD003030-2
67.
Ouelette J, Wood W: Habit and intention in everyday life: the multiple processes by which past behavior predicts future behavior. Psychol Bull. 1998, 124 (1): 54-74.CrossRef
Metadata
Title
Evaluation of the theory-based Quality Improvement in Physical Therapy (QUIP) programme: a one-group, pre-test post-test pilot study
Authors
Geert M Rutten
Janneke Harting
L Kay Bartholomew
Angelique Schlief
Rob AB Oostendorp
Nanne K de Vries
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-194

Other articles of this Issue 1/2013

BMC Health Services Research 1/2013 Go to the issue

Research article

The role of a student-run clinic in providing primary care for Calgary’s homeless populations: a qualitative study

Research article

The relationship between number of primary health care visits and hospitalisations: evidence from linked clinic and hospital data for remote Indigenous Australians

Research article

Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental health care settings: a validity study

Research article

Mapping the concept of vulnerability related to health care disparities: a scoping review

Research article

Does implementation of a hospitalist program in a Canadian community hospital improve measures of quality of care and utilization? an observational comparative analysis of hospitalists vs. traditional care providers

Research article

Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis