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Open Access Research article

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

Geert M Rutten1*, Janneke Harting2, L Kay Bartholomew3, Angelique Schlief4, Rob AB Oostendorp4 and Nanne K de Vries1

Author Affiliations

1 Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands

2 Department of Public Health, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands

3 Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas, Houston, TX, USA

4 Scientific Institute for Quality in Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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BMC Health Services Research 2013, 13:194  doi:10.1186/1472-6963-13-194

Published: 25 May 2013

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.

Keywords:
Guideline implementation; Quality improvement; Multilevel programme; Individual professional; Practice management; Physical therapy