scholarly journals An Innovative Peer Assessment Approach to Enhance Guideline Adherence in Physical Therapy: Single-Masked, Cluster-Randomized Controlled Trial

2015 ◽  
Vol 95 (4) ◽  
pp. 600-612 ◽  
Author(s):  
Marjo J.M. Maas ◽  
Philip J. van der Wees ◽  
Carla Braam ◽  
Jan Koetsenruijter ◽  
Yvonne F. Heerkens ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Reflective Practice ◽  
Guideline Adherence ◽  
Physical Therapists ◽  
Peer Assessment ◽  
Controlled Trial ◽  
Personal Goals ◽  
Randomized Controlled ◽  
Clinical Vignettes ◽  
Cluster Randomized

Background Clinical practice guidelines (CPGs) are not readily implemented in clinical practice. One of the impeding factors is that physical therapists do not hold realistic perceptions of their adherence to CPGs. Peer assessment (PA) is an implementation strategy that aims at improving guideline adherence by enhancing reflective practice, awareness of professional performance, and attainment of personal goals. Objective The purpose of this study was to compare the effectiveness of PA with the usual case discussion (CD) strategy on adherence to CPGs for physical therapist management of upper extremity complaints. Design A single-masked, cluster-randomized controlled trial with pretest-posttest design was conducted. Intervention Twenty communities of practice (n=149 physical therapists) were randomly assigned to groups receiving PA or CD, with both interventions consisting of 4 sessions over 6 months. Both PA and CD groups worked on identical clinical cases relevant to the guidelines. Peer assessment focused on individual performance observed and evaluated by peers; CD focused on discussion. Outcomes Guideline adherence was measured with clinical vignettes, reflective practice was measured with the Self-Reflection and Insight Scale (SRIS), awareness of performance was measured via the correlation between perceived and assessed improvement, and attainment of personal goals was measured with written commitments to change. Results The PA groups improved more on guideline adherence compared with the CD groups (effect=22.52; 95% confidence interval [95% CI]=2.38, 42.66; P=.03). The SRIS scores did not differ between PA and CD groups. Awareness of performance was greater for the PA groups (r=.36) than for the CD groups (r=.08) (effect=14.73; 95% CI=2.78, 26.68; P=.01). The PA strategy was more effective than the CD strategy in attaining personal goals (effect=0.50; 95% CI=0.04, 0.96; P=.03). Limitations Limited validity of clinical vignettes as a proxy measure of clinical practice was a limitation of the study. Conclusions Peer assessment was more effective than CD in improving adherence to CPGs. Personal feedback may have contributed to its effectiveness. Future research should address the role of the group coach.

An approach to standardize, quantify and record progress of routine upper limb therapy for stroke subjects: The Action Medical Research Upper Limb Therapy protocol

Hand Therapy ◽  
2009 ◽  
Vol 14 (3) ◽  
pp. 60-68 ◽  
Author(s):  
Sheeba B Rosewilliam ◽  
Catherine BüCher ◽  
Christine Roffe ◽  
Anand D Pandyan
Keyword(s):  
Clinical Practice ◽  
Medical Research ◽  
Upper Limb ◽  
Physical Therapists ◽  
Controlled Trial ◽  
Group Discussion ◽  
Occupational Therapists ◽  
Randomized Controlled ◽  
Stage Process ◽  
Therapy Protocol

Introduction. Explicitly describing therapy for research purposes, in terms of content and quantity, improves the validity of research and facilitates evidence-based clinical practice. However, such descriptions are not common in therapy research. The aim was to develop an upper limb therapy protocol which reflected local clinical practice in the stroke unit, and a recording form to document the content, quantity and progression of therapy. Methods. This was a multi-method study. A list of interventions commonly used for the rehabilitation of the stroke upper limb was compiled following a systematic literature search. This was then refined into the Action Medical Research Upper Limb Therapy (AMRULT) protocol in a two-stage process involving a survey and a group discussion. Six physical therapists and three occupational therapists supported its development. The AMRULT protocol was then piloted in a two-arm randomized controlled trial with 90 stroke patients for therapy and recording purposes. Results. The protocol classified therapies based on therapy input as passive, active assisted, active/strengthening and functional. Using this form it was possible to not only summarize the content of therapy but also objectively document progression (e.g. 14% of the participants progressed to functional exercises between the 5th and 8th weeks after stroke onset). Discussion. The AMRULT protocol and associated recording form were useful in both standardizing the delivery and quantification (content and progression) of therapy. While the AMRULT protocol was devised for a specific purpose, the method used can be adapted to develop protocols to support other research studies.

Effectiveness of Peer Assessment for Implementing a Dutch Physical Therapy Low Back Pain Guideline: Cluster Randomized Controlled Trial

2014 ◽  
Vol 94 (10) ◽  
pp. 1396-1409 ◽  
Author(s):  
Simone A. van Dulmen ◽  
Marjo Maas ◽  
J. Bart Staal ◽  
Geert Rutten ◽  
Henri Kiers ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Outcome Measure ◽  
Peer Assessment ◽  
Controlled Trial ◽  
Control Group ◽  
Low Back ◽  
Self Reflection ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Case Based

BackgroundClinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting.ObjectiveThe aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP).DesignA cluster randomized controlled trial was conducted.Setting and ParticipantsTen communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41).InterventionBoth groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions.MeasurementsOutcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0–100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20–100).ResultsVignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection.LimitationsThe small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study.ConclusionsPeer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.

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