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BackgroundIn many countries, the need for physical therapists to use standardised measures has been recognised and is recommended in clinical practice guidelines. Research has shown a lack of clinimetric knowledge and clinical application of measurement instruments in daily practice may hamper implementation of these guidelines.ObjectivesThe aims of our study were a) to investigate the current use of measurement instruments by Dutch physical therapists; b) to investigate the facilitators and barriers in using measurement instruments.MethodsTo get a complete and valid overview of relevant barriers and facilitators, different methods of data collection were used. We conducted a literature search, semi-structured interviews with 20 physical therapists and an online survey.ResultsFacilitators are the fact that most therapists indicated a positive attitude and were convinced of the advantages of the use of measurement instruments. The most important barriers to the use of measurement instruments included physical therapists' competence and problems in changing behaviour, practice organisation (no room; no time) and the unavailability and feasibility of measurement instruments. Furthermore, physical therapists indicated the need to have a core set of measurement instruments with a short user's instruction on application, scoring and interpretation.ConclusionsThe main barriers are on the level of the physical therapist (lack of knowledge; not focusing on the use of outcome measures) and organisation (lack of time; availability; lack of management support).There seems to be a disparity between what physical therapists say and what they do. The majority of participating physical therapists indicated a positive attitude and were convinced of the advantages of the use of measurement instruments. However, the main problem for physical therapists is when to use which instrument for what patient (lack of knowledge). Furthermore, physical therapists indicated a need to compile a core set of measurement instruments with instructions concerning application, scoring and interpretation. Based on the identified factors, a number of strategies will be developed and evaluated in future studies.

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Purpose: To describe the development of an educational programme for physiotherapists in the Netherlands, two toolkits of measurement instruments, and the evaluation of an implementation strategy. Method: The study used a controlled pre- and post-measurement design. A tailored educational programme for the use of outcome measures was developed that consisted of four training sessions and two toolkits of measurement instruments. Of 366 invited physiotherapists, 265 followed the educational programme (response rate 72.4%), and 235 randomly chosen control physiotherapists did not (28% response rate). The outcomes measured were participants' general attitude toward measurement instruments, their ability to choose measurement instruments, their use of measurement instruments, the applicability of the educational programme, and the changes in physiotherapy practice achieved as a result of the programme. Results: Consistent (not occasional) use of measurement instruments increased from 26% to 41% in the intervention group; in the control group, use remained almost the same (45% vs 48%). Difficulty in choosing an appropriate measurement instrument decreased from 3.5 to 2.7 on a 5-point Likert-type scale. Finally, 91% of respondents found the educational programme useful, and 82% reported that it changed their physiotherapy practice. Conclusions: The educational programme and toolkits were useful and had a positive effect on physiotherapists' ability to choose among many possible outcome measures.

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PurposeTo empirically define the concept of burden of neck pain. The lack of a clear understanding of this construct from the perspective of persons with neck pain and care providers hampers adequate measurement of this burden. An additional aim was to compare the conceptual model obtained with the frequently used Neck Disability Index (NDI).MethodsConcept mapping, combining qualitative (nominal group technique and group consensus) and quantitative research methods (cluster analysis and multidimensional scaling), was applied to groups of persons with neck pain (n = 3) and professionals treating persons with neck pain (n = 2). Group members generated statements, which were organized into concept maps. Group members achieved consensus about the number and description of domains and the researchers then generated an overall mind map covering the full breadth of the burden of neck pain.ResultsConcept mapping revealed 12 domains of burden of neck pain: impaired mobility neck, neck pain, fatigue/concentration, physical complaints, psychological aspects/consequences, activities of daily living, social participation, financial consequences, difficult to treat/difficult to diagnose, difference of opinion with care providers, incomprehension by social environment, and how person with neck pain deal with complaints. All ten items of the NDI could be linked to the mind map, but the NDI measures only part of the burden of neck pain.ConclusionThis study revealed the relevant domains for the burden of neck pain from the viewpoints of persons with neck pain and their care providers. These results can guide the identification of existing measurements instruments for each domain or the development of new ones to measure the burden of neck pain.

The objective of this study is to provide a critical overview of available instruments to assess impairments in patients with rheumatic disorders, and to recommend reliable and valid instruments for use in allied health care and rehabilitation medicine. A computer-aided literature search in several databases was performed to identify studies focusing on the clinimetric properties of instruments designed to assess impairments in function in patients with rheumatic disorders. Data on intra-rater reliability, interrater reliability and construct validity were extracted in a standardized way. Explicit criteria were applied for reliability and validity. Results: The search identified a total of 49 instruments to assess impairments in functions in patients with rheumatic disorders; 19 met the criteria for reliability, 22 met the criteria for validity, and 11 out of the 49 appeared to meet the criteria for both reliability and validity. In summary, evidence of both reliability and validity was only found for 11 out of 49 instruments for the assessment of impairments in patients with rheumatic disorders. Only a limited number of the identified instruments for the assessment of impairments is both reliable and valid. Allied health care professionals should be cautious in the selection of measurement instruments to assess their patients.

Samenvatting Dit artikel pretendeert niet alle problemen rond vragenlijsten op te lossen, maar geprobeerd wordt de problemen hieromtrent enigszins te structureren. Daarbij komt in het bijzonder de vraag aan de orde 'wat is het doel van het meten?' en 'hoe kies ik het meest geschikte meetinstrument bij dat doel?'. In vervolgnummers van Stimulus zal met regelmaat een vragenlijst specifiek worden belicht, of een set van vragenlijsten worden toegelicht aan de hand van een casusbespreking. Daarin komen andere aspecten naar voren, zoals de methodologische kwaliteit, problemen bij de interpretatie van een score en dergelijke. InleidingDe afgelopen dertig jaar is er een indrukwekkend aantal vragenlijsten ontwikkeld, aanvankelijk eigenlijk alleen voor gebruik bij wetenschappelijk onderzoek. Het afgelopen decennium groeide de belangstelling voor gebruik van deze vragenlijsten voor klinische doeleinden in de dagelijkse praktijk. De poging om de fysiotherapie/kinesitherapie op wetenschappelijke basis te profileren is daarbij een grote stimulerende factor geweest.In dit artikel wordt voornamelijk getracht bij te dragen aan het oplossen van het probleem hoe een keuze te maken uit het grote aanbod. Hierbij doen zich twee soorten problemen voor: keuzeproblemen op grond van de methodologische kwaliteit en die op grond van de inhoud: wanneer gebruik ik welke vragenlijst bij wie en waarom?Hierna wordt ingegaan op het doel van vragenlijsten en op de problemen bij het maken van een keuze uit het grote aanbod. Daarna wordt de International Classification of Functioning, Disability and Health (ICF) kort in de context geplaatst van het gebruik van meetinstrumenten. Vervolgens zal aan de hand van het op de ICF gebaseerd gezondheidsprofiel worden beschreven welke soorten meetinstrumenten er zijn en hoe men deze kan classificeren. Tot slot wordt een leidraad gegeven waarmee men de meest geschikte meetinstrumenten kan selecteren.