<p>Relationships Between Context, Process, and Outcome Indicators to Assess Quality of Physiotherapy Care in Patients with Whiplash-Associated Disorders: Applying Donabedian’s Model of Care</p>

Abstract

Background: Quality indicators (QIs) are measurable elements of practice performance and may relate to context, process, outcome and structure. A valid set of QIs have been developed, reflecting the clinical reasoning used in primary care physiotherapy for patients with whiplash-associated disorders (WAD). Donabedian's model postulates relationships between the constructs of quality of care, acting in a virtuous circle. Aim: To explore the relative strengths of the relationships between context, process, and outcome indicators in the assessment of primary care physiotherapy in patients with WAD. Materials and Methods: Data on WAD patients (N=810) were collected over a period of 16 years in primary care physiotherapy practices by means of patients records. This routinely collected dataset (RCD-WAD) was classified in context, process, and outcome variables and analyzed retrospectively. Clinically relevant variables were selected based on expert consensus. Associations were expressed, using zero-order, as Spearman rank correlation coefficients (criterion: r s >0.25 [minimum: fair]; α-value = 0.05). Results: In round 1, 62 of 85 (72.9%) variables were selected by an expert panel as relevant for clinical reasoning; in round 2, 34 of 62 (54.8%) (context variables 9 of 18 [50.0%]; process variables 18 of 34 [52.9]; outcome variables 8 of 10 [90.0%]) as highly relevant. Associations between the selected context and process variables ranged from 0.27 to 0.53 (p≤0.00), between selected context and outcome variables from 0.26 to 0.55 (p≤0.00), and between selected process and outcome variables from 0.29 to 0.59 (p≤0.00). Moderate associations (r s >0.50; p≤0.00) were found between "pain coping" and "fear avoidance" as process variables, and "pain intensity" and "functioning" as outcome variables. Conclusion: The identified associations between selected context, process, and outcome variables were fair to moderate. Ongoing work may clarify some of these associations and provide guidance to physiotherapists on how best to improve the quality of clinical reasoning in terms of relationships between context, process, and outcome in the management of patients with WAD.

Developing an implementation strategy for a praziquantel mass drug administration for children aged five years and below: A conceptual framework

“…The model assess healthcare systems based on structure, process and outcomes [14]. Structure refers to resources that are used by the healthcare system such as human resources and medication [14,15]. Process refers to the chronological arrangement of activities that are accomplished by the healthcare system, for example a triaging system [14,15].…”

<p>Clinical Characteristics and Patient-Reported Outcomes of Primary Care Physiotherapy in Patients with Whiplash-Associated Disorders: A Longitudinal Observational Study</p>

“…The study was based on an existing dataset (routinely collected dataset whiplash-associated disorders [RCD-WAD]), and details of the design and execution of this retrospective cohort study have been published elsewhere. 35,36 The Medical Ethics Committee of Radboud University Medical Centre Nijmegen, The Netherlands waived the requirement for ethical approval. Retrospective research based on anonymized patient files does not fall within the scope of the Medical Research Involving Human Subjects Act because the subject is not physically involved in the research.…”

“…Three newly formulated quality indicators were added to the earlier developed and tested set of quality indicators that were already embedded in the clinical reasoning process for physiotherapy in patients with WAD. 35,36 Pain intensity was measured using the Visual Analogue Scale for Pain (VAS-P), which consists of a horizontal 100 mm line scored from 0 (no pain) to 100 (worst imaginable pain). 49,50 The minimal clinically important difference (MCID) on VAS-P is 20 mm (≥30% of the initial score).…”

“…In contrast to the prognostic profiles used here, scores on the PCI and FABQ were moderately but significantly associated with the PROs "pain intensity", "functioning" and "perceived improvement" in patients with WAD. 36 Integration of these measurement scores into the clinical reasoning process and the treatment plan, goals and modalities in the physiotherapy assessment of patients with WAD would represent a further improvement.…”

Befund und Therapie von Schleudertrauma-Patienten

“…85 % aller WAD-Patienten über Schmerzen in Nacken, Rücken sowie in den Extremitäten, welche häufig mit Kopfschmerzen und Schwindel verbunden sind [1]. Die Intensität der Symptomatikund damit auch der geeignete physiotherapeutische Behandlungsansatzhängen eindeutig mit dem Schweregrad des Schleudertraumas sowie dessen klinischem Verlauf und dem Krankheitsstadium zusammen [2]. Im Folgenden werden die Untersuchungs-und Behandlungsstrategien bei Patienten der WAD-Klassen I bis III auf Basis der bis dato vorliegenden wissenschaftlichen Erkenntnisse vorgestellt und gegebenenfalls hinterfragt.…”