First published on May 20, 2010

Physical Therapy 2010;90:1111.

Physical Therapy
DOI: 10.2522/ptj.20090173
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
ptj.20090173v1
90/8/1111    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Google Scholar
Right arrow Articles by Rutten, G. M.
Right arrow Articles by Oostendorp, R. A.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Rutten, G. M.
Right arrow Articles by Oostendorp, R. A.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Research Reports

Adherence to Clinical Practice Guidelines for Low Back Pain in Physical Therapy: Do Patients Benefit?

Geert M. Rutten, Saskia Degen, Erik J. Hendriks, Jozé C. Braspenning, Janneke Harting and Rob A. Oostendorp

G.M. Rutten, MPH, PT, MPT, is Researcher, Physical Therapist, and Manipulative Physical Therapist, Scientific Institute for Quality in Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQhealthcare, 6500 HB Nijmegen, the Netherlands, and Department of Health Promotion and Health Education/GVO, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
S. Degen, PT, MSc, is Physical Therapist, Practice for Physical Therapy FysioPlus Rozendaal, Nijmegen, the Netherlands.
E.J. Hendriks, PT, PhD, is Senior Researcher, Epidemiologist, and Health Scientist, Centre for Evidence Based Physiotherapy, Department of Epidemiology, Maastricht, University Medical Centre, Maastricht, the Netherlands.
J.C. Braspenning, PhD, is Associate Professor, Scientific Institute for Quality in Healthcare, Radboud University Nijmegen Medical Centre.
J. Harting, PhD, BA in Physiotherapy, is Postdoctoral Researcher, Department of Social Medicine, Amsterdam Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
R.A. Oostendorp, PhD, PT, MPT, is Emeritus Professor in Allied Health Sciences, Scientific Institute for Quality in Healthcare, Radboud University Nijmegen Medical Centre.

g.rutten{at}gvo.unimaas.nl

Background: Various guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health outcomes, however, is not conclusive.

Objective: The main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes. The study further explored whether this relationship differs for the individual steps of the process of care and for distinct subgroups of patients.

Design: This was an observational prospective cohort study (2005–2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients.

Methods: Therapists recorded the process of care and the number of treatment sessions in Web-based patient files. Guideline adherence was assessed using quality indicators. Physical functioning was measured by the Dutch version of the Quebec Back Pain and Disability Scale, and average pain was measured with a visual analog scale. Relationships between the percentage of guideline adherence and outcomes of care were evaluated with regression analyses.

Results: Higher percentages of adherence were associated with fewer functional limitations (β=–0.21, P=.023) and fewer treatment sessions (β=–0.27, P=.005).

Limitations: The relatively small self-selected sample might limit external validity, but it is not expected that the small sample greatly influenced the internal validity of the study. Larger samples are required to enable adequate subgroup analyses.

Conclusions: The results indicate that higher percentages of guideline adherence are related to better improvement of physical functioning and to a lower utilization of care. A proper assessment of the relationship between the process of physical therapy care and outcomes may require a comprehensive set of process indicators to measure guideline adherence.


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?