Rutten Geert, Kremers Stef, Rutten Steven, Harting Janneke
Department of IQ Healthcare, Nijmegen Medical Centre, Radboud University, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands.
J Clin Epidemiol. 2009 Feb;62(2):167-176.e1. doi: 10.1016/j.jclinepi.2008.04.004. Epub 2008 Sep 10.
To assess physiotherapists' adherence to the Dutch guidelines for nonspecific low back pain, the motivational determinants related to guideline adherence, and the role of physiotherapists' awareness of their performance in this respect.
STUDY DESIGN & SETTING: This was a cross-sectional survey among a random sample of 1,500 private practice physiotherapists in the Netherlands. The actual guideline adherence was measured by means of validated clinical vignettes and self-reported adherence by asking the physiotherapists to report their own level of adherence. The assessment of motivational determinants was based on a theoretical framework.
The response rate was 31.5% (N=472). The average guideline adherence rate was 50.4% (SD=16.8). Only 38.5% of the physiotherapists had realistic perceptions of their personal performance. Awareness levels seriously interfered with the relationship between motivational determinants and actual guideline adherence. Actual adherence was mainly related to the perceived relative advantages and awareness of adherence to the perceived social norm.
The moderating role of awareness in this study confirms the view that motivational determinants of a particular behavior can only be accurately assessed if people hold realistic perceptions of that behavior. Our approach illustrates the added value of a theory-based approach in guideline implementation studies.
评估物理治疗师对荷兰非特异性下背痛指南的遵循情况、与指南遵循相关的动机决定因素，以及物理治疗师在这方面对自身表现的认知所起的作用。
这是一项对荷兰1500名私人执业物理治疗师的随机样本进行的横断面调查。实际的指南遵循情况通过经过验证的临床案例进行测量，并通过要求物理治疗师报告自己的遵循水平来进行自我报告式的遵循情况调查。对动机决定因素的评估基于一个理论框架。
回复率为31.5%（N = 472）。平均指南遵循率为50.4%（标准差 = 16.8）。只有38.5%的物理治疗师对自己的个人表现有现实的认知。认知水平严重干扰了动机决定因素与实际指南遵循之间的关系。实际遵循主要与感知到的相对优势以及对感知到的社会规范的遵循认知有关。
本研究中认知的调节作用证实了这样一种观点，即只有当人们对特定行为有现实的认知时，才能准确评估该行为的动机决定因素。我们的方法说明了基于理论的方法在指南实施研究中的附加价值。
