Scientific Institute for Quality in Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQhealthcare, 6500 HB Nijmegen, the Netherlands.
Phys Ther. 2010 Aug;90(8):1111-22. doi: 10.2522/ptj.20090173. Epub 2010 May 20.
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.
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.
This was an observational prospective cohort study (2005-2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients.
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.
Higher percentages of adherence were associated with fewer functional limitations (beta=-0.21, P=.023) and fewer treatment sessions (beta=-0.27, P=.005).
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.
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.
为了提高医疗护理的效果和效率，已经制定了各种针对腰痛管理的指南。然而，有循证医学证据表明，遵循指南的护理并不能确保获得更好的健康结果。
本研究的主要目的是评估荷兰针对腰痛的物理治疗和手法治疗指南的遵循程度与改善结局之间是否存在关联。本研究还进一步探讨了这种关系是否因护理过程的各个步骤以及不同患者亚组而存在差异。
这是一项在荷兰进行的观察性前瞻性队列研究（2005-2006 年），纳入了 61 名私人执业治疗师和 145 名患者。
治疗师在基于网络的患者档案中记录护理过程和治疗次数。使用质量指标评估指南遵循程度。使用荷兰版魁北克腰痛和残疾量表评估躯体功能，使用视觉模拟评分法评估平均疼痛程度。使用回归分析评估指南遵循程度与护理结局之间的关系。
更高的指南遵循率与较少的功能受限（β=-0.21，P=.023）和较少的治疗次数（β=-0.27，P=.005）相关。
相对较小的自我选择样本可能会限制外部有效性，但预计样本较小不会对研究的内部有效性产生重大影响。需要更大的样本量才能进行充分的亚组分析。
结果表明，更高的指南遵循率与躯体功能的改善程度更好和护理利用度更低相关。要正确评估物理治疗护理过程与结局之间的关系，可能需要一套全面的过程指标来衡量指南遵循程度。
