School of Allied Health, La Trobe University, Melbourne, Australia.
School of Public Health, La Trobe University, Melbourne, Australia.
Disabil Rehabil. 2020 Apr;42(8):1173-1182. doi: 10.1080/09638288.2018.1518493. Epub 2019 Jan 22.
Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effective clinical supervision of allied health professionals improves patients' outcomes. This study investigated whether effective clinical supervision of allied health professionals is associated with improved patient functional independence. A prospective longitudinal study design and multi-level regression analysis were used to explore the association between effective clinical supervision and patient functional independence. The effectiveness of clinical supervision was assessed using the Manchester Clinical Supervision Scale. Functional improvement in patients treated by allied health professionals was measured utilising the mobility and self-care subscales of the functional independence measure. Physiotherapists ( = 27) and occupational therapists ( = 26) in inpatient rehabilitation were recruited and the medical records of their patients ( = 1846) audited. The effectiveness of clinical supervision of physiotherapists was positively associated with improvement in personal care. Therapist variables accounted for less than 2.5% of the variation in patient improvement in functional independence. Effectiveness of a reflective model of clinical supervision of physiotherapists and occupational therapists was not associated with an improvement in their patients' mobility or personal care, respectively.Implications for rehabilitationEffective clinical supervision of physiotherapists and occupational therapists using a reflective model of practice is a poor predictor of improved functional independence in rehabilitation inpatients.Patient variables, such as the intensity of therapy, were more important predictors of patient functional improvement than effective clinical supervision.Initiatives aimed at increasing intensity of therapy will likely have a greater effect on improving patient functional independence compared with initiatives aimed at improving the effectiveness of clinical supervision using a reflective model of practice.Initiatives to improve the effectiveness of clinical supervision in improving quality of care could explore the use of a direct model of practice where supervisors directly observe and support supervisees during patient treatment sessions.
临床监督被广泛认为是确保患者获得高质量医疗服务的重要环节。然而，目前尚不清楚有效的临床监督是否能改善医疗服务人员的治疗效果。本研究旨在调查医疗服务人员是否能通过有效的临床监督来提高患者的功能独立性。
采用前瞻性纵向研究设计和多级回归分析来探讨有效的临床监督与患者功能独立性之间的关系。使用曼彻斯特临床监督量表评估临床监督的有效性。使用功能独立性量表的移动和自理子量表来衡量接受医疗服务人员治疗的患者的功能改善情况。招募了在住院康复中心的物理治疗师（ = 27）和职业治疗师（ = 26），并对其患者（ = 1846）的病历进行了审核。物理治疗师临床监督的有效性与自理能力的改善呈正相关。治疗师变量仅占患者功能独立性改善差异的 2.5%以下。物理治疗师和职业治疗师的临床监督有效性与他们的患者移动或自理能力的改善之间没有相关性。
康复的意义
使用实践反思模型对物理治疗师和职业治疗师进行有效的临床监督，对改善康复住院患者的功能独立性预测效果不佳。患者变量，如治疗强度，是预测患者功能改善的重要因素，比有效的临床监督更为重要。与提高实践反思模型的临床监督有效性的措施相比，增加治疗强度的措施可能对提高患者的功能独立性产生更大的影响。提高临床监督在提高护理质量方面的有效性的措施，可以探索使用直接实践模式，在该模式中，监督者在治疗过程中直接观察和支持被监督者。
