Oostendorp Rob A B, Elvers J W Hans, van Trijffel Emiel, Rutten Geert M, Scholten-Peeters Gwendolyne G M, Heijmans Marcel, Hendriks Erik, Mikolajewska Emilia, De Kooning Margot, Laekeman Marjan, Nijs Jo, Roussel Nathalie, Samwel Han
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Patient Prefer Adherence. 2020 Mar 2;14:425-442. doi: 10.2147/PPA.S234800. eCollection 2020.
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.
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.
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: >0.25 [minimum: fair]; α-value = 0.05).
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 >0.50; p≤0.00) were found between "pain coping" and "fear avoidance" as process variables, and "pain intensity" and "functioning" as outcome variables.
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.
质量指标（QIs）是实践表现的可衡量要素，可能与背景、过程、结果和结构相关。已经制定了一套有效的质量指标，反映了初级保健物理治疗中用于鞭打相关疾病（WAD）患者的临床推理。Donabedian模型假设了护理质量各要素之间的关系，形成一个良性循环。
探讨背景、过程和结果指标之间的关系在评估WAD患者初级保健物理治疗中的相对强度。
通过患者记录，在16年的时间里收集了初级保健物理治疗机构中WAD患者（N = 810）的数据。这个常规收集的数据集（RCD-WAD）被分类为背景、过程和结果变量，并进行回顾性分析。基于专家共识选择临床相关变量。使用零阶相关，将关联表示为Spearman等级相关系数（标准：>0.25[最低：一般]；α值=0.05）。
在第一轮中，85个变量中的62个（72.9%）被专家小组选为与临床推理相关；在第二轮中，62个变量中的34个（54.8%）（背景变量18个中的9个[50.0%]；过程变量34个中的18个[52.9%]；结果变量10个中的8个[90.0%]）被选为高度相关。所选背景和过程变量之间的关联范围为0.27至0.53（p≤0.00），所选背景和结果变量之间的关联范围为0.26至0.55（p≤0.00），所选过程和结果变量之间的关联范围为0.29至0.59（p≤0.00）。在作为过程变量的“疼痛应对”和“恐惧回避”之间，以及作为结果变量的“疼痛强度”和“功能”之间，发现了中度关联（>0.50；p≤0.00）。
所选背景、过程和结果变量之间确定的关联为一般至中度。正在进行的工作可能会阐明其中一些关联，并就如何根据WAD患者管理中背景、过程和结果之间的关系，以最佳方式提高临床推理质量为物理治疗师提供指导。
