Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Institute of Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands.
Phys Ther. 2021 Aug 1;101(8). doi: 10.1093/ptj/pzab118.
The purpose of this study was to define and select a core set of outcome-based quality indicators, accepted by stakeholders on usability and perceived added value as a quality improvement tool, and to formulate recommendations for the next implementation step.
In phase 1, 15 potential quality indicators were defined for patient-reported outcome measures and associated domains, namely the Numeric Pain Rating Scale (NPRS) for pain intensity, the Patient Specific Functioning Scale (PSFS) for physical activity, the Quebec Back Pain Disability Scale for physical functioning, and the Global Perceived Effect-Dutch Version for perceived effect. Their comparability and discriminatory characteristics were described using cohort data. In phase 2, a core set of quality indicators was selected based on consensus among stakeholders in focus group meetings.
In total, 65,815 completed treatment episodes for patients with nonspecific low back pain were provided by 1009 physical therapists from 219 physical therapist practices. The discriminability between physical therapists of all potential 15 quality indicators was adequate, with intraclass correlation coefficients between 0.08 and 0.30. Stakeholders selected a final core set of 6 quality indicators: 2 process indicators (the routine measurement of NPRS and the PSFS) and 4 outcome indicators (pretreatment and posttreatment change scores for the NPRS, PSFS, Quebec Back Pain Disability Scale, and the minimal clinically important difference of the Global Perceived Effect-Dutch Version).
This study described and selected a core set of outcome-based quality indicators for physical therapy in patients with nonspecific low back pain. The set was accepted by stakeholders for having added value for daily practice in physical therapy primary care and was found useful for quality improvement initiatives. Further studies need to focus on improvement of using the core set of outcome-based quality indicators as a quality monitoring and evaluation instrument.
Patient-reported outcome-based quality indicators developed from routinely collected clinical data are promising for use in quality improvement in daily practice.
本研究旨在定义和选择一组基于结果的核心质量指标，这些指标得到利益相关者的认可，具有可用性和感知附加值，可作为质量改进工具，并为下一步实施提出建议。
在第 1 阶段，为患者报告的结果测量及其相关领域定义了 15 个潜在的质量指标，即数字疼痛评分量表（NPRS）用于疼痛强度，特定于患者的功能量表（PSFS）用于身体活动，魁北克腰痛残疾量表用于身体功能，以及全球感知效果-荷兰语版本用于感知效果。使用队列数据描述了它们的可比性和区分特征。在第 2 阶段，根据焦点小组会议中利益相关者的共识，选择了一组核心质量指标。
共有 1009 名物理治疗师来自 219 家物理治疗实践机构，为 65815 名非特异性腰痛患者提供了完整的治疗疗程。所有 15 个潜在质量指标的物理治疗师之间的区分能力足够，组内相关系数在 0.08 至 0.30 之间。利益相关者选择了最终的核心质量指标集，包括 6 个质量指标：2 个过程指标（常规测量 NPRS 和 PSFS）和 4 个结果指标（NPRS、PSFS、魁北克腰痛残疾量表和全球感知效果荷兰语版的最小临床重要差异的治疗前和治疗后变化评分）。
本研究描述并选择了一组非特异性腰痛患者物理治疗的基于结果的核心质量指标。该指标集得到了利益相关者的认可，对物理治疗初级保健实践具有附加值，被认为对质量改进计划有用。进一步的研究需要集中在提高使用基于结果的核心质量指标作为质量监测和评估工具的效果上。
从常规收集的临床数据中开发的基于患者报告的结果的质量指标有望在日常实践中用于质量改进。
