Guideline adherence in physical therapy: a systematic review

Abstract

Background: The development and use of evidence based clinical practice guidelines is widely advocated. Adherence with guidelines seems however to be moderate. To date no review has been published addressing the latest state of the art of adherence with clinical practice state of the art guidelines in physical therapy or even with non-evidence based statements, protocols or treatment methods. The aim of this systematic review is to establish the contemporary stand of adherence in physical therapy with these guidelines, to compare the adherence rates and the methods used to assess adherence and to assess whether and how validity and reliability of the assessment instruments are established. Methods: A literature search on Pubmed, Cochrane Central register of Controlled Trials, EMBASE, CINAHL, PsycINFO, PEDro, ERIC, Health Psychosocial Instrument (HaPI), Social Sciences Citation Index (SSCI), Science Citation Index Expanded, BMJ Clinical Evidence and Google. Inclusion criteria were 1) participants had to be PT’s and 2) studies had to be written in English, German or Dutch. Results: Out of 350 references 72 studies were included. Studies varied concerning study methods and adherence assessment methods used, the way adherence was classified i.e. what was considered to be adherence, the adherence scoring or rating method, the type of performance activities or the aspects of care, the kind of activity or if concerning diagnostic or treatment activities what condition, aspects of care, guideline or treatment method was addressed. Next to that, there were differences in reporting and whether items were operationalised, validated and /or reliability was tested. Adherence rates varied, ranging from 1% to 100%. Conclusions: The differences of methods used for assessing and reporting adherence makes a fair comparison impossible and highlights the lack of a uniform method to do so. These differences provide substance for recommendations to create such methods.