Development of quality indicators for nonspecific low back pain in Dutch primary physiotherapy care.

Abstract

ABSTRACT Background: Improving the quality of care is an important goal in physiotherapy practice. Physiotherapists use patient-reported outcomes measurements (PROMs) for shared decision-making, goal setting and evaluating outcomes in clinical processes. PROMs could be eligible variables to develop quality indicators to provide physiotherapists insight into outcomes of treatment and to use these outcomes in continuous quality improvement.

Aim: To develop and test quality indicators to evaluate differences in outcomes of physiotherapy care using PROMs in patients with nonspecific low back pain in the Netherlands and to describe different ways to quantify and present quality indicators.

Methods: Data from the physiotherapy national registry was used (n=213.245). Data was checked for robustness. Possible indicators were change scores and minimal clinically important differences. Hierarchic multilevel analyses were used to test the ability to differentiate between physiotherapists or physiotherapist practices. Selected PROMs were Numeric Pain Rating Scale (NPRS), Quebec Back Pain Disability Scale (QBPDS), Patient Specific Complaints questionnaire (PSC). Selected case-mix adjusters were age, sex, chronicity and severity. When adjusted mean of physiotherapists or practices differed from the nationwide mean, the quality indicator had the ability to differentiate. The differences between physiotherapists or practices were measured with an Interclass Correlation Coefficient (ICC). Two ways of presentation were developed to inform the physiotherapists of their outcomes.

Results: 16.7%-40.5% of the physiotherapists had adjusted means that differed from the nationwide mean (ICC=0.16-0.36). 26.5%-45.6% of the practices had adjusted means that differed from the nationwide mean (ICC=0.15-0.20).

Conclusion: PROMs have the ability to differentiate between physiotherapists or practices for indicators. It is possible to develop quality indicators based on routine measurement of outcomes using PROMs. Both ways of presenting quality indicators give insight into the differentiation between physiotherapists or practices. Further development of national registries, possible quality indicators, subgroup analyses, and presentation is recommended before quality indicators can be implemented in daily practice.

Clinical Relevance: Quality indicators based on PROMs could be used as an opportunity to reflect on outcomes achieved and to create a learning cycle of continuous improvement.