1.Development and validation of quality indicators FT COPD-care
Introduction: In the Netherlands over 300.000 patients are diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Many of these patients are treated by physiotherapists within a multidisciplinary setting. A COPD evidence-based guideline for physiotherapists has been developed to support in clinical decision making. However, it is unclear, whether physiotherapists adhere to recommendations in the guideline. To measure this adherence quality indicators are developed and validated.
Methods: The RAND modified Delphi method was used to develop quality indicators based on recommendations of the COPD-guideline. Experts were used to establish content validity of the indicators. Feasibility, discrimination ability, and adherence to the quality indicators was measured using patient case vignettes. The vignettes were specifically designed for this study based on existing patients. Scores for adhering to the indicators were derived from answers to dosed multiple-choice questions for clinical decision making based on the presented vignettes. The case vignettes were distributed among 76 physiotherapists in three regions in the Netherlands.
Results: Fifty nine potential quality indicators were identified from the recommendations of the COPD-guideline. Content validity was established by an expert panel that selected 21 process indicators in two written rounds and a consensus meeting. These process indicators were built in three patient case vignettes representing mild, moderate and severe patients with COPD. Sixty five physiotherapists (85%) completed the case vignettes showing feasibility of the indicators. Interquartile range was > 1 in 42 out of 50 eligible indicator scores (84%). GOLD stage was scored correctly in 90% of the three vignettes. Average score for good adherence was 26% for assessment of physical activity, and 45% for the use of supplemented oxygen.
Discussion: This paper shows content validity for developing quality indicators using the RAND modified Delphi method. Deriving indicators from an evidence-based guideline strengthened this process. The use of real patient case vignettes appeared to be a feasible and discriminative tool to measure quality of clinical practice.
Conclusion: A set of quality indicators for physiotherapy COPD-care was tested in three patient case vignettes and turned out to be relevant, measurable, and discriminative to evaluate quality of care in patients with COPD.
2.Effectiveness of Chronic Disease Self Management Support to Stimulate Healthy Active Lifestyle in Primary Care; a Systematic Review
A sedentary lifestyle is a common risk factor for patients with chronic diseases, like asthma, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), Diabetes Mellitus (DM) type II and osteoarthritis. This specific group of patients’ in primary care are at risk for reduced mobility and activity. Regular physical activity improves ability to perform their daily activities, and might enhance their quality of life. Stimulation of a healthy active lifestyle is an important element of primary care to gain health benefits related to the specific medical condition, quality of life and well-being of patients with chronic disease.
The objective of this study was to assess the effectiveness of self management support interventions aimed at patients’ adherence to healthy active lifestyle on health outcomes in patients’ with asthma and COPD, CVD, DM-II, and osteoarthritis. This article focuses on health-related quality of life measured using the Chronic Respiratory Questionnaire (CRQ) in patients with asthma and COPD only.
Studies were identified from searches in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), DocOnline, PEDro database, PsycINFO and ERIC. Reference lists were searched. Searches were current from 1985 until June 2010. Selection criteria were (randomized) controlled trials including self management support interventions to stimulate healthy active lifestyle in primary care in patients with chronic diseases. Two reviewers independently assessed study eligibility, methodological quality and extracted data.
Main results (part one: Asthma and COPD)
The reviewers found 1171 potential articles and included seven studies involving 669 patients with asthma and COPD after checking eligibility. Self management support to stimulate healthy active lifestyle was associated with increased subjective rating of quality of life measured with the CRQ total in patients with COPD only in comparison with usual care (MD 3.95; 95% CI -0.17,8.08) and in patients with asthma and COPD combined (MD 3.33; 95% CI -0.55,7.22). The effects were not statistically significant. Comparisons for the CRQ subscales showed an overall effect in patients with COPD only (MD 1.28; 95% CI 0.93,1.63) and in patients with asthma and COPD combined (MD 1.17; 95% CI 0.85,1.50).
On the disease specific CRQ total, differences did not reach statistical significance for self management support as an add-on treatment to exercise in comparison with exercise alone (MD 1.89; 95% CI -2.32, 6.11). Overall mean difference for the CRQ subscales was 0.00 (95% CI -0.06, 0.06).
Evidence from small studies of moderate methodological quality suggests that self management support to stimulate healthy active lifestyle is associated with improved quality of life measured with the CRQ. Self management support as an add-on treatment to exercise did not result in significant differences. Stimulation of healthy active lifestyle is recommended for patients with asthma and COPD because it might enhance quality of life. It is not clear why self management support as an add-on treatment to exercise is not superior to exercise alone. There is still much to be learned about self management programs in asthma and COPD. More research in large studies is required to gain insight in the mechanisms in health behaviour in patients with a chronic disease, such as asthma or COPD.||