Guideline-based development and practice test of quality indicators for physiotherapy care in patients with neck pain

J Eval Clin Pract. 2013 Dec;19(6):1044-53. doi: 10.1111/jep.12025. Epub 2013 Mar 19.


Rationale, aims and objectives: Little is currently known about the quality of physiotherapy care for patients with musculoskeletal pain. Neck pain was used as an example. The aim is to develop a set of quality indicators, including a practice test.

Methods: A systematic method is used to develop potential process and outcome indicators. An expert and user panel is used to appraise the potential quality indicators regarding clarity, relevancy, feasibility, acceptability and improvement potential. An invitation to participate in the practice test was sent to physiotherapy practices. The resulting algorithm is used to calculate the degree to which physiotherapists met these indicators (0-100%). Differences in valid outcomes are tested for significance (Student's t-test; α = 0.05) and compared with established values for clinical relevance [minimal clinically important change (MCIC)].

Results: A representative set of 40 quality indicators (28 process indicators and 12 outcome indicators) is selected from 44 initial guidelines and literature-based recommendations. The process indicators (n = 28) are classified per step of the clinical reasoning process of physiotherapy care. Of the 106 potential participants from 27 practices, 38 physiotherapists (35.8%) submitted data on 96 patients with non-specific neck pain. On average, the participating physiotherapists showed a 55.6% adherence to process indicators with a great variation in scores per step of the clinical reasoning process. The outcomes for 'pain', 'headache' and 'daily functioning' were significantly better compared with baseline, and the mean differences exceeded established values for MCICs.

Conclusion: Guardedly, we can conclude that a systematic approach is a valuable means to develop a preliminary set of process and outcome indicators for physiotherapy care for patients with non-specific neck pain, and a practice test should be an intrinsic part of such a systematic approach as it provides valuable information on the key attributes of the set indicators.

Keywords: guideline adherence; neck pain; physiotherapy; process and outcome; quality indicator.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Protocols
  • Female
  • Guideline Adherence*
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / rehabilitation*
  • Outcome and Process Assessment, Health Care
  • Physical Therapy Modalities / standards*
  • Practice Guidelines as Topic*
  • Quality Indicators, Health Care*