Development of a Standard Set of Outcome Domains and Proposed Measures for Chronic Obstructive Pulmonary Disease in Primary Care Physical Therapy Practice in the Netherlands: a Modified RAND/UCLA Appropriateness Method

Int J Chron Obstruct Pulmon Dis. 2019 Nov 28;14:2649-2661. doi: 10.2147/COPD.S219851. eCollection 2019.


Background: Standardization of measures in a common set opens the opportunity to learn from differences in treatment outcomes which can be used for improving the quality of care. Furthermore, a standard set can provide the basis for development of quality indicators and is therefore useful for quality improvement and public reporting purposes. The aim of this study was to develop a standard set of outcome domains and proposed measures for patients with COPD in Dutch primary care physical therapy practice, including a proposal to stratify patients in subgroups.

Material and methods: A consensus-driven modified RAND-UCLA appropriateness method was conducted with relevant stakeholders (patients, physical therapists, researchers, policy makers and health insurers) in Dutch primary physical therapy care in eight steps: (1) literature search, (2) first online survey, (3) patient interviews, (4) expert meeting, resulting in a concept standard set and methods to identify subgroups' (5) consensus meeting, (6) expert meeting (7) second online survey and (8) final approval of an advisory board resulting of the approved standard set.

Results: Five outcome domains were selected for COPD: physical capacity, muscle strength, physical activity, dyspnea and quality of life. A total of 21 measures were rated and discussed. Finally, eight measures were included, of which four mandatory measures: Characteristics of practices and physical therapists, Clinical COPD Questionnaire (CCQ) for quality of life, Global Perceived Effect (GPE) for experience, 6-mins Walk Test (6-MWT) for physical capacity; two conditional measures: Hand-Held Dynamometer (HHD) (with Microfet™) for Quadriceps strength, Medical Research Council Dyspnea (MRC) for monitoring dyspnea; and two exploratory measures: Accelerometry for physical activity, and the Assessment of Burden of COPD tool (ABC). To identify subgroups, a method described in the Dutch standard of care from the Lung Alliance was included.

Conclusion: This study described the development of a standard set of outcome domains and proposed measures for patients with COPD in primary care physical therapy. Each measure was accepted for relevance and feasibility by the involved stakeholders. The set is currently used in daily practice and tested on validity and reliability in a pilot for the development of quality indicators.

Keywords: COPD; Delphi; PREMs; PROMs; outcome domains; quality measures; standard set.

Publication types

  • Consensus Development Conference
  • Review

MeSH terms

  • Actigraphy / standards*
  • Consensus
  • Delphi Technique
  • Dyspnea / diagnosis
  • Dyspnea / physiopathology
  • Dyspnea / psychology
  • Dyspnea / therapy*
  • Exercise Test / standards*
  • Health Status
  • Humans
  • Lung / physiopathology*
  • Mental Health
  • Muscle Strength
  • Muscle Strength Dynamometer / standards
  • Netherlands
  • Patient Reported Outcome Measures*
  • Physical Fitness
  • Physical Therapy Modalities / standards*
  • Predictive Value of Tests
  • Primary Health Care / standards*
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Quality Improvement / standards
  • Quality Indicators, Health Care / standards
  • Quality of Life
  • Treatment Outcome

Grant support

Funding support for this study was provided by Dutch health insurer CZ. The sponsor had no influence on the process or outcomes of the paper.