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Outcome measures in physiotherapy management of patients with stroke: A survey into self-reported use, and barriers to and facilitators for use

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Author: Peppen, R.P.S. van · Maissan, F.J.F. · Genderen, F.R. van · Dolder, R. van · Meeteren, N.L.U. van
Institution: TNO Kwaliteit van Leven
Source:Physiotherapy Research International, 4, 13, 255-270
Identifier: 241252
doi: doi:10.1002/pri.417
Keywords: Health · Cerebrovascular disorders · Guideline · Outcome measures · Physiotherapy · Survey · adult · article · daily life activity · female · human · male · middle aged · Netherlands · organization and management · outcome assessment · physiotherapy · practice guideline · psychometry · standard · statistics · stroke · utilization review · Activities of Daily Living · Adult · Female · Guideline Adherence · Humans · Male · Middle Aged · Netherlands · Outcome Assessment (Health Care) · Physical Therapy (Specialty) · Physical Therapy Modalities · Practice Guidelines as Topic · Psychometrics · Stroke · Healthy for Life · Healthy Living


Objective. To investigate physiotherapists' self-reported use of outcome measures as recommended in the Dutch Clinical Practice Guideline on Physiotherapy Management of Patients with Stroke (CPGPS) and to assess perceived barriers to and facilitators for the use of outcome measures in everyday practice. Method. A 41-item survey, including the barriers and facilitators questionnaire (BFQ), was sent by post to 400 physiotherapists in each of the following settings in the Netherlands: acute care hospitals (ACH; n = 100), rehabilitation centres (RC; n = 100), nursing homes (NH; n = 100) and private physiotherapy practices (PPP; n = 100). Results. One hundred and eighty-nine physiotherapists returned the survey (47%; ACH, n = 57; RC, n = 67; NH, n = 26 and PPP, n = 39) and the surveys of 167 physiotherapists involved in stroke settings were analysed. These physiotherapists reported regularly using three (median; range 0-7) of the seven recommended outcome measures, with those working in RC or ACH reporting a significantly higher use than their colleagues in PPP (4 vs. 0 and 3 vs. 0; p < 0.001 and p = 0.02, respectively). The BFQ revealed that there were setting-specific facilitators, such as 'a positive attitude towards outcome measures' (as mentioned by 93% of the physiotherapists) and 'acquaintance with outcome measures' (90%), and barriers such as 'changing routines' (32%), 'time investment' (29%) and 'financial compensation' (21%). Conclusion. Despite an almost uniformly positive attitude, physiotherapists infrequently use the outcome measures recommended in the CPGPS. Robust setting-specific tailored implementation strategies based on the reported barriers and facilitators are needed. Copyright © 2008 John Wiley & Sons, Ltd.