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REVIEW ARTICLE
Year : 2019  |  Volume : 24  |  Issue : 2  |  Page : 113-120

The quality of physiotherapy care: the development and application of quality indicators using scientific evidence and routinely collected data embedded in the process of clinical reasoning


1 Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen; Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physiotherapy, International Research Group - Pain in Motion-, Vrije Universiteit Brussel, Brussels, Belgium; Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, The Netherlands
2 Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
3 Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels; Department of Education, SOMT University of Physiotherapy, Amersfoort, The Netherlands; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium

Correspondence Address:
PhD, PT, MPT Rob A.B Oostendorp
Oude Kleefsebaan 325, 6572 AT Berg en Dal, The Netherlands
The Netherlands
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bfpt.bfpt_4_19

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Quality improvement has become a central tenet of physiotherapy care. Quality indicators (QIs) as measurable elements of care have been used over the past 25 years to analyze and evaluate the quality of physiotherapy care. The aim of this article is to describe the state of the art regarding the development and application of QIs in physiotherapy primary care when embedded in a clinical reasoning process. In contrast to international clinical practice guidelines, Dutch physiotherapy clinical practice guidelines are generally based on the clinical reasoning process in combination with best available evidence. Information required to develop QIs is preferably derived by combining available systematic review-based scientific evidence, guideline-based recommendations, and routinely collected data with clinical evidence, professional expertise and standards, and patient perspectives. A set of QIs (n=28) in patients with whiplash-associated disorders was developed and embedded per step of the clinical reasoning process in physiotherapy care: (a) administration (n=2); (b) history taking (n=7); (c) objectives of examination (n=1); (d) clinical examination (n=4); (e) analysis and conclusion (n=2); (f) treatment plan (n=3); (g) treatment (n=2); (h) evaluation (n=5); and (i) discharge (n=2). The use of QIs represents a useful tool for measuring the (improvement of) quality of physiotherapy primary care, as many evidentiary gaps still exist in terms of diagnostics, prognostics, and treatment, and concerning patient-related outcome measurements in different patient groups such as patients with musculoskeletal pain. The recommended set of QIs embedded in the clinical reasoning process for patients with whiplash-associated disorders can be used as a starting point for the development of a general set of QIs that measure the (improvement of) quality of primary care physiotherapy.


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