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An innovative peer assessment program to improve evidence based practice in physical therapy.


- candidate number12856
- NTR NumberNTR3461
- ISRCTNISRCTN wordt niet meer aangevraagd.
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR5-jun-2012
- Secondary IDs8203 KNGF
- Public TitleAn innovative peer assessment program to improve evidence based practice in physical therapy.
- Scientific TitleThe effectiveness of Peer assessment to improve the quality of physical therapy diagnosis and treatment in patients with shoulder complaints: A clustered randomised controlled trial.
- ACRONYMn.v.t.
- hypothesisPeer assessment, as a educational guideline implementation strategy, results in more improvement of evidence based reasoning than case based discussion.
- Healt Condition(s) or Problem(s) studiedPhysical therapy, Evidence Based Medicine (EBM), Guideline Adherence, Peer assessment
- Inclusion criteriaAll by KNGF registered Communities of Practice (COP's). The trial was limited to 20 COPís (10+10). After 20 applications of COPís, registration was closed. There were no restrictions for registration of COPís. The program started in February 2012.
- Exclusion criteriaN/A
- mec approval receivedno
- multicenter trialno
- randomisedyes
- masking/blindingNone
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-feb-2012
- planned closingdate31-dec-2012
- Target number of participants174
- InterventionsIntervention:
The educational program for both groups contained four meetings of 3 hours over a period of 6 months, starting in February 2012. At baseline all participants received an introductory letter, a program schedule, a program manual and a link to the Practice Guidelines. At February 8, all participants received a link to the online baseline assessment. Follow up measurement will be in July 2012.

Intervention group:
The peer groups were provided with a manual that contained a highly structured program, guidelines for giving and receiving feedback and a scoring form, based on quality indicators.
During the peer assessment meetings, participants performed in the role of physical therapist and in the role of assessor. In the physical therapist role they demonstrated diagnostic and therapeutic reasoning and skills based on written cases. Cases covered the content domain of the guidelines on shoulder complaints.
In the assessor role they observed the performance of their peers and provided them of improvement feedback.
The peer assessment meetings were tightly scheduled and discussion time was limited. The peer assessment process was coached by a trained external assessor (n = 4) who presented short clinical cases on the spot (not in advance) accompanied by a small set of questions. The external assessor only provided additional feedback when necessary.
When the program was finalized, all participants received a written answering key to the questions by email.

Control group:
The case based discussion groups also received a program manual that was loosely structured and allowed for more discussion time. Detailed clinical cases and questions to guide the discussion process, were provided in advance to allow for preparation. There was no external coach to guide the discussion process. When the program was finalized, all participants received a written answering key to the questions by email.
- Primary outcomeOutcome measures:
1. Evidence based clinical reasoning;
2. Self-reflection and insight;
3. Commitments to change.

Outcome measures are conducted at baseline and follow up after 6 months.

Measurement instruments:
1. Assessment of evidence based reasoning; an online questionnaire based on 4 clinical vignettes (cases). Evidence based reasoning is assessed by a set of closed questions and a 3-pt response format. Questions represent pre-set quality indicators for guideline adherence;
2. Self-reflection and insight scale (SRIS). At baseline participants will be asked to fill out the online Self-Reflection and Insight Scale (SRIS). The SRIS is a validated 20-item closed questionnaire in which respondents use a 5-point Likert scale. Commitments To Change Statements measurement. CTS statements have been successfully used in medicine to measure practice change in clinical practice. CTC statements are administered by an online open questionnaire.
- Secondary outcomePerceived Guideline adherent clinical practice After finishing the program, we ask participants to score on a 5-point likert scale how much they have learned and to what extent this knowledge affects their daily practice.
- TimepointsBaseline: 01-02-2012;
Follow-up: 01-07-2012.
- Trial web siteN/A
- statusinclusion stopped: follow-up
- CONTACT FOR PUBLIC QUERIESProf. R. Nijhuis
- CONTACT for SCIENTIFIC QUERIESProf. R. Nijhuis
- Sponsor/Initiator IQ healthcare
- Funding
(Source(s) of Monetary or Material Support)
Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF), Amersfoort., HAN university of Applied Sciences, Nijmegen
- PublicationsSubmission article of this study: January 2013.
Authors:
Marjo MJ Maas 1,3, Carla Braam, research scientist, Philip J van der Wees research scientist 1,4,5, Cees van de Vleuten, professor 6 ,Maria W.G. Nijhuis-van der Sanden, professor1

1 Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, 6500 HB Nijmegen, the Netherlands; 2 School for Physical Therapy, University of Applied Sciences Arnhem en Nijmegen, the Netherlands; 3 School for Physical Therapy, University of Applied Sciences Utrecht, the Netherlands; 4 Royal Dutch Society for Physical Therapy, Amersfoort, the Netherlands; 5 School CAPHRI, Department of Epidemiology, Maastricht University, the Netherlands; 6 Maastricht University Medical Centre, Department of Health promotion, the Netherlands. 6 Maastricht University, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands.
- Brief summaryIntroduction:
The Royal Dutch Society of Physical Therapy (KNGF) promotes the development and implementation of clinical guidelines for diagnoses and treatment. However, guideline adherence in daily practice appears to be limited. Several strategies have been developed to improve guideline adherence. Peer assessment is considered a promising implementation strategy.

Aim:
In this study the effectiviness of an innovative peer assessment program to implement physical therapy guidelines will be compared to the regular program case-discussion program.

Design:
Exploratory clustered randomized controlled trial with 1) peer assessment (PA)as intervention and 2) traditional case based discussion as control.

Methods:
20 groups of Physical Therapists were randomly assigned to the intervention group (peer assessment) and the control group (case-based discussion).
Outcome measures were evidence based reasoning according to pre-set guideline quality indicators, commitment to change statements, reflection and insight, perceived guideline adherent practice. The essence of the peer assessment method is that physical therapists assess their peers for competences in clinical reasoning and hands-on expertise for diagnosis and treatment. Moreover they judge the quality of their peers patient records.
- Main changes (audit trail)
- RECORD5-jun-2012 - 23-jun-2012


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