Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association.

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials).

Defining, agreeing on, and testing an international physical therapy core data set: results of a feasibility study involving seven countries.

BACKGROUND: To date, there has been no attempt to describe or compare physical therapy as practiced globally, nor any evidence that an international data set exists to support this effort. It is known that research evidence can be used in strategic and tactical ways, especially within the highly politicized context of the policy arena. The International Private Practitioners Association recognized the potential value a global evidence base could have in influencing policy and supporting professional development in a number of countries, yet it lacked a mechanism to achieve these aims. OBJECTIVES: The purposes of this study were: (1) to identify and test an international data set, definitions, and means of data collection and (2) to establish views in relation to the value of international collaborations. DESIGN: A mixed, prospective design was used in the study. METHOD: Phase 1 (2006-2007) involved the development of a data set, definitions, and Web-based and paper-based data collection options involving 98 physical therapists from 68 physical therapy practices in 7 countries. Phase 2 (2008-2009) involved testing of the data set in 34 practices involving 3,195 patient episodes and included physical therapist feedback of experience, local relevance of the data set, and value of international collaborations. RESULTS: Testing confirmed the relevance and reliability of the data set and definitions and a preference for Web-based data collection (74.0%). Physical therapist feedback supported these findings. Most respondents (60.0%-100.0%) reported the value of further international collaborations for their profession nationally or internationally. LIMITATIONS: Although a true international collaboration, the limited sample size should be recognized. CONCLUSIONS: It is possible to develop an agreed-upon international data set and means of data collection. Testing appears to support its acceptability and relevance for use in practice. Participants highly valued the opportunity to undertake international collaborations that may benefit their profession nationally and internationally. Further testing and use of the data set are advocated before final validation is sought.

Low back pain and physiotherapy use of red flags: the evidence from Scotland.

BACKGROUND: Red flags are recognised as indicators of possible serious spinal pathology, and their use is indicated by numerous guidelines. Similar to other countries worldwide, Scotland lacked a national view about the overall quality of the physiotherapy management of low back pain and the use of red flags. Anecdotal evidence suggested that practice varied considerably. AIM: To improve the use and documentation of red flags by physiotherapists during the assessment and management of low back pain. DESIGN: Prospective, multicentred, national data collection and improvement initiative. SETTING: National Health Service (NHS) health boards in Scotland (n=14) plus two private provider sites. PARTICIPANTS: One hundred and eighty-six individual NHS provider sites and two private provider sites, with in excess of 360 physiotherapists providing services to low back pain patients. METHOD: Measurement of documented practice in line with evidence- and consensus-based recommendations from guidelines collected via a web-based tool over two 5-week audit cycles interspersed with an improvement phase over 1 year (2008-2009). RESULTS: Data from 2147 patients showed improvement in the documentation of all red flags assessed from 33% (n=709) to 65% (n=1396), and improvement in the documentation of cauda equina syndrome from 60% (n=1288) to 84% (n=1804) over the two cycles. Only two regions provided evidence of 100% documentation of all components of cauda equina syndrome, with wide variation across the country. CONCLUSION: This national initiative resulted in considerable improvement in the documentation of red flags. Despite this, however, one in five patients did not receive optimal management as recommended by guidance. This has significant implications for patient safety and highlights the need for ongoing education of physiotherapists in this area.

A national framework for supporting improvements in the physiotherapy assessment and management of low back pain: the Scottish experience.

BACKGROUND: Similar to other countries worldwide, Scotland lacked a national view of whether the quality of the physiotherapy management of low back pain was compliant with national guidelines. Anecdotal evidence suggested that standards of care varied considerably despite the wide availability of clinical guidelines to clinicians. AIM: To develop a framework that supports National Health Service (NHS) Scotland in providing consistently applied high-quality physiotherapy assessment and management of low back pain in line with guideline recommendations. DESIGN: Prospective, multicentred national study, data collection and improvement phase. SETTING: All NHS boards in Scotland (n=14) plus two private provider sites. PARTICIPANTS: One hundred and eighty-six individual NHS sites and two private providers of services to patients with low back pain. METHOD: A national dataset was developed from evidence- and consensus-based guideline sources. All sites collected data (two 5-week periods) over 1 year (2008-2009) using a web-based database. This was interspersed by an improvement phase during which required improvements were considered and implemented. Issues were shared through a national network and national meeting. RESULTS: Data from 2147 patients showed improvements in the documented physiotherapy management of low back pain over the two cycles. All participants developed and implemented remedial action plans based on the results of the first cycle. CONCLUSION: It is possible to implement a framework, which is led nationally but driven and owned locally, supporting physiotherapists in an active programme of locally determined improvement. However, although process and outcome are linked, the direct impact of this initiative on patient outcome is not known.