title: An Innovative Peer Assessment Approach to Enhance Guideline Adherence in Physical Therapy: Single-Masked, Cluster-Randomized Controlled Trial Does Teaching Physical Therapists to Deliver a Biopsychosocial Treatment Program Result in Better Patient Outcomes? A Randomized Controlled Trial Implementing evidence-informed policy into practice for health care professionals managing people with low back pain in Australian rural settings: a preliminary prospective single-cohort study. Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial Systematic reviews of the effectiveness of quality improvement strategies and programmes Effectiveness of Peer Assessment for Implementing a Dutch Physical Therapy Low Back Pain Guideline: Cluster Randomized Controlled Trial Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial. Evaluation of the theory-based Quality Improvement in Physical Therapy (QUIP) programme: a one-group, pre-test post-test pilot study Reported quality of randomized controlled trials in neglect rehabilitation Do physiotherapists' attitudes towards evidence-based practice change as a result of an evidence-based educational programme? The Effectiveness of a Posted Information Package on the Beliefs and Behavior of Musculoskeletal Practitioners: The UK Chiropractors, Osteopaths, and Musculoskeletal Physiotherapists Low Back Pain ManagemENT (COMPLeMENT) Randomized Trial Effectiveness of an interactive postgraduate educational intervention with patient participation on the adherence to a physiotherapy guideline for hip and knee osteoarthritis: a randomised controlled trial Reliability of the PEDro scale for rating quality of randomized controlled trials. Do physical therapists change their beliefs, attitudes, knowledge, skills and behaviour after a biopsychosocially orientated university course? Does Continuing Education Improve Physical Therapists’ Effectiveness in Treating Neck Pain? A Randomized Clinical Trial Does physiotherapy management of low back pain change as a result of an evidence-based educational programme? Effect of a self-determination theory-based communication skills training program on physiotherapists' psychological support for their patients with chronic low back pain: a randomized controlled trial. The theory of planned behaviour: Reactions and reflections Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study
abstract: Background Clinical practice guidelines ( CPGs ) are not readily implemented in clinical practice . One of the impeding factors is that physical therapists do not hold realistic perceptions of their adherence to CPGs . Peer assessment ( PA ) is an implementation strategy that aims at improving guideline adherence by enhancing reflective practice , awareness of professional performance , and attainment of personal goals . Objective The purpose of this study was to compare the effectiveness of PA with the usual case discussion ( CD ) strategy on adherence to CPGs for physical therapist management of upper extremity complaints . Design A single-masked , cluster-r and omized controlled trial with pretest-posttest design was conducted . Intervention Twenty communities of practice ( n=149 physical therapists ) were r and omly assigned to groups receiving PA or CD , with both interventions consisting of 4 sessions over 6 months . Both PA and CD groups worked on identical clinical cases relevant to the guidelines . Peer assessment focused on individual performance observed and evaluated by peers ; CD focused on discussion . Outcomes Guideline adherence was measured with clinical vignettes , reflective practice was measured with the Self-Reflection and Insight Scale ( SRIS ) , awareness of performance was measured via the correlation between perceived and assessed improvement , and attainment of personal goals was measured with written commitments to change . Results The PA groups improved more on guideline adherence compared with the CD groups ( effect=22.52 ; 95 % confidence interval [ 95 % CI]=2.38 , 42.66 ; P=.03 ) . The SRIS scores did not differ between PA and CD groups . Awareness of performance was greater for the PA groups ( r=.36 ) than for the CD groups ( r=.08 ) ( effect=14.73 ; 95 % CI=2.78 , 26.68 ; P=.01 ) . The PA strategy was more effective than the CD strategy in attaining personal goals ( effect=0.50 ; 95 % CI=0.04 , 0.96 ; P=.03 ) . Limitations Limited validity of clinical vignettes as a proxy measure of clinical practice was a limitation of the study . Conclusions  Peer assessment  was more effective than CD in improving adherence to CPGs . Personal feedback may have contributed to its effectiveness . Future research should address the role of the group coach Background Psychosocial prognostic factors are important in the development of chronic pain , but treatment providers often lack knowledge and skills to assess and address these risk factors . Objective The aim of this study was to examine the effects on outcomes ( pain and disability ) in patients of a course about psychosocial prognostic factors for physical therapists . Design This study was a r and omized , controlled trial . Setting The setting was primary care practice . Participants Forty-two primary care physical therapists attended an 8-day university course ( over 8 weeks ) aim ed at identifying and addressing psychosocial risk factors . Intervention The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Measurements We measured physical therapists ' attitudes and beliefs about psychosocial factors , knowledge , and skills before and after the course . We measured patients ' pain , disability , catastrophizing , and mood at the start of treatment and at a 6-month follow-up . Methods The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Results Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course . Pain and disability outcomes in patients with a low risk of developing long-term disability— and pain outcomes in patients with a high risk of developing long-term disability — were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course . However , disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed . Limitations A limitation of this study was that actual practice behavior was not measured . Conclusions An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability . However , patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course OBJECTIVE To provide access to professional development opportunities for health care professionals , especially in rural Australian regions , consistent with recommendations in the Australian National Pain Strategy and state government policy . DESIGN AND SETTING A preliminary prospect i ve , single-cohort study design , which aligned health policy with evidence -informed clinical practice , evaluated the implementation and effectiveness of an interprofessional , health care provider pain education program ( hPEP ) for management of nonspecific low back pain ( nsLBP ) in rural Western Australia . INTERVENTION The 6.5-hour hPEP intervention was delivered to 60 care providers ( caseload nsLBP 19.8 % ± 22.5 ) at four rural WA regions . OUTCOME MEASURES Outcomes were recorded at baseline and 2 months post-intervention regarding attitudes , beliefs ( modified Health Care Providers Pain and Impairment Relationship Scale [ HC-PAIRS ] ) , Back Pain Beliefs Question naire [ BBQ ] ) , and self-reported evidence -based clinical practice ( knowledge and skills regarding nsLBP , rated on a 5-point Likert scale with 1 = nil and 5 = excellent ) . RESULTS hPEP was feasible to implement . At 2 months post-hPEP , responders ' ( response rate 53 % ) improved evidence -based beliefs were indicated by HC-PAIRS scores : baseline mean ( SD ) [ 43.2 ( 9.3 ) ] ; mean difference ( 95 % CI ) [ -5.9 ( -8.6 to -3.1 ) ] ; and BBQ baseline [ 34.3 ( 6.8 ) ] ; mean difference [ 2.1 ( 0.5 to 3.6 ) ] . Positive shifts were observed for all measures of clinical knowledge and skills ( P < 0.001 ) and increased assistance with planning lifestyle changes ( P < 0.001 ) , advice on self-management ( P = 0.010 ) , and for decreased referrals for spinal imaging ( P = 0.03 ) . CONCLUSIONS This policy-into- practice educational program is feasible to implement in rural Western Australia ( WA ) . While preliminary data are encouraging , a further r and omized controlled trial is recommended Objectives : To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain . Design : A cluster r and omised controlled trial comparing an active strategy with st and ard dissemination . Setting : Primary care physiotherapy practice s. Participants : 113 physiotherapists were r and omly allocated to receive the guidelines by mail ( control group ) or to receive an additional active strategy ( intervention group ) which consisted of a multifaceted programme including education , discussion , role playing , feedback , and reminders . Main outcome measures : Adherence to the guidelines was measured by means of individual patients ’ forms recording the treatment completed by the physiotherapist . The forms were assessed using an algorithm based on the number of treatment sessions , treatment goals , interventions , and patient education . Results : Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain ( OR 2.39 ; 95 % CI 1.12 to 5.12 ) , more often set functional treatment goals ( OR 1.99 ; 95 % CI 1.06 to 3.72 ) , more often used mainly active interventions ( OR 2.79 ; 95 % CI 1.19 to 6.55 ) , and more often gave adequate patient education ( OR 3.59 ; 95 % CI 1.35 to 9.55 ) . They also adhered more to all four criteria ( OR 2.05 ; 95 % CI 1.15 to 3.65 ) . Conclusions : The active strategy moderately improved adherence to the guidelines . Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain BACKGROUND AND PURPOSE An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain . The effect of this strategy on patients ' physical functioning , coping strategy , and beliefs regarding their low back pain was studied . SUBJECTS One hundred thirteen primary care physical therapists treated a total of 500 patients . METHODS The physical therapists were r and omly assigned to 1 of 2 groups . The control group received the guidelines by mail ( st and ard passive method of dissemination ) . The intervention group , in contrast , received an additional active training strategy consisting of 2 sessions with education , group discussion , role playing , feedback , and reminders .  Patients with low back pain , treated by the participating therapists , completed question naires on physical functioning , pain , sick leave , coping , and beliefs . RESULTS Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks . Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up . DISCUSSION AND CONCLUSION The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain . Active implementation strategies are not recommended if patient outcomes are to be improved OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review Background Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence -based practice ( EBP ) . There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy . The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden . Methods An implementation strategy based on theory and current evidence was developed . A tailored , multi-component implementation intervention , addressing earlier identified determinants , was carried out in three areas comprising 28 physical therapy practice s including 277 physical therapists ( PTs ) ( intervention group ) . In two adjacent areas , 171 PTs at 32 practice s received no intervention ( control group ) . The core component of the intervention was an implementation seminar with group discussion s. Among other components were a website and email reminders . Data were collected at baseline and follow-up with a web-based question naire . Primary outcomes were the self-reported awareness of , knowledge of , access to , and use of guidelines . Secondary outcomes were self-reported attitudes toward EBP and guidelines . Analyses were performed using Pearson ’s χ2 test and approximative z-test . Results 168 PTs ( 60.6 % ) in the intervention group and 88 PTs ( 51.5 % ) in the control group responded to the follow-up question naire . 186/277 PTs ( 67.1 % ) participated in the implementation seminars , of which 97 ( 52.2 % ) responded . The proportions of PTs reporting awareness of ( absolute difference in change 20.6 % , p = 0.023 ) , knowledge where to find ( 20.4 % , p = 0.007 ) , access to ( 21.7 % , p < 0.001 ) , and frequent use of ( 9.5 % , NS ) guidelines increased more in the intervention group than in the control group . The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2 % ( p = 0.043 ) higher than the proportion in the control group . A higher proportion considered EBP helpful in decision making ( p = 0.018 ) . There were no other significant differences in secondary outcomes . Conclusions A tailored , theory- and evidence -informed , multi-component intervention for the implementation of clinical practice guidelines had a modest , positive effect on awareness of , knowledge of , access to , and use of guidelines , among PTs in primary care in western Sweden . In general , attitudes to EBP and guidelines were not affected Systematic review s provide the best evidence on the effectiveness of healthcare interventions including quality improvement strategies . The methods of systematic review of individual patient r and omised trials of healthcare interventions are well developed . We discuss method ological and practice issues that need to be considered when undertaking systematic review s of quality improvement strategies including developing a review protocol , identifying and screening evidence sources , quality assessment and data abstract ion , analytical methods , reporting systematic review s , and appraising systematic review s. This paper builds on our experiences within the Cochrane Effective Practice and Organisation of Care ( EPOC ) review group Background Clinical practice guidelines are considered important instruments to improve quality of care . However , success is dependent on adherence , which may be improved using peer assessment , a strategy in which professionals assess performance of their peers in a simulated setting . Objective The aim of this study was to determine whether peer assessment is more effective than case-based discussion s to improve knowledge and guideline -consistent clinical reasoning in the Dutch physical therapy guideline for low back pain ( LBP ) . Design A cluster r and omized controlled trial was conducted . Setting and Participants Ten communities of practice ( CoPs ) of physical therapists were cluster r and omized ( N=90 ) : 6 CoPs in the peer- assessment group ( n=49 ) and 4 CoPs in the case-based discussion group ( control group ) ( n=41 ) . Intervention Both groups participated in 4 educational sessions and used clinical patient cases . The peer- assessment group reflected on performed LBP management in different roles . The control group used structured discussion s. Measurements Outcomes were assessed at baseline and at 6 months . The primary outcome measure was knowledge and guideline -consistent reasoning , measured with 12 performance indicators using 4 vignettes with specific guideline -related patient profiles . For each participant , the total score was calculated by adding up the percentage scores ( 0–100 ) per vignette , divided by 4 . The secondary outcome measure was reflective practice , as measured by the Self-Reflection and Insight Scale ( 20–100 ) . Results Vignettes were completed by 78 participants ( 87 % ) . Multilevel analysis showed an increase in guideline -consistent clinical reasoning of 8.4 % in the  peer- assessment group , whereas the control group showed a decline of 0.1 % ( estimated group difference=8.7 % , 95 % confidence interval=3.9 to 13.4 ) . No group differences were found on self-reflection . Limitations The small sample size , a short-term follow-up , and the use of vignettes as a proxy for behavior were limitations of the study . Conclusions Peer assessment leads to an increase in knowledge and guideline -consistent clinical reasoning QUESTION Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash ? DESIGN Cluster-r and omised trial . PARTICIPANTS Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients ( 4 dropouts ) who presented to them with acute whiplash . INTERVENTION The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them . OUTCOME MEASURES The primary outcome was patient disability , measured using the Functional Rating Index , collected on admission to the trial and at 1.5 , 3 , 6 and 12 months . Physiotherapist knowledge about the guidelines was measured using a custom-made question naire . Physiotherapist practice and cost of care were measured by audit of patient notes . RESULTS There were no significant differences between groups for any of the patient outcomes at any time . The implementation patients had 0.6 points ( 95 % CI -7.8 to 6.6 ) less disability than the dissemination patients at 12 months ; 44 % more physiotherapists in the implementation group reported that they prescribed two out of the five guideline -recommended treatments ; and 32 % more physiotherapists actually prescribed them . The cost of care for patients in the implementation group was $ 255 ( 95 % CI -1505 to 996 ) less than for patients in the dissemination group . CONCLUSION Although the active implementation program increased guideline -consistent practice , patient outcomes and cost of care were not affected Background Guideline adherence in physical therapy is far from optimal , which has consequences for the effectiveness and efficiency of physical therapy care . Programmes to enhance guideline adherence have , so far , been relatively ineffective . We systematic ally developed a theory-based Quality Improvement in Physical Therapy ( QUIP ) programme aim ed at the individual performance level ( practicing physiotherapists ; PTs ) and the practice organization level ( practice quality manager ; PQM ) . The aim of the study was to pilot test the multilevel QUIP programme ’s effectiveness and the fidelity , acceptability and feasibility of its implementation . Methods A one-group , pre-test , post-test pilot study ( N = 8 practice s ; N = 32 PTs , 8 of whom were also PQMs ) done between September and December 2009 . Guideline adherence was measured using clinical vignettes that addressed 12 quality indicators reflecting the guidelines ’ main recommendations . Determinants of adherence were measured using quantitative methods ( question naires ) . Delivery of the programme and management changes were assessed using qualitative methods ( observations , group interviews , and document analyses ) . Changes in adherence and determinants were tested in the paired sample s T-tests and expressed in effect sizes ( Cohen ’s d ) . Results Overall adherence did not change ( 3.1 % ; p = .138 ) . Adherence to three quality indicators improved ( 8 % , 24 % , 43 % ; .000 ≤ p ≤ .023 ) . Adherence to one quality indicator decreased ( −15.7 % ; p = .004 ) . Scores on various determinants of individual performance improved and favourable changes at practice organizational level were observed . Improvements were associated with the programme ’s multilevel approach , collective goal setting , and the application of self-regulation ; unfavourable findings with programme deficits . The one-group pre-test post-test design limits the internal validity of the study , the self-selected sample its external validity . Conclusions The QUIP programme has the potential to change physical therapy practice but needs considerable revision to induce the ongoing quality improvement process that is required to optimize overall guideline adherence . To assess its value , the programme needs to be tested in a r and omized controlled trial The aim of this study is to assess the reported quality of r and omized controlled trials ( RCTs ) on the effectiveness of neglect rehabilitation using a st and ardized scale . A search of seven electronic data bases was carried out . Selected articles were scored using the PEDro scale and classified as high or low quality study both with the original cut off of 6 and a modified cut off of 5 . A linear regression analysis between year of publication and quality rate was used to test whether the quality of the studies improved with time . A total of 18 RCTs were selected . Six articles ( 33.3 % ) and 10 articles ( 55.56 % ) were classified as having high quality when the original cut off or the modified cut off of the PEDro scale were used , respectively . Analysis shows no time-related changes in PEDro scores . The results show that reported quality is moderate for RCTs in neglect rehabilitation RATIONALE The concept of evidence -based practice ( EBP ) encourages health care professionals to provide the most effective health care , and to be accountable for the interventions they provide . Little work has been undertaken to examine how practically allied health professionals ' encompass EBP and how they perceptive and underst and the concept of EBP . The use of opinion leaders to disseminate new evidence into practice , and thereby encourage the behaviour of health care professionals has been proposed . AIMS The aims of this study were to investigate physiotherapists ' attitudes towards EBP and to examine change in their attitudes following an education package , which utilized local opinion leaders . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work to two groups . The intervention group received an evidence -based programme on aspects of EBP including literature search ing and critical appraisal . The attention control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' attitudes towards EBP were measured at baseline ( before r and omization ) and at 3 and 6 months follow-up . RESULTS Physiotherapists reported that they primarily relied on ' courses ' and ' in-service training ' for informing their clinical practice . Most agreed that clinical practice should be based on the best available evidence and that they would change their clinical practice if evidence suggested they should do so . However , many of the physiotherapists reported difficulty in reading journals and could not identify opinion leaders in key areas . In terms of clinical practice , literature , journals and research were ascribed low priority throughout . Differences in attitudes between the intervention and control groups were observed in relation to management support for EBP at 3 and 6 months follow-up . CONCLUSIONS In this study , physiotherapists appeared to be in favour of the idea of EBP , yet they remained reluctant to change their practice . Opinion leaders were not easily identifiable by physiotherapists , suggesting that this method alone may not be an effective method of changing attitudes in clinical practice . The process of changing attitudes in the clinical environment is a complex issue worthy of further research Study Design . R and omized controlled trial . Objective . To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners ( chiropractors , osteopaths , and musculoskeletal physiotherapists ) across the United Kingdom . Summary of Background Data . A substantial proportion of musculoskeletal practitioners in United Kingdom does not follow current LBP guideline recommendations . Methods . In total , 1758 practitioners were r and omly allocated to either of the 2 study arms . One arm was posted a printed information package containing guideline recommendations for the management of LBP ( n = 876 ) and the other received no intervention ( n = 882 ) . The primary outcome measure consisted of 3 “ quality indicators ” ( activity , work , and bed-rest ) relating to a vignette of a patient with LBP , in which responses were dichotomized into either “ guideline -inconsistent ” or “ guideline -consistent . ” The secondary outcome was the practitioners ' LBP-related beliefs , measured using the Health Care Providers Pain and Impairment Relationship Scale . Outcomes were measured at baseline and at 6 months . Results . Follow-up at 6 months was 89 % . The changes in reported behavior on the quality indicators were as follows : activity , odds ratio ( OR ) 1.29 ( 95 % confidence interval , 1.03–1.61 ) and number needed to be treated ( NNT ) , 19 ( 15–28 ) ; work , OR 1.35 ( 1.07–1.70 ) and NNT 19 ( 14–29 ) ; and bed-rest , OR 1.31 ( 0.97–1.76 ) and NNT 47 ( 33–103 ) . The composite NNT for a change from guideline -inconsistent to guideline -consistent behavior on at least 1 of the 3 quality indicators was 10 ( 9–14 ) . LBP-related beliefs were significantly improved in those who were sent the information package ( P = 0.002 ) , but only to a small degree ( mean difference , 0.884 scale points ; 95 % confidence interval , 0.319–1.448 ) . Conclusion . Printed educational material can shift LBP-related beliefs and reported behaviors of musculoskeletal practitioners , toward practice that is more in line with guideline recommendations Abstract Purpose : To determine the effectiveness of an interactive educational intervention on a physiotherapy guideline for hip and knee osteoarthritis . Method : Physiotherapists were r and omly allocated to a 3-h interactive educational course with the collaboration of three patient partners or no intervention . Assessment s comprised question naires on adherence ( score range 0–24 ) , knowledge ( score range 0–76 ) , and barriers to use the guideline ( score range 0–80 ) . Assessment s were conducted 1 week before the interactive course ( T0 ) immediately after ( T1 ) , and 3 months thereafter ( T2 ) . Change scores were compared between the groups by means of Mann – Whitney U tests and linear mixed models . Results : 284 of 4328 eligible PTs ( 7 % ) were included . The intervention ( n = 133 ) was significantly more effective than no intervention ( n = 151 ) concerning self-reported adherence and knowledge with mean differences in change scores ( 95 % CI ) at T1 and T2 being 1.4 ( 0.7–2.0 ) and 0.9 ( 0.2–1.7 ) for adherence and 6.8 ( 4.5–9.1 ) and 3.9 ( 1.7–6.2 ) for knowledge , ( all p values < 0.005 ) . In both groups the barrier score increased at T1 and decreased at T2 , with a significantly larger increase at T1 and decrease at T2 in the intervention group ( mean differences 3.1 ( 1.8–4.4 ) and 3.3 ( 0.5–6.1 ) , respectively . Conclusions : A short interactive educational course with patient participation on a PT guideline on hip and knee osteoarthritis showed a small to moderate positive effect on self-reported guideline adherence and knowledge , whereas for perceived barriers an advantage was only seen on the longer term . Implication s for Rehabilitation Continuing professional development is important and effective , it works very well when patients are engaged in the process , and hence it is supportive overall of enhancing clinical practice . Interactive education can reduce barriers in guideline usage in daily practice BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . AIM The aim of this study is to examine the effects of an 8-day university-based training course , aim ed at identifying and addressing psychosocial prognostic factors during physiotherapy treatment , in shifting therapists towards a more biopsychosocial orientation as measured by changes in beliefs/attitudes , knowledge , skills and behaviour . METHOD We combined a r and omized controlled trail with a pre-post design . Forty-two physiotherapists applied for a university-accredited training course design ed to enhance knowledge and management of psychosocial factors in their practice with patients suffering from musculoskeletal pain . The course participants were r and omized either to receiving the course or to a waiting list for training . Attitudes and beliefs towards , and knowledge of psychosocial factors , patient vignettes and a video of an imaginary patient were tested before and after training . The patients of the course participants were asked to fill out a question naire with background questions at treatment start . The patients also received a question naire about the physical therapists ' behaviour and patient satisfaction 6 weeks after treatment start . RESULTS The results show that physical therapists ' attitudes and believes became more biopsychosocially and less biomedically orientated , they were less convinced that pain justifies disability and limitation of activities , and their knowledge and skills on psychosocial risk factors increased after a university-accredited training course . Yet despite these changes their patients perceived their practice behaviour before and after the course as similar and were equally satisfied with their treatment and treatment result . CONCLUSION A course , which enhanced biopsychosocial attitudes and beliefs , as well as increased such knowledge and skills did not change the way patients perceived their physical therapists . A future question is whether it improves patient outcome Background and Purpose : Physical therapists often attend continuing education ( CE ) courses to improve their overall clinical performance and patient outcomes . However , evidence suggests that CE courses may not improve the outcomes for patients receiving physical therapy for the management of neck pain . The purpose of this study was to investigate the effectiveness of an ongoing educational intervention for improving the outcomes for patients with neck pain . Participants : The study participants were 19 physical therapists who attended a 2-day CE course focusing on the management of neck pain . All patients treated by the therapists in this study completed the Neck Disability Index ( NDI ) and a pain rating scale at the initial examination and at their final visit . Methods : Therapists from 11 clinics were invited to attend a 2-day CE course on the management of neck pain . After the CE course , the therapists were r and omly assigned to receive either ongoing education consisting of small group sessions and an educational outreach session or no further education . Clinical outcomes achieved by therapists who received ongoing education and therapists who did not were compared for both pretraining and posttraining periods . The effects of receiving ongoing education were examined by use of linear mixed-model analyses with time period and group as fixed factors ; improvements in disability and pain as dependent variables ; and age , sex , and the patient 's initial NDI and pain rating scores as covariates . Results : Patients treated by therapists who received ongoing education experienced significantly greater reductions in disability during the study period ( pretraining to posttraining ) than those treated by therapists who did not receive ongoing training ( mean difference=4.2 points ; 95 % confidence interval [CI]=0.69 , 7.7 ) . Changes in pain did not differ for patients treated by the 2 groups of therapists during the study period ( mean difference=0.47 point ; 95 % CI=−0.11 , 1.0 ) . Therapists in the ongoing education group also used fewer visits during the posttraining period ( mean difference=1.5 visits ; 95 % CI=0.81 , 2.3 ) . Discussion and Conclusion : The results of this study demonstrated that ongoing education for the management of neck pain was beneficial in reducing disability for patients with neck pain while reducing the number of physical therapy visits . However , changes in pain did not differ for patients treated by the 2 groups of therapists . Although it appears that a typical CE course does not improve the overall outcomes for patients treated by therapists attending that course , more research is needed to evaluate other educational strategies to determine the most clinical ly effective and cost-effective interventions RATIONALE The concept of evidence -based medicine is important in providing efficient health care . The process uses research findings as the basis for clinical decision making . Evidence -based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide . Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence . The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed . AIMS The aim of this study was to investigate if physiotherapists ' clinical management of patients with low back pain would change following an evidence -based education package , which utilized local opinion leaders and delivered the best evidence . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work , to two groups . The intervention group received an evidence -based programme on the management of low back pain , including advice regarding increasing activity levels and return to normal activity and challenging patients ' fears and beliefs about their pain . The control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' clinical management of patients with low back pain was measured prior to training and 6 months post training . Outcome measures were based on physiotherapists completing ' discharge summary ' question naires , which included information relating to the use and importance of therapies for treating their low back pain patients . RESULTS There were few significant differences in treatment options between the intervention and control groups post training . Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain , there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention . CONCLUSIONS Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain . This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice . Whilst there were some limitations in the overall size of the study , the results help to give an insight into the challenges faced by the health care system and research ers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care OBJECTIVE To examine the effects of communication skills training on physiotherapists ' supportive behavior during clinical practice . DESIGN R and omized trial . SETTING Hospital outpatient physiotherapy clinics . PARTICIPANTS Physiotherapists ( N=24 ) and patients ( N=24 ) with chronic low back pain . INTERVENTIONS Two hospital clinics were r and omly assigned to the intervention arm . Physiotherapists ( n=12 ) received 8 hours of communication skills training focused on supporting patients ' psychological needs . Physiotherapists ( n=12 ) from 2 other hospital clinics formed a waitlist control arm . MAIN OUTCOME MEASURES Verbal communication between each physiotherapist and a patient was recorded on an audiotape , and independent , blinded raters used the Health Care Climate Question naire to assess physiotherapists ' needs-supportive behavior ( primary outcome ) . RESULTS Independent raters ' Health Care Climate Question naire scores favored the intervention arm ( Cohen 's d=2.27 ; P<.01 ) . CONCLUSIONS Compared with controls , independent ratings demonstrated that physiotherapists who completed the Communication style and exercise compliance in physiotherapy training were found to provide greater support for patients ' needs in a single assessed session . Long-term maintenance of this needs-supportive behavior should be examined The seven articles in this issue , and the accompanying meta- analysis in Health Psychology Review [ McEachan , R.R.C. , Conner , M. , Taylor , N. , & Lawton , R.J. ( 2011 ) . Prospect i ve prediction of health-related behaviors with the theory of planned behavior : A meta- analysis . Health Psychology Review , 5 , 97–144 ] , illustrate the wide application of the theory of planned behaviour [ Ajzen , I. ( 1991 ) . The theory of planned behavior . Organizational Behavior and Human Decision Processes , 50 , 179–211 ] in the health domain . In this editorial , Ajzen reflects on some of the issues raised by the different authors . Among the topics addressed are the nature of intentions and the limits of predictive validity ; rationality , affect and emotions ; past behaviour and habit ; the prototype/willingness model ; and the role of such background factors as the big five personality traits and social comparison tendency Background The effectiveness of risk stratification for  low back pain ( LBP ) management has not been demonstrated in outpatient physical therapy setting s. Objective The purpose s of this study were : ( 1 ) to assess implementation of a stratified care approach for LBP management by evaluating short-term treatment effects and ( 2 ) to determine feasibility of conducting a larger-scale study . Design This was a 2-phase , preliminary study . Methods In phase 1 , clinicians were r and omly assigned to receive st and ard ( n=6 ) or stratified care ( n=6 ) training . Stratified care training included 8 hours of content focusing on psychologically informed practice . Changes in LBP attitudes and beliefs were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists ( PABS-PT ) and the Health Care Providers Pain and Impairment Relationship Scale ( HC-PAIRS ) . In phase 2 , clinicians receiving the stratified care training were instructed to incorporate those strategies in their practice and 4-week patient outcomes were collected using a numerical pain rating scale ( NPRS ) , and the Oswestry Disability Index ( ODI ) . Study feasibility was assessed to identify potential barriers for completion of a larger-scale study . Results In phase 1 , minimal changes were observed for PABS-PT and HC-PAIRS scores for st and ard care clinicians ( Cohen d=0.00–0.28 ) . Decreased biomedical ( −4.5±2.5 points , d=1.08 ) and increased biopsychosocial ( + 5.5±2.0 points , d=2.86 ) treatment orientations were observed for stratified care clinicians , with these changes sustained 6 months later on the PABS-PT . In phase 2 , patients receiving stratified care ( n=67 ) had greater between-group improvements in NPRS ( 0.8 points ; 95 % confidence interval=0.1 , 1.5 ; d=0.40 ) and ODI ( 8.9 % points ; 95 % confidence interval=4.1 , 13.6 ; d=0.76 ) scores compared with patients receiving st and ard physical therapy care ( n=33 ) . Limitations In phase 2 , treatment was not r and omly assigned , and therapist adherence to treatment recommendations was not monitored . This study was not adequately powered to conduct subgroup analyses . Conclusions In physical therapy setting s , biomedical orientation can be modified , and risk-stratified care for LBP can be effectively implemented . Findings from this study can be used for planning of larger studies
target: RESULTS Knowledge translation interventions appear to have result ed in a positive change in physiotherapist beliefs , attitudes , skills and guideline awareness .
  However , no consistent improvement in clinical practice , patient and economic outcomes were observed .
  AND IMPLICATION OF KEY FINDINGS The intensity and type of knowledge translation intervention seem to have an effect on practice change .
background: BACKGROUND Many physiotherapists underuse evidence -based practice guidelines or recommendations when treating patients with musculoskeletal disorders , yet synthesis of knowledge translation interventions used within the field of physiotherapy fails to offer clear conclusions to guide the implementation of clinical practice guidelines .
  OBJECTIVES To evaluate the effectiveness of various  knowledge translation interventions used to implement changes in the practice of current physiotherapists treating common musculoskeletal issues .