Condition category
Not Applicable
Date applied
05/10/2012
Date assigned
11/10/2012
Last edited
11/10/2012
Prospective/Retrospective
Retrospectively registered
Overall trial status
Completed
Recruitment status
No longer recruiting

Plain English Summary

Lay summary under review 2

Trial website

Contact information

Type

Scientific

Primary contact

Dr Philip van der Wees

ORCID ID

Contact details

Harvard Medical School
Department of Health Care Policy
180 Longwood Avenue
Boston
MA 02115-5821
United States of America

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

N/A

Study information

Scientific title

The effectiveness of peer-assessment to improve guideline adherence and reflective practice compared with regular case-based discussions about the Dutch physical therapy guideline on low back pain. A clustered randomized controlled trial in Communities of Practice (CoP) of primary care physical therapists.

Acronym

Study hypothesis

A significant improvement of guideline adherence, clinical reasoning, and self-reflection after the intervention peer-assessment compared with the regular intervention case-based discussions.

Ethics approval

The Regional Committee on Medical Research Ethics, Nijmegen, The Netherlands, July 2012, ref: 2012/211.

Study design

Clustered randomized trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Other

Trial type

Quality of life

Patient information sheet

Not applicable

Condition

Implementation of the Dutch guideline on low back pain for physical therapists

Intervention

All participants will be invited for a joint meeting where the updated low back pain guideline will be discussed in an interactive educational session. Both peer-assessment groups and case-based discussion groups (regular implementation) consist of a series of four meetings during a six month period. Both programs are aimed at improving clinical reasoning and clinical decision making according to de guideline low back pain.

Intervention group
Peer-assessment consist of the performance and assessment of tasks of individual clinical cases that are derived from the Dutch physical therapy guideline on low back pain. Peer groups will be provided with a manual that contained a highly structured program, guidelines for giving and receiving feedback and a scoring form.
During the peer-assessment meetings, participants will be performing the physical therapist role, a patient role, and an assessor role. In the physical therapist role they have to demonstrate diagnostic and therapeutic reasoning and skills based on written cases. Cases cover the content domain of the guideline. In the assessor role they have to observe the performance of their peers and provide them of improvement feedback. The peer-assessment meetings are tightly scheduled and discussion time is limited. Based on the feedback of their performance of the first two meetings the participants will develop a personal plan for improvement, including an action plan, which will be evaluated and discussed during the third meeting. In the final meeting another session of peer-assessment will be scheduled based on explicit learning objectives of the individual physical therapists. This session is identical to the first two meetings, with patient cases focused on learning objectives of the physical therapists. The peer-assessment process will be coached by an external assessor who provide additional feedback.

Control group
The case-based discussion groups will also receive a structured program schedule that allows time for group discussion. The manual include a preparation phase for each meeting, joint discussion and evaluation. Clinical cases are provided in advance to allow for preparation.
During the fourth meeting 25 statements about low back pain will be discussed. After this meeting participants will answer individually the statements as being true or false via an electronic system and received feedback on the results. There is no external coach to guide the discussion process.

Outcomes will be assessed at baseline and after 8 months when both groups have finalized their meetings.

Intervention type

Other

Phase

Not Applicable

Drug names

Primary outcome measures

Adherence to the low back pain guideline with 12 validated performance indicators.
These indicators reflect all steps in the care process and are directly related to the clinical vignettes based on the Dutch physical therapy guideline on low back pain. The degree to which physical therapists adhere to these indicators will be assessed by means of an online assignment using vignettes of four cases of low back pain that adequately cover the patient profiles described in the guideline. For each vignette, a score of guideline adherence will be calculated by dividing the actual score by the maximum possible score, and multiplying the result by 100. In addition, a mean score of overall guideline adherence will be calculated by adding up the four scores per vignette and dividing the total by four.

Secondary outcome measures

Self-reflection, which is measured by the Self-Reflection and Insight Scale (SRIS) at baseline and after 8 months follow up.

Overall trial start date

01/09/2009

Overall trial end date

31/10/2010

Reason abandoned

Eligibility

Participant inclusion criteria

Communities of Practice with physical therapists working in a primary care setting and treating patients with low back pain on a regular basis.

Participant type

Patient

Age group

Adult

Gender

Both

Target number of participants

12 Communities of Practice with 6-12 physical therapists per COP (2 x 6 groups)

Participant exclusion criteria

Communities of Practices with physical therapist who are not working in primary care and not treating patients with low back pain on a regular basis.

Recruitment start date

01/09/2009

Recruitment end date

31/10/2010

Locations

Countries of recruitment

Netherlands

Trial participating centre

Harvard Medical School
Boston
MA 02115-5821
United States of America

Sponsor information

Organisation

Royal Dutch Society for Physical Therapy (Netherlands)

Sponsor details

PO Box 248
Amersfoort
3800 AE
Netherlands
+31 334 672 900
wees@kngf.nl

Sponsor type

Research organisation

Website

http://www.fysionet.nl/

Funders

Funder type

Research organisation

Funder name

Royal Dutch Society for Physical Therapy (Netherlands) ref: 8203

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Funder name

Radboud University Nijmegen Medical Centre (Netherlands) ref: RG000365

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Funder name

School for Physical Therapy, University of Applied Sciences (Netherlands) ref: 443142

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Results - basic reporting

Publication summary

Publication citations

Additional files

Editorial Notes