Condition category
Not Applicable
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting

Plain English Summary

Lay summary under review 2

Trial website

Contact information



Primary contact

Dr Philip van der Wees


Contact details

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

Additional identifiers

EudraCT number number

Protocol/serial number


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.


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


Secondary study design

Randomised controlled trial

Trial setting


Trial type

Quality of life

Patient information sheet

Not applicable


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


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



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


Overall trial end date


Reason abandoned


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


Age group




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


Recruitment end date



Countries of recruitment


Trial participating centre

Harvard Medical School
MA 02115-5821
United States of America

Sponsor information


Royal Dutch Society for Physical Therapy (Netherlands)

Sponsor details

PO Box 248
3800 AE
+31 334 672 900

Sponsor type

Research organisation



Funder type

Research organisation

Funder name

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

Alternative name(s)

Funding Body Type

Funding Body Subtype


Funder name

Radboud University Nijmegen Medical Centre (Netherlands) ref: RG000365

Alternative name(s)

Funding Body Type

Funding Body Subtype


Funder name

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

Alternative name(s)

Funding Body Type

Funding Body Subtype


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