- Email: [email protected]
Implementation of the Dutch physical therapy quality program for patient reported outcomes measurement, an observational study
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The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
(ECGs) were recorded in pre-supine, sitting, and post supine postures for 5 minutes each. The power spectral density of HRV was calculated using fast Fourier transformation to obtain 3 separate frequency bands: low-frequency (LF), 0.04 to 0.15 Hz; high frequency (HF), 0.15 to 0.40 Hz; and total power (TP) < 0.40 Hz. The lnTP, natural logarithms of TP, lnHF, and LF/HF ratio were assessed. The lnHF and lnHF indicated total and parasympathetic autonomic activity, respectively, while LF/HF ratio indicated sympathetic activity. Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) measured three times and averaged at a posture. One-way repeated measures analysis of variance (ANOVA) with Tukey’s post hoc test was used for statistical analysis. The present study was approved by a local ethics committee of Nagoya University based on Helsinki’s declaration. Results: The lnTP value decreased and increased, and HR increased and decreased at sitting and post spine posture, respectively, during the 3rd to 7th days after stroke. On the 3rd, 5th, and 6th days, the lnHF increased solely at post supine posture. On the 7th day, the lnHF decreased and increased at sitting and post supine posture, respectively, while the LF/HF ratio changed reciprocally to the lnHF. The DBP showed a decrement tendency at post supine after the 3rd day, but the SBP did not changed during the period. Discussion and conclusions: Recovery of parasympathetic function was observed from the 3rd day after the onset of stroke, while both parasympathetic and sympathetic functions recovered by the 7th day. During the first week after stroke, when postural changes might be practiced during physical therapy, the recovery condition of autonomic function should be taken into account to prevent cardiac complication, such as postural hypotension during physical therapy. Impact and implications: The present study contributes to the program for early mobilization and physical therapy during early recovery phase after stroke. Funding acknowledgement: N/A. http://dx.doi.org/10.1016/j.physio.2016.10.112
POS055 Implementation of the Dutch physical therapy quality program for patient reported outcomes measurement, an observational study G.A. Meerhoff 1,2,∗ , S. van Dulmen 1 , M. Maas 1 , K. Heijblom 1 , R. Nijhuis-van der Sanden 1 , P.J. van der Wees 1 1 Radboud
University Medical Center, IQ Healthcare, Nijmegen, Netherlands 2 Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands Relevance: The primary aim of modern healthcare systems is to realize optimal health outcomes for patients and populations and to deliver services that are of the highest possible quality. High quality healthcare has been defined as care that is safe, timely, equitable, effective, efficient, and patientcentered. In 2013 the Royal Dutch Society for Physical Therapy (KNGF) started the development and implementation of their national quality program ‘Quality in Motion’. The rationale behind this program was the desire to establish a quality system that would stimulate patient-centered care and improve the effectiveness of care. Purpose: This study describes the development of strategies for implementing the national quality program of the KNGF and it evaluates the success of the implementation. The program aims to collect patient-reported outcome measures (PROMs) data via a national registry. This data is fed back to physical therapists (PTs) to facilitate quality improvement activities via peer assessment sessions using a plan-do-check-act cycle. Methods/analysis: A stepwise implementation, based on the 8-steps of Grol for the implementation of innovations in healthcare, was established in three consecutive pilots with a total of 355 PTs. Due to this stepwise implementation, improvements could be made to the strategy based on experiences in the previous pilots. Core component of the implementation was the introduction of knowledge brokers to support participants in establishing routine in using PROMs in their clinical reasoning, and to assist in executing the peer assessment sessions. PROMs-Data was collected in the registry via electronic health records. The implementation was evaluated using a self-assessment questionnaire, process evaluation, and the June and December 2014 datasets from the registry. Descriptive statistics and Chi-square analysis were used to estimate the feasibility of implementing PROMs as part of the national quality program. Execution of this study is approved by the Medical Ethical Committee of Radboud university medical center (registration #2014/260) and conducted conform the Declaration of Helsinki.
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
Results: Although the initial implementation strategy was amended to improve its effect, all pilots showed a significant improvement on the self-assessment questionnaire regarding the use of PROMs and, the knowledge and attitude towards PROMs. Regarding the data gathered in the registry it is shown that in July 2014, 65% of the PT practices delivered data to the registry, which increased to 92% in December 2014, containing 19,222 completed patient records. In December 2014, pre- and post-treatment PROMs measurements were registered in 21.4% of patient records. Discussion and conclusions: The implementation strategies were successful in facilitating PROM-use in PT practice and quality improvement. The routine use of PROMs needs to increase before being suitable for external accountability. Using KBs in support of the participating PTs is promising for implementing the program via peer assessment sessions. Impact and implications: Data in the registry can be used for quality improvement purposes in safe settings, but is not yet robust enough for external accountability purposes. Participating PTs need increase their routine in PROM-use. The KBs are expected to play an important role in increasing this routine, since they function as a motivator and educator in the further implementation. Funding acknowledgement: The national program was funded by the KNGF. The different pilots were co-funded by the networks of physical therapists that participated in the pilots, with additional funding of the health insurance companies Menzis and Centraal Ziekenfonds CZ. The cofunding health insurance companies did not have a role in the study design, data collection and analysis, or interpreting the data and writing of the report. http://dx.doi.org/10.1016/j.physio.2016.10.113 POS056 Evidence for exercise training in autonomic function modulation in patients with chronic obstructive pulmonary disease (COPD): a systematic review J. Mohammed 1,2,∗ , E. Derom 3 , J. Van Oosterwijck 1,4 , H. Da Silva 1 , P. Calders 1 1 Ghent
University, Rehabilitation Sciences and Physiotherapy, Ghent, Belgium 2 Bayero University Kano, Physiotherapy, Kano, Nigeria 3 Ghent University/Hospital, Ghent, Belgium 4 Reserch Foundation Flanders, Brussels, Belgium Relevance: Chronic obstructive pulmonary disease (COPD) is a highly prevalent systemic disease which has a negative influence on both cardiovascular and autonomic nervous systems (ANS). One of the most important components of pulmonary rehabilitation for COPD is exercise
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training. Exercise training improves dyspnea, quality of life, medical consumption, neuromuscular coordination and selfconfidence in COPD. The use of exercise training programme for modulating the ANS in patients with COPD has been sparsely reported. However, no systematic review has been conducted to support the use of exercise training for ANS modulation in these patients. Purpose: To assess the evidence for the effectiveness of different exercise training on autonomic function (AF) outcomes in patients with COPD. Methods/analysis: Following the PRISMA-guidelines a systematic search was performed in search engines of PubMed, Web of Science and CINAHL using a combination of predefined keywords regarding COPD/exercise training and rehabilitation/outcomes of AF. Full text reports from research studies assessing any measure of AF before and after an exercise training in patients with COPD were included. The included articles were reviewed on methodological quality, and evidence synthesis was done using the GRADE guidelines. Results: Eleven studies were included and discussed in this review. A total of 406 (279 males) patients with COPD (%FEV1 predicted; 32 ± 11 to 50 ± 19 l) were investigated in the studies. Continuous training mode at vigorous intensity (60% to 80% of VO2 max; 60$ to 75% of maximal speed/peak work rate) was used in majority of the included studies. Additionally, the exercise training duration and frequency studies was between 30 and 40 minutes/session and at least three times/week, respectively. The evidence synthesis of reviewed results from studies with high methodological quality per AF outcome provided different levels of evidence. Specifically, significant increment for heart rate variability (HRV) in the time domain analysis and heart rate recovery (HRR) following exercise training programmes was supported by a high level evidence. However, the effectiveness of exercise training in enhancing the baroreceptor sensitivity (BRS) and frequency domain analysis of HRV was supported by a limited evidence and no evidence, respectively. Discussion and conclusions: Based on the reviewed studies, it was concluded that exercise training has limited beneficial effects in the AF modulation of patients with COPD. Future studies with high methodological quality and large sample sizes are still necessary. Impact and implications: Summarizing results of studies investigating the effectiveness of exercise training for important COPD co-morbidities, such as autonomic dysfunction will promote an outcome-targeted approach to COPD rehabilitation. Funding acknowledgement: Jibril Mohammed is an awardee of a PhD study scholarship at Ghent University funded by the Tertiary Education Trust Fund (TETFund), Nigeria. Jessica Van Oosterwijck is a postdoctoral research fellow funded by the Research Foundation – Flanders (FWO), Belgium. http://dx.doi.org/10.1016/j.physio.2016.10.114
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
(ECGs) were recorded in pre-supine, sitting, and post supine postures for 5 minutes each. The power spectral density of HRV was calculated using fast Fourier transformation to obtain 3 separate frequency bands: low-frequency (LF), 0.04 to 0.15 Hz; high frequency (HF), 0.15 to 0.40 Hz; and total power (TP) < 0.40 Hz. The lnTP, natural logarithms of TP, lnHF, and LF/HF ratio were assessed. The lnHF and lnHF indicated total and parasympathetic autonomic activity, respectively, while LF/HF ratio indicated sympathetic activity. Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) measured three times and averaged at a posture. One-way repeated measures analysis of variance (ANOVA) with Tukey’s post hoc test was used for statistical analysis. The present study was approved by a local ethics committee of Nagoya University based on Helsinki’s declaration. Results: The lnTP value decreased and increased, and HR increased and decreased at sitting and post spine posture, respectively, during the 3rd to 7th days after stroke. On the 3rd, 5th, and 6th days, the lnHF increased solely at post supine posture. On the 7th day, the lnHF decreased and increased at sitting and post supine posture, respectively, while the LF/HF ratio changed reciprocally to the lnHF. The DBP showed a decrement tendency at post supine after the 3rd day, but the SBP did not changed during the period. Discussion and conclusions: Recovery of parasympathetic function was observed from the 3rd day after the onset of stroke, while both parasympathetic and sympathetic functions recovered by the 7th day. During the first week after stroke, when postural changes might be practiced during physical therapy, the recovery condition of autonomic function should be taken into account to prevent cardiac complication, such as postural hypotension during physical therapy. Impact and implications: The present study contributes to the program for early mobilization and physical therapy during early recovery phase after stroke. Funding acknowledgement: N/A. http://dx.doi.org/10.1016/j.physio.2016.10.112
POS055 Implementation of the Dutch physical therapy quality program for patient reported outcomes measurement, an observational study G.A. Meerhoff 1,2,∗ , S. van Dulmen 1 , M. Maas 1 , K. Heijblom 1 , R. Nijhuis-van der Sanden 1 , P.J. van der Wees 1 1 Radboud
University Medical Center, IQ Healthcare, Nijmegen, Netherlands 2 Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands Relevance: The primary aim of modern healthcare systems is to realize optimal health outcomes for patients and populations and to deliver services that are of the highest possible quality. High quality healthcare has been defined as care that is safe, timely, equitable, effective, efficient, and patientcentered. In 2013 the Royal Dutch Society for Physical Therapy (KNGF) started the development and implementation of their national quality program ‘Quality in Motion’. The rationale behind this program was the desire to establish a quality system that would stimulate patient-centered care and improve the effectiveness of care. Purpose: This study describes the development of strategies for implementing the national quality program of the KNGF and it evaluates the success of the implementation. The program aims to collect patient-reported outcome measures (PROMs) data via a national registry. This data is fed back to physical therapists (PTs) to facilitate quality improvement activities via peer assessment sessions using a plan-do-check-act cycle. Methods/analysis: A stepwise implementation, based on the 8-steps of Grol for the implementation of innovations in healthcare, was established in three consecutive pilots with a total of 355 PTs. Due to this stepwise implementation, improvements could be made to the strategy based on experiences in the previous pilots. Core component of the implementation was the introduction of knowledge brokers to support participants in establishing routine in using PROMs in their clinical reasoning, and to assist in executing the peer assessment sessions. PROMs-Data was collected in the registry via electronic health records. The implementation was evaluated using a self-assessment questionnaire, process evaluation, and the June and December 2014 datasets from the registry. Descriptive statistics and Chi-square analysis were used to estimate the feasibility of implementing PROMs as part of the national quality program. Execution of this study is approved by the Medical Ethical Committee of Radboud university medical center (registration #2014/260) and conducted conform the Declaration of Helsinki.
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
Results: Although the initial implementation strategy was amended to improve its effect, all pilots showed a significant improvement on the self-assessment questionnaire regarding the use of PROMs and, the knowledge and attitude towards PROMs. Regarding the data gathered in the registry it is shown that in July 2014, 65% of the PT practices delivered data to the registry, which increased to 92% in December 2014, containing 19,222 completed patient records. In December 2014, pre- and post-treatment PROMs measurements were registered in 21.4% of patient records. Discussion and conclusions: The implementation strategies were successful in facilitating PROM-use in PT practice and quality improvement. The routine use of PROMs needs to increase before being suitable for external accountability. Using KBs in support of the participating PTs is promising for implementing the program via peer assessment sessions. Impact and implications: Data in the registry can be used for quality improvement purposes in safe settings, but is not yet robust enough for external accountability purposes. Participating PTs need increase their routine in PROM-use. The KBs are expected to play an important role in increasing this routine, since they function as a motivator and educator in the further implementation. Funding acknowledgement: The national program was funded by the KNGF. The different pilots were co-funded by the networks of physical therapists that participated in the pilots, with additional funding of the health insurance companies Menzis and Centraal Ziekenfonds CZ. The cofunding health insurance companies did not have a role in the study design, data collection and analysis, or interpreting the data and writing of the report. http://dx.doi.org/10.1016/j.physio.2016.10.113 POS056 Evidence for exercise training in autonomic function modulation in patients with chronic obstructive pulmonary disease (COPD): a systematic review J. Mohammed 1,2,∗ , E. Derom 3 , J. Van Oosterwijck 1,4 , H. Da Silva 1 , P. Calders 1 1 Ghent
University, Rehabilitation Sciences and Physiotherapy, Ghent, Belgium 2 Bayero University Kano, Physiotherapy, Kano, Nigeria 3 Ghent University/Hospital, Ghent, Belgium 4 Reserch Foundation Flanders, Brussels, Belgium Relevance: Chronic obstructive pulmonary disease (COPD) is a highly prevalent systemic disease which has a negative influence on both cardiovascular and autonomic nervous systems (ANS). One of the most important components of pulmonary rehabilitation for COPD is exercise
eS107
training. Exercise training improves dyspnea, quality of life, medical consumption, neuromuscular coordination and selfconfidence in COPD. The use of exercise training programme for modulating the ANS in patients with COPD has been sparsely reported. However, no systematic review has been conducted to support the use of exercise training for ANS modulation in these patients. Purpose: To assess the evidence for the effectiveness of different exercise training on autonomic function (AF) outcomes in patients with COPD. Methods/analysis: Following the PRISMA-guidelines a systematic search was performed in search engines of PubMed, Web of Science and CINAHL using a combination of predefined keywords regarding COPD/exercise training and rehabilitation/outcomes of AF. Full text reports from research studies assessing any measure of AF before and after an exercise training in patients with COPD were included. The included articles were reviewed on methodological quality, and evidence synthesis was done using the GRADE guidelines. Results: Eleven studies were included and discussed in this review. A total of 406 (279 males) patients with COPD (%FEV1 predicted; 32 ± 11 to 50 ± 19 l) were investigated in the studies. Continuous training mode at vigorous intensity (60% to 80% of VO2 max; 60$ to 75% of maximal speed/peak work rate) was used in majority of the included studies. Additionally, the exercise training duration and frequency studies was between 30 and 40 minutes/session and at least three times/week, respectively. The evidence synthesis of reviewed results from studies with high methodological quality per AF outcome provided different levels of evidence. Specifically, significant increment for heart rate variability (HRV) in the time domain analysis and heart rate recovery (HRR) following exercise training programmes was supported by a high level evidence. However, the effectiveness of exercise training in enhancing the baroreceptor sensitivity (BRS) and frequency domain analysis of HRV was supported by a limited evidence and no evidence, respectively. Discussion and conclusions: Based on the reviewed studies, it was concluded that exercise training has limited beneficial effects in the AF modulation of patients with COPD. Future studies with high methodological quality and large sample sizes are still necessary. Impact and implications: Summarizing results of studies investigating the effectiveness of exercise training for important COPD co-morbidities, such as autonomic dysfunction will promote an outcome-targeted approach to COPD rehabilitation. Funding acknowledgement: Jibril Mohammed is an awardee of a PhD study scholarship at Ghent University funded by the Tertiary Education Trust Fund (TETFund), Nigeria. Jessica Van Oosterwijck is a postdoctoral research fellow funded by the Research Foundation – Flanders (FWO), Belgium. http://dx.doi.org/10.1016/j.physio.2016.10.114