- Email: [email protected]
Revision of the Dutch method for guideline development and revision, a policy report
eS184
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
and attitudes required for professional functioning, observed when carrying out occupational core tasks and students’ knowledge base assessed separately and additionally using assessment interviews or knowledge tests. The purpose of the study was to identify the students’ perception of their competence gained at university and clinical environment after a three-year physiotherapy course. Methods/analysis: Students participating in this study were enrolled in physiotherapy bachelor programme, offered by the Faculty of Health Sciences of University of Ljubljana. Fifty-three subjects, 8 male and 45 female, aged average 2.8 years (range 22 to 29 years) filled out the questionnaire. The format of the physiotherapy competence scale was used to develop a questionnaire for this study. Scales were constructed for 12 occupational core competences and for 12 qualification-based competences. Students were asked how much confidence they have in their competence at two settings, university and clinical. Answers were given on a five-point scale ranging from (1) ‘not at all’ to (5) ‘very much’. Mean scores and standard deviations were calculated for overall students’ perceptions of competences. Kendall’s tau-b and Pearson correlations were calculated (P < 0.01) for relationship between demographic features of the students and perceptions of their competence. Results: Students’ perceptions of their overall competences averaged 3.58 (±0.68). The average of gained competences at university and clinical environment was 3.41 (±0.74) and 3.74 (±0.68), respectively. The highest average value of occupational core competence gained at university was 4.21 (±1.02) and 4.53 (±0.80) in clinical environment. The lowest average value was 3.51 at (±1.01) university and 3.06 (±1.20) in clinical environment. The highest average value of qualification-based competence gained at university was 3.60 (±0.98) and 4.11 (±0.93) in clinical environment. The lowest average value gained at university was 3.26 (±1.02) and 3.11 (±1.07) in clinical environment. No correlation was found between demographic features of the students and perceptions of their competence. Discussion and conclusions: Perceived competence appears to increase at clinical environment. This finding was expected because students get a more accurate picture of the complexity of the workplace and can more accurately compare their own competence to the requirements of the workplace. Comparing competences gained at two settings, students appear to be able to judge their own competence quite well. Practical experiences are important, as they offer the opportunity to compare what is learned at school to the reality and complexity of the workplace. To get a more accurate picture of individual students’ development process after a three-year course, longitudinal research would be needed. For example, by questioning about student’s perception after graduation and after completed internships. Impact and implications: This research sheds a first light on this issue by showing the students’ perceptions of their own competence at two settings, university and clinical, in a competence-based physiotherapy course in higher education.
Funding acknowledgement: No acknowledgements for funding, the work was unfunded. http://dx.doi.org/10.1016/j.physio.2016.10.220 POS163 Revision of the Dutch method for guideline development and revision, a policy report G.A. Meerhoff ∗ , K. Heijblom, J. Knoop Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands Relevance: Evidence-based practice is the integration of best available evidence, professional expertise and patient values, with the aim of improving healthcare. One of the mechanisms to stimulate evidence-based practice is the development and implementation of guidelines. The Royal Dutch Society for Physical Therapy (KNGF) has been developing these guidelines since the nineties. Nowadays, 17 guidelines function as the cornerstone for Dutch physical therapy, regarding the definition of good professional practice and in obtaining reimbursement agreements. Purpose: In 2015 the KNGF decided to update its method for guideline development and revision with the aim to develop/revise guidelines: 1) That are easier to apply in clinical practice. Multiple studies have shown that the implementation of guidelines within healthcare is suboptimal due to the lack of clinical applicability. This applicability is planned to be improved by presenting our guidelines in a standard template on an easy to interpret modern web-portal; 2) That meet the new quality standards defined by the Dutch National Health Care Institute (DNHCI). These standards oblige guideline developers to actively involve patient representatives, health insurance companies and all healthcare providers primarily involved in the developmental process. A guideline can only officially be approved by the DNHCI if all stakeholders involved authorize the final document. 3) In a more efficient and uniform manner. Until now for the development/revision of each guideline the KNGF contracted a different Dutch University. Within these collaborations we’ve experienced it was difficult to adhere to the schedule for delivery and to present the different final documents in a uniform manner. From 2016 the KNGF will start to develop/revise guidelines at her own office. With this changed strategy the KNGF expects to increase efficiency and be able to deliver the guidelines in a more uniform manner. Approach/evaluation: Based on input obtained from different clinical practitioners and researchers, and the new quality standards defined by the DNHCI, a concept version of
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
the revised method for guideline development/revision was written. This concept document has been presented to an expert group existing of: (1) the former author of the method for guideline development, (2) the authors of existing KNGFguidelines, (3) lecturers and professors who participate in KNGF’s scientific advisory board and (4) stakeholders such as the Dutch Patient Federation, the Dutch College of General Practitioners and the Dutch Federation of Medical Specialists. Outcomes: After three rounds of feedback all experts agreed that the method for guideline development and revision corresponded to the needs. Discussion and conclusions: The revision of the method for the development and revision of guidelines creates the possibility for the KNGF to autonomously develop/revise our guidelines and enables us to be more successful in achieving our process of development and revision. In addition all products will adhere to the new quality standards and their clinical applicability will be improved by presenting our guidelines in a standard template on a modern and easy to interpret web-portal. Impact and implications: In 2016 two existing guidelines will be revised. Based on the experiences of these revisions we plan to further optimize our method for guideline development. Funding acknowledgement: The revision of the method for guideline development was funded and executed by the Royal Dutch Society for Physical Therapy (KNGF). http://dx.doi.org/10.1016/j.physio.2016.10.221 POS164 RAPID3 as toll in prediction of hand function in RA M. Qorolli 1,∗ , H. Hundozi-Hysenaj 2 , S. Grazio 3 1 University
Clinical Center of Kosova, Rheumatology Clinic, Prishtina, Kosovo 2 Faculty of Medicine, University of Prishtina, University Clinical Center of Kosova, Department of Physical Medicine and Rehabilitation, Prishtina, Kosovo 3 School of Medicine, University of Zagreb, Department of Rheumatology, Physical and Rehabilitation Medicine, Zagreb, Croatia Relevance: This research is conducted at Rheumatology Clinic, University Clinical Center of Kosova. Since Rheumatoid Arthritis (RA) is a lifelong, systemic, destructive, autoimmune disease, it is crucial to follow different disease components which lead to impairment and disability. Now days, the use of patients report outcome measures are continuously greater. RAPID3 is patients report outcome, without formal joint count and laboratory tests, which can
eS185
be calculated in 5 seconds. Since patient’s needs are ever evolving, the aim of our study is to explore the relation of RAPID3 with hand function in order to expand implementation of RAPID3 in every day clinical practice that can be used by all medical practitioners (especially by physiotherapist), while patients assessment will be more complete and less time consuming. Purpose: In RA although any joint can be involved, in 90 percent of patients the hand and wrist joints are affected. Thus, the outcome measures in RA patients involve assessments of different disease components. RAPID3 is patients report outcome which includes assessment of physical function, pain, and global health, without formal joint count and laboratory tests. Since hand involvement is inevitable, our aim is to investigate RAPID3 regarding its association with functional ability of the hand measured by different hand assessment tools. Methods/analysis: Sixty-eight consecutive RA patients, of both genders (85% female), aged 18 to 75 years, with RA, disease duration of at least 6 months, and with no change on disease-modified drugs and glucocorticoids within last 3 months, were included in the study, during their outpatient visit at the Rheumatologic Clinic University Clinical Center of Kosova. The patient’s data consists of demographic (gender, age, occupation, education level, family history regarding RA, duration of the disease, and hand dominance) and clinical data (RAPID3, DAS28, HAQ-DI, Grip strength, SOFI-hand and pulp to palm distance, VAS-pain). Results: The mean value of RAPID3 was 14.1, where female scored higher disease activity, and showed more deterioration in hand function. The positive correlation was found between RAPID3 and HAQ-DI, SOFI, pulp to palm distance, while the negative correlation was found between RAPID3 and Grip strength. As for the strength of correlation of RAPID3 with other variables the order from the strongest to the weakness was as follows: HAQ-DI, Grip strength, SOFI and pulp to palm distance. The hand assessment data have stronger correlations with RAPID3 than with DAS28. Discussion and conclusions: Our study showed that RAPID3 was strongly associated with measures of functional ability of the hand, as a preferable site of RA. Impact and implications: RAPID 3, a pure and simple PRO instrument, encompasses a hand function ability and it can be used in clinical practice. Funding acknowledgement: We declare no funding for research. We would like to thank all study participants. http://dx.doi.org/10.1016/j.physio.2016.10.222
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
and attitudes required for professional functioning, observed when carrying out occupational core tasks and students’ knowledge base assessed separately and additionally using assessment interviews or knowledge tests. The purpose of the study was to identify the students’ perception of their competence gained at university and clinical environment after a three-year physiotherapy course. Methods/analysis: Students participating in this study were enrolled in physiotherapy bachelor programme, offered by the Faculty of Health Sciences of University of Ljubljana. Fifty-three subjects, 8 male and 45 female, aged average 2.8 years (range 22 to 29 years) filled out the questionnaire. The format of the physiotherapy competence scale was used to develop a questionnaire for this study. Scales were constructed for 12 occupational core competences and for 12 qualification-based competences. Students were asked how much confidence they have in their competence at two settings, university and clinical. Answers were given on a five-point scale ranging from (1) ‘not at all’ to (5) ‘very much’. Mean scores and standard deviations were calculated for overall students’ perceptions of competences. Kendall’s tau-b and Pearson correlations were calculated (P < 0.01) for relationship between demographic features of the students and perceptions of their competence. Results: Students’ perceptions of their overall competences averaged 3.58 (±0.68). The average of gained competences at university and clinical environment was 3.41 (±0.74) and 3.74 (±0.68), respectively. The highest average value of occupational core competence gained at university was 4.21 (±1.02) and 4.53 (±0.80) in clinical environment. The lowest average value was 3.51 at (±1.01) university and 3.06 (±1.20) in clinical environment. The highest average value of qualification-based competence gained at university was 3.60 (±0.98) and 4.11 (±0.93) in clinical environment. The lowest average value gained at university was 3.26 (±1.02) and 3.11 (±1.07) in clinical environment. No correlation was found between demographic features of the students and perceptions of their competence. Discussion and conclusions: Perceived competence appears to increase at clinical environment. This finding was expected because students get a more accurate picture of the complexity of the workplace and can more accurately compare their own competence to the requirements of the workplace. Comparing competences gained at two settings, students appear to be able to judge their own competence quite well. Practical experiences are important, as they offer the opportunity to compare what is learned at school to the reality and complexity of the workplace. To get a more accurate picture of individual students’ development process after a three-year course, longitudinal research would be needed. For example, by questioning about student’s perception after graduation and after completed internships. Impact and implications: This research sheds a first light on this issue by showing the students’ perceptions of their own competence at two settings, university and clinical, in a competence-based physiotherapy course in higher education.
Funding acknowledgement: No acknowledgements for funding, the work was unfunded. http://dx.doi.org/10.1016/j.physio.2016.10.220 POS163 Revision of the Dutch method for guideline development and revision, a policy report G.A. Meerhoff ∗ , K. Heijblom, J. Knoop Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands Relevance: Evidence-based practice is the integration of best available evidence, professional expertise and patient values, with the aim of improving healthcare. One of the mechanisms to stimulate evidence-based practice is the development and implementation of guidelines. The Royal Dutch Society for Physical Therapy (KNGF) has been developing these guidelines since the nineties. Nowadays, 17 guidelines function as the cornerstone for Dutch physical therapy, regarding the definition of good professional practice and in obtaining reimbursement agreements. Purpose: In 2015 the KNGF decided to update its method for guideline development and revision with the aim to develop/revise guidelines: 1) That are easier to apply in clinical practice. Multiple studies have shown that the implementation of guidelines within healthcare is suboptimal due to the lack of clinical applicability. This applicability is planned to be improved by presenting our guidelines in a standard template on an easy to interpret modern web-portal; 2) That meet the new quality standards defined by the Dutch National Health Care Institute (DNHCI). These standards oblige guideline developers to actively involve patient representatives, health insurance companies and all healthcare providers primarily involved in the developmental process. A guideline can only officially be approved by the DNHCI if all stakeholders involved authorize the final document. 3) In a more efficient and uniform manner. Until now for the development/revision of each guideline the KNGF contracted a different Dutch University. Within these collaborations we’ve experienced it was difficult to adhere to the schedule for delivery and to present the different final documents in a uniform manner. From 2016 the KNGF will start to develop/revise guidelines at her own office. With this changed strategy the KNGF expects to increase efficiency and be able to deliver the guidelines in a more uniform manner. Approach/evaluation: Based on input obtained from different clinical practitioners and researchers, and the new quality standards defined by the DNHCI, a concept version of
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
the revised method for guideline development/revision was written. This concept document has been presented to an expert group existing of: (1) the former author of the method for guideline development, (2) the authors of existing KNGFguidelines, (3) lecturers and professors who participate in KNGF’s scientific advisory board and (4) stakeholders such as the Dutch Patient Federation, the Dutch College of General Practitioners and the Dutch Federation of Medical Specialists. Outcomes: After three rounds of feedback all experts agreed that the method for guideline development and revision corresponded to the needs. Discussion and conclusions: The revision of the method for the development and revision of guidelines creates the possibility for the KNGF to autonomously develop/revise our guidelines and enables us to be more successful in achieving our process of development and revision. In addition all products will adhere to the new quality standards and their clinical applicability will be improved by presenting our guidelines in a standard template on a modern and easy to interpret web-portal. Impact and implications: In 2016 two existing guidelines will be revised. Based on the experiences of these revisions we plan to further optimize our method for guideline development. Funding acknowledgement: The revision of the method for guideline development was funded and executed by the Royal Dutch Society for Physical Therapy (KNGF). http://dx.doi.org/10.1016/j.physio.2016.10.221 POS164 RAPID3 as toll in prediction of hand function in RA M. Qorolli 1,∗ , H. Hundozi-Hysenaj 2 , S. Grazio 3 1 University
Clinical Center of Kosova, Rheumatology Clinic, Prishtina, Kosovo 2 Faculty of Medicine, University of Prishtina, University Clinical Center of Kosova, Department of Physical Medicine and Rehabilitation, Prishtina, Kosovo 3 School of Medicine, University of Zagreb, Department of Rheumatology, Physical and Rehabilitation Medicine, Zagreb, Croatia Relevance: This research is conducted at Rheumatology Clinic, University Clinical Center of Kosova. Since Rheumatoid Arthritis (RA) is a lifelong, systemic, destructive, autoimmune disease, it is crucial to follow different disease components which lead to impairment and disability. Now days, the use of patients report outcome measures are continuously greater. RAPID3 is patients report outcome, without formal joint count and laboratory tests, which can
eS185
be calculated in 5 seconds. Since patient’s needs are ever evolving, the aim of our study is to explore the relation of RAPID3 with hand function in order to expand implementation of RAPID3 in every day clinical practice that can be used by all medical practitioners (especially by physiotherapist), while patients assessment will be more complete and less time consuming. Purpose: In RA although any joint can be involved, in 90 percent of patients the hand and wrist joints are affected. Thus, the outcome measures in RA patients involve assessments of different disease components. RAPID3 is patients report outcome which includes assessment of physical function, pain, and global health, without formal joint count and laboratory tests. Since hand involvement is inevitable, our aim is to investigate RAPID3 regarding its association with functional ability of the hand measured by different hand assessment tools. Methods/analysis: Sixty-eight consecutive RA patients, of both genders (85% female), aged 18 to 75 years, with RA, disease duration of at least 6 months, and with no change on disease-modified drugs and glucocorticoids within last 3 months, were included in the study, during their outpatient visit at the Rheumatologic Clinic University Clinical Center of Kosova. The patient’s data consists of demographic (gender, age, occupation, education level, family history regarding RA, duration of the disease, and hand dominance) and clinical data (RAPID3, DAS28, HAQ-DI, Grip strength, SOFI-hand and pulp to palm distance, VAS-pain). Results: The mean value of RAPID3 was 14.1, where female scored higher disease activity, and showed more deterioration in hand function. The positive correlation was found between RAPID3 and HAQ-DI, SOFI, pulp to palm distance, while the negative correlation was found between RAPID3 and Grip strength. As for the strength of correlation of RAPID3 with other variables the order from the strongest to the weakness was as follows: HAQ-DI, Grip strength, SOFI and pulp to palm distance. The hand assessment data have stronger correlations with RAPID3 than with DAS28. Discussion and conclusions: Our study showed that RAPID3 was strongly associated with measures of functional ability of the hand, as a preferable site of RA. Impact and implications: RAPID 3, a pure and simple PRO instrument, encompasses a hand function ability and it can be used in clinical practice. Funding acknowledgement: We declare no funding for research. We would like to thank all study participants. http://dx.doi.org/10.1016/j.physio.2016.10.222