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  • Too Many Questions Could Decrease Value of Patient Surveys of Physical Therapy

    When it comes to getting an accurate take on patient experience with physical therapy, it may be a matter of the less asked, the better.

    That's one of the conclusions reached in a Norwegian study that analyzed physical therapist (PT) patient surveys to find out whether a lengthy multidimension instrument could be simplified. Researchers used factor analysis to study results from a 41-item survey administered to 2,221 patients from 52 physical therapy practices, and found that more than a third of the questions did not yield meaningful results. Additionally, they discovered that the survey's 10 topical areas ("dimensions") could be reduced to 3: personal interaction, practice organization, and outcome. Results were published in the June 18 issue of BioMed Central (.pdf), an open-access journal.

    "Quality of care from the patient's perspective is increasingly in the spotlight, but what exactly does it mean?" authors write. Often, they argue, it's hard to extract meaningful data from lengthy patient surveys that attempt to cover too much ground—respondents are quickly fatigued and tend to be less discerning in their answers, resulting in high overall scores and little variance. With these kinds of scores, authors write, "it becomes very difficult to distinguish high performing practices from practices with lower quality of care."

    Researchers started by administering a 10-dimension, 41-item questionnaire that included areas such as accessibility, accommodation, communication, "physical therapist's approach," and "patient-centeredness," among others. Through an analysis of the performance of individual items in each dimension, researchers were able to identify the items that were consistently high-rated, with minimal (or no) variation. Once these were set aside, authors examined the remaining questions and determined that they could be regrouped into a much more straightforward, 3-dimension set of 28 questions that got to the heart of patient experience.

    Authors suggest that the streamlined questionnaire could be administered "every 3 years or so" to a random sample of a practice's patients. They also recommend that practices include "a visible and mandatory complaint desk (physical or digital) … to monitor the quality of care at all times."

    "Sharpening the definitions of the patient's perspective will help better measure the quality of care," authors write. "Patients do not benefit from too many vaguely formulated dimensions, but with 3 clear dimensions they can compare practices with ease on the dimensions they value the most."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Consumer Group Voices Opposition to Unnecessary Tests

    Is that advertised offer of a low-cost screening for stroke risk and heart disease good public health outreach or an "unethical" exercise in "fear mongering?" According to a consumer group that issued strongly worded letters to 20 hospital systems, the answer is clear—and hospitals need to do something.

    Public Citizen announced last week that it is calling on hospital systems across the country to sever partnerships with companies providing the screenings, which are usually well-advertised and often provided in buses adapted for the purpose. Public Citizen asserts that administering the screening to asymptomatic, unselected individuals is an "unethical" and "exploitative" practice that "is more likely to cause harm than benefit."

    The group's efforts are focused on screening packages from HealthFair that include 6 tests: echocardiogram, electrocardiogram, carotid artery ultrasound, abdominal aortic aneurysm ultrasound, hardening of the arteries test, and peripheral arterial disease test. When administered to asymptomatic individuals, the group writes, the tests can yield false-positive results that can lead to "unnecessary, risky, and costly diagnostic procedures and treatment interventions" or can result in overdiagnosis, "in which individuals are diagnosed with conditions that will never cause symptoms or death."

    In its letter to hospitals, Public Citizen minces no words about the screenings. "It is exploitative to promote and provide medically nonbeneficial testing through the use of misleading and fearmongering advertisements and solicitations in order to general medically unnecessary but profitable referrals to your institution," the group writes, adding that "this screening violates the ethical principles of beneficence … and nonmaleficence."

    The questions around the appropriateness of certain tests are similar to other efforts being made within the broader health care provider community. For instance, the American Board of Internal Medicine Foundation’s "Choosing Wisely" campaign is centered around lists of procedures (.pdf) that tend to be done frequently, yet whose usefulness is called into question by evidence. APTA was 1 of the first 3 nonphysician organizations invited to join the campaign, and the association has included its participation within APTA's wider "Integrity in Practice" initiative.

    2014 APTA Component Award Winners Recognized

    Real-world innovation and excellence in support of the physical therapy profession were on display when APTA announced this year's component awards. Recognitions took place at the Component Leadership Meeting on June 8 in Charlotte, North Carolina.

    This year’s Innovative Component Award was given to the Tennessee Chapter for its creative partnership with the Tennessee Titans professional football team. The chapter hosted its annual conference in the Titans stadium and sponsored radio ads across the state focusing on the benefits of working with a physical therapist (PT). The Kentucky Chapter was also recognized with an Innovative Effort Award for its work to establish collaborative relationships with the state's occupational therapy, speech-language-hearing pathology, and athletic trainer associations.

    In the Outstanding Component category, the Indiana Chapter and the Washington Chapter were acknowledged for their exemplary legislative efforts for direct access and spinal manipulation, respectively. The Oklahoma Chapter was recognized as the outstanding small chapter, while Illinois and Florida chapters received the award for outstanding large chapters.

    Other award winners were the Alabama Chapter, which partnered with APTA’s Learning Center to create an online jurisprudence course to help licensees fulfill state requirements for license renewal; the Aquatic Physical Therapy Section which partnered with the APTA Learning Center to create the new Certificate of Aquatic Physical Therapy Clinical Competency program; and the Section on Pediatrics, which was acknowledged for expanding the international reach of its Pediatric Physical Therapy journal.