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Development of evidence-based standards for inpatient physiotherapy services: a systematic review and content
Jacqueline Claire Plater1,2, G David Baxter3, Lincoln C Wood4
1Allied Health, Te Whatu Ora Health New Zealand, Te Matau a Maui Hawke's Bay, Hastings, New Zealand Jacqui.plater@otago.ac.nz.
Insights
Developing evidence-based standards for inpatient physiotherapy in New Zealand is crucial. This study used clinical practice guidelines (CPGs) to create 27 statements, highlighting gaps in physiotherapy dosage recommendations.
Area of Science:
- Healthcare Quality Improvement
- Evidence-Based Practice
- Physiotherapy Standards
Background:
- Performance standards are essential for designing and improving healthcare services.
- Currently, no published standards exist for inpatient physiotherapy care in Aotearoa New Zealand.
- This research addresses the need for evidence-based standards in this area.
Purpose of the Study:
- To explore the feasibility of using clinical practice guidelines (CPGs) to develop evidence-based standards for inpatient physiotherapy.
- To identify key recommendations for physiotherapy practice in secondary care settings.
Main Methods:
- A systematic review and content analysis of clinical practice guidelines (CPGs).
- Searched scholarly databases and grey literature for relevant CPGs (July-September 2021).
- Included CPGs for common secondary care conditions, excluding mental health, paediatrics, and tertiary care.
Main Results:
- 32 CPGs were analyzed, yielding 27 distinct practice statements.
- Statements synthesized recommendations relevant to inpatient physiotherapy.
Conclusions:
- Twenty-seven statements offer a distillation of evidence-based recommendations for inpatient physiotherapy.
- Significant gaps exist in physiotherapy dosage (frequency, intensity, duration) recommendations.
- Future CPG development should prioritize including dosage information for service commissioning.
Objective:
Performance standards are critical to service design and quality improvement. There are no published standards defining the care inpatients should receive from physiotherapists in Aotearoa New Zealand. This study aims to explore the potential of using clinical practice guidelines (CPGs) to develop a set of evidence-based standards for physiotherapy in inpatient settings.
Design:
A systematic review and content analysis of CPGs.
Data Sources:
Scholarly databases (Web of Science, CINAHL and Scopus, PEDro) and grey literature (guideline databases - NICE, SIGN, ECRI guideline trust, Guidelines International Network (GIN)) were searched between July and September 2021.
Eligibility Criteria:
CPGs related to conditions and treatments common to physiotherapy in a secondary care setting were included. Mental health conditions, paediatrics, COVID-19 and conditions common to tertiary care were excluded.
Data Extraction And Synthesis:
A pragmatic approach was taken to group guidelines aligned with common physiotherapy services and select only the most recent and comprehensive guidelines for final analysis. The quality of CPGs was assessed using the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II). Data from guideline recommendations of relevance to inpatient physiotherapy were grouped into themes. Summative 'statements' were drafted to represent the content of each theme; these were given a confidence rating based on the number of supporting guidelines and the strength or grade of evidence awarded by the guideline group.
Results:
The recommendations of 32 CPGs yielded 27 statements.
Conclusion:
Twenty-seven statements represent a distillation of the best evidence-based practice recommendations from CPGs in inpatient physiotherapy. Statements of physiotherapy dosage (frequency, intensity and duration) are not available for many areas of practice; researchers and CPG groups should consider the importance of these data for service commissioning. .
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