Quality indicators for Spanish hospital-based physical therapy units: a feasibility and inter-rater reliability study

The aim of this study was to assess the feasibility and inter-rater reliability of a set of 22 quality indicators and to identify quality problems in the clinical practice of hospital-based physical therapy units.

An observational, descriptive, cross-sectional, multicentre study with a mixed approach was conducted in three hospitals in Spain. Twenty-two indicators (nine management and thirteen clinical) were evaluated and refined according to the feasibility of the available data, and interobserver agreement (inter-rater reliability) was measured. The analysis combined qualitative and quantitative methods.

Of the 22 quality indicators, 13 were feasible and showed concordance between evaluators across all hospitals included in the study. The main difficulties the evaluators observed were: inadequate identification of the pathologies of interest, limited identification of the initial diagnosis or index episode in patients with chronic conditions, and failure to record essential evaluation information. Opportunities for improvement include enhancing the detailed assessment of therapeutic objectives, providing early care for stroke patients, and clearly prescribing exercise treatment.

A total of 13 quality indicators (9 clinical and 4 management indicators) were feasible and reliable. The remaining 9 were refined to assess those units that so request. The quality levels, along with analyses of feasibility and inter-rater reliability, provided relevant information on the performance of the physical therapy service across three hospitals. Implementing this set of indicators provides hospitals with a systematic evaluation tool that promotes improvements in care quality and organizational learning.