Selecting relevant and feasible measurement instruments for the revised Dutch clinical practice guideline for physical therapy in patients after stroke

Abstract

Purpose: To select relevant and feasible instruments for the revision of the Dutch clinical practice guideline for physical therapy in patients with stroke.

Methods: In this implementation study a comprehensive proposal for ICF categories and matching instruments was developed, based on reliability and validity. Relevant instruments were then selected in a consensus round by 11 knowledge brokers who were responsible for the implementation of the selected instruments. The feasibility of the selected instruments was tested by 36 physical therapists at different work settings within stroke services. Finally, instruments that were deemed relevant and feasible were included in the revised guideline.

Results: A total of 28 instruments were recommended for inclusion in the revised guideline. Nineteen instruments were retained from the previous guideline. Ten new instruments were tested in clinical practice, seven of which were found feasible. Two more instruments were added after critical appraisal of the set of the measurement instruments.

Conclusions: The revised guideline contains 28 relevant and feasible instrument selected and tested in clinical practice by physical therapists. Further education and implementation is needed to integrate instruments in clinical practice. Further research is proposed for developing and implementing a core set of measurement instruments to be used at fixed time points to establish data registries that allow for continuous improvement of rehabilitation for stroke patients.

Implications for Rehabilitation

• The revised Dutch Stroke Physical Therapy Guideline recommends a total of 28 instruments, that are relevant and feasible for clinical practice of physical therapist in the different settings of stroke rehabilitation.

• The selection of instrument in daily practice should be part of the clinical reasoning process of PTs and be tailored to individual patients’ needs and the degree of priority of the affected ICF category.

• Suggested education strategies for further integration of instruments in of the daily practice of PTs in Stroke Rehabilitation are: ‘Training on the job’ and ‘peer assessment in clinical situations’.

Keywords:

• Assessment
• outcome
• physical therapy
• practice guideline
• stroke

Acknowledgements

We would like to thank the knowledge brokers for their contributions to this study: Jos Goos (Franciscus ziekenhuis, Roosendaal), Walter Hanssen (Osira/Amstelring, Sint Jacob, Amsterdam), Barbara Harmeling – van der Wel (Erasmus MC, Rotterdam), Jip Kamphuis MSc (ViaReva, Apeldoorn), Margo Noom (Polikliniek voor fysiotherapie en ergotherapie Texel/ABC Omring Texel, Den Burg), Rob van der Schaft (Medisch Centrum Alkmaar, Alkmaar), Caroline Smeets (Motion Fysiotherapie en Preventie, Uithoorn), Saskia Valk-Minnen (De Vogellanden, Zwolle), Dennis Vijsma (KBO Zonnehuisgroep Amstelland, Amstelveen; Motion Fysiotherapie en Preventie, Uithoorn), Tom Vluggen MSc (Envida zorg’thuis, Maastricht, Maastricht; Maastricht University, Maastricht) and Caroline Vollmar (Stichting de Waalboog, Joachim en Anna, Nijmegen). Furthermore, we would like to thank the steering group for the KNGF-guideline on stroke for their contributions: Roland van Peppen (Hogeschool Utrecht), Erwin van Wegen (VU Medisch Centrum), Erik Hendriks and Marc Rietberg (VU Medisch Centrum) and Karin Heijblom (KNGF).

Disclosure statement

We declare that there is no financial interest or any conflict of interest.

Funding information

This research project was supported by the Royal Dutch Society for Physical Therapy (KNGF Grant No. 8091.1; http://www.fysionet.nl/).