title: Adherence to clinical practice guidelines for low back pain in physical therapy: do patients benefit?
abstract: BACKGROUND
  Various guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health outcomes, however, is not conclusive.
  
  
  OBJECTIVE
  The main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes. The study further explored whether this relationship differs for the individual steps of the process of care and for distinct subgroups of patients.
  
  
  METHODS
  This was an observational prospective cohort study (2005-2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients.
  
  
  METHODS
  Therapists recorded the process of care and the number of treatment sessions in Web-based patient files. Guideline adherence was assessed using quality indicators. Physical functioning was measured by the Dutch version of the Quebec Back Pain and Disability Scale, and average pain was measured with a visual analog scale. Relationships between the percentage of guideline adherence and outcomes of care were evaluated with regression analyses.
  
  
  RESULTS
  Higher percentages of adherence were associated with fewer functional limitations (beta=-0.21, P=.023) and fewer treatment sessions (beta=-0.27, P=.005).
  
  
  CONCLUSIONS
  The relatively small self-selected sample might limit external validity, but it is not expected that the small sample greatly influenced the internal validity of the study. Larger samples are required to enable adequate subgroup analyses.
  
  
  CONCLUSIONS
  The results indicate that higher percentages of guideline adherence are related to better improvement of physical functioning and to a lower utilization of care. A proper assessment of the relationship between the process of physical therapy care and outcomes may require a comprehensive set of process indicators to measure guideline adherence.
authors.affiliation: Scientific Institute for Quality in Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQhealthcare, 6500 HB Nijmegen, the Netherlands. g.rutten@gvo.unimaas.nl
authors.forename: Geert M
authors.initials: GM
authors.lastname: Rutten
authors.forename: Saskia
authors.initials: S
authors.lastname: Degen
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Hendriks
authors.forename: Jozé C
authors.initials: JC
authors.lastname: Braspenning
authors.forename: Janneke
authors.initials: J
authors.lastname: Harting
authors.forename: Rob A
authors.initials: RA
authors.lastname: Oostendorp
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012044:Regression Analysis; D011795:Surveys and Questionnaires