title: Quality indicators for physiotherapy care in hip and knee osteoarthritis: development and clinimetric properties.
abstract: OBJECTIVE
  The aim of the present study was to develop process quality indicators for physiotherapy care based on key recommendations of the Dutch physiotherapy guideline on hip and knee osteoarthritis (OA).
  
  
  METHODS
  Guideline recommendations were rated for their relevance by an expert panel, transformed into potential indicators and incorporated into a questionnaire, the Quality Indicators for Physiotherapy in Hip and Knee Osteoarthritis (QIP-HKOA). Adherence with each indicator was rated on a Likert scale (0 = never to 4 = always). The QIP-HKOA was administered to groups of expert (n = 51) and general (n = 134) physiotherapists (PTs) to test its discriminative power. Reliability was tested in a subgroup of 118 PTs by computing the intraclass correlation coefficient (ICC). QIP-HKOA items were included if they were considered to be related to the cornerstones of physiotherapy in hip and knee OA (exercises and education), had discriminative power and/or if they were followed by <75% of PTs in both groups.
  
  
  RESULTS
  Nineteen indicators were derived from 41 recommendations. Twelve indicators were considered to be the cornerstones of physiotherapy care; six indicators had discriminative power and/or were followed by <75% PTs in both groups, resulting in an 18-item QIP- HKOA. The QIP-HKOA score was significantly higher with expert [60.73; standard deviation (SD) 5.67] than with general PTs (54.65; SD 6.17) (p < 0.001). The ICC of the QIP-HKOA among 46/118 PTs was 0.89.
  
  
  CONCLUSIONS
  The QIP-HKOA, based on 18 process indicators derived from a physiotherapy guideline on hip and knee OA was found to be reliable and discriminated between expert and general PTs. Its ability to measure improvement in the quality of the process of physiotherapy care needs to be further examined.
authors.affiliation: Department of Orthopaedics, Leiden University Medical Centre (LUMC), Leiden, the Netherlands; Reade, Centre of Rehabilitation and Rheumatology (formerly Jan van Breemen Institute), Amsterdam, the Netherlands.
authors.forename: W F
authors.initials: WF
authors.lastname: Peter
authors.forename: P J
authors.initials: PJ
authors.lastname: van der Wees
authors.forename: E J M
authors.initials: EJ
authors.lastname: Hendriks
authors.forename: R A
authors.initials: RA
authors.lastname: de Bie
authors.forename: J
authors.initials: J
authors.lastname: Verhoef
authors.forename: Z
authors.initials: Z
authors.lastname: de Jong
authors.forename: L
authors.initials: L
authors.lastname: van Bodegom-Vos
authors.forename: W K H A
authors.initials: WK
authors.lastname: Hilberdink
authors.forename: T P M
authors.initials: TP
authors.lastname: Vliet Vlieland
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000534:rehabilitation*; D020370:Osteoarthritis, Knee / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000592:standards*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Quality indicators; hip and knee; osteoarthritis; physiotherapy