Effectiveness of peer assessment for implementing a Dutch physical therapy low back pain guideline: cluster randomized controlled trial.
BACKGROUND
Clinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting.


OBJECTIVE
The aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP).


METHODS
A cluster randomized controlled trial was conducted.


METHODS
Ten communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41).


METHODS
Both groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions.


METHODS
Outcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0-100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20-100).


RESULTS
Vignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection.


CONCLUSIONS
The small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study.


CONCLUSIONS
Peer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.
S.A. van Dulmen, MSc, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Internal Code 114, PO Box 9101, 6500 HB Nijmegen, the Netherlands. simone.vandulmen@radboudumc.nl.
Simone A
SA
van Dulmen
M. Maas, MSc, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, and Department of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands.
Marjo
M
Maas
J.B. Staal, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare.
J Bart
JB
Staal
G. Rutten, PhD, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.
Geert
G
Rutten
H. Kiers, MSc, Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, the Netherlands.
Henri
H
Kiers
M. Nijhuis-van der Sanden, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare.
Maria
M
Nijhuis-van der Sanden
P. van der Wees, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare.
Philip
P
van der Wees
D000293:Adolescent; D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration*; D017408:Guidelines as Topic; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010147:Pain Measurement; D010379:Peer Group; D011361:Professional Competence