title: Comparison of clinical vignettes and standardized patients as measures of physiotherapists' activity and work recommendations in patients with non-specific low back pain.
abstract: OBJECTIVE
  To validate clinical vignettes as a measure of physiotherapists' activity and work recommendations given to patients with non-specific low back pain.
  
  
  METHODS
  Validation study comparing two methods for measuring aspects of health providers' clinical management: Clinical vignettes and unannounced visits of standardized patients (the gold standard).
  
  
  METHODS
  Outpatient physiotherapy clinics.
  
  
  METHODS
  Physiotherapists (N = 59) who consented to see unannounced standardized patients in their clinical practice.
  
  
  METHODS
  Clinical vignettes were used to initially measure physiotherapists' self-reported activity and work recommendations. Subsequently, actors performing as standardized patients visited physiotherapists in their clinical practice and rated the advice given by the physiotherapist regarding activity and work. A total of 23 standardized patients were randomly scheduled to physiotherapists. Physiotherapists were blinded towards the standardized patients. To test whether standardized patients were detected, physiotherapists reported if they suspected that they had treated an actor.
  
  
  RESULTS
  The 23 standardized patients visited 22 different physiotherapists. Physiotherapists detected 12 out of 23 unannounced standardized patients (detection rate: 52%). The estimated agreement between the two measures was poor, for both activity and work recommendations (weighted kappa coefficients: 0.29 resp. -0.21).
  
  
  CONCLUSIONS
  The poor concordance between clinical vignettes and standardized patients indicates the potentially limited validity of clinical vignettes as a measure of health providers' activity and work recommendations in low back pain practice.
authors: School of Health Professions, Zurich University of Applied Sciences (ZHAW), Institute of Physiotherapy, Winterthur, Switzerland Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven (KU Leuven), Leuven, Belgium Institute of Physiotherapy, Kantonsspital Winterthur (KSW), Winterthur, Switzerland emanuel.brunner@zhaw.ch.
authors: Emanuel
authors: E
authors: Brunner
authors: Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven (KU Leuven), Leuven, Belgium.
authors: Michel
authors: M
authors: Probst
authors: School of Health Professions, Zurich University of Applied Sciences (ZHAW), Institute of Physiotherapy, Winterthur, Switzerland.
authors: André
authors: A
authors: Meichtry
authors: School of Health Professions, Zurich University of Applied Sciences (ZHAW), Institute of Physiotherapy, Winterthur, Switzerland.
authors: Hannu
authors: H
authors: Luomajoki
authors: Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven (KU Leuven), Leuven, Belgium.
authors: Wim
authors: W
authors: Dankaerts
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D001530:Belgium; D002983:Clinical Competence; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D059825:Physical Therapists / Q000592:standards*; D026741:Physical Therapy Modalities / Q000592:standards*; D011369:Professional-Patient Relations; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013557:Switzerland; D013647:Task Performance and Analysis
keywords: Low back pain; clinical vignettes; physiotherapy; standardized patients; validity