The following article has just been accepted for publication in Journal of Neurologic Physical Therapy:
“A QUALITY IMPROVEMENT PROJECT IN BALANCE AND VESTIBULAR REHABILITATION AND ITS EFFECT ON CLINICAL OUTCOME MEASURES”
Mohammad A. ALMohiza, Ph.D., PT; Patrick J. Sparto, PhD, PT; Gregory F. Marchetti, PhD, PT; Anthony Delitto, PhD, PT, FAPTA; Joseph M. Furman, MD, PhD; Debora L. Miller, PT, MBA; Susan L. Whitney, PhD, PT, NCS, ATC
Purpose/Hypothesis: Variation in practice is one of the leading causes of sub-optimal outcomes in healthcare which can be minimized via quality improvement initiatives. However, quality improvement projects focus mostly on assessing the processes and less attention is given to their effect on clinical outcomes. An effective implementation of a clinical treatment algorithm (CTA) could improve care for individuals with balance and vestibular disorders. The first aim of this quality improvement project was to examine compliance and adherence to a CTA developed by physical therapists who treat persons with balance and vestibular disorders. The second aim of this project was to examine the effect of adherence on patient outcomes.
Materials/Methods: Twenty-three physical therapists who provided rehabilitation for individuals with balance and vestibular disorders participated in the quality improvement project that lasted 16 weeks. All physical therapists worked for the same health care provider, and developed the minimum data set (MDS) and CTA. The physical therapists were cluster randomized into two groups; both groups received educational training and reminders regarding and adherence to the CTA. The first group received the training and reminders after an eight week baseline period (Initial Group), and the second group (Delayed Group) after a 12 week baseline period. The prescribed interventions were classified as being adherent or non-adherent to the CTA. Clinical outcomes, including the Activities-specific Balance Confidence scale (ABC), Dizziness Handicap Inventory (DHI), and the Global Rating of Change (GRC), were recorded at the initial evaluation and discharge for 454 individuals.
Results: Across the 16 week project, adherence rates improved significantly by 9 and 12% for the Initial and Delayed groups, respectively (p=0.008), but there was no difference between groups due to the timing of the educational training and adherence reminders. Clinical outcomes improved significantly for individuals, but there was no significant difference in change in ABC, DHI, and GRC scores according to if the interventions were adherent to the CTA.
Conclusions: This quality improvement project was effective in increasing the adherence to the CTA in both groups. Although on average individuals with balance and vestibular disorders showed improvement on the clinical outcomes, there was no additional benefit in the clinical outcome for adherent interventions.
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