Balance and Vestibular Rehabilitation Quality Improvement
المهيزع, د. محمد بن عبدالله . 2014
Quality improvement (QI) in healthcare aims for higher performance. Nonetheless, QI and guidelines implementation focus mostly on assessing the processes and less attention is given to the effect on clinical outcomes. This project examined the adherence of physical therapists to the clinical decision rules (CDRs) in balance and vestibular rehabilitation and its effect on clinical outcomes. We hypnotized that physical therapists would be more adherent to the CDRs after the QI interventions. Also, we hypothesized that persons with balance and vestibular disorders who were treated in adherence to the CDRs would have better scores on the clinical outcomes.
Eighteen physical therapists were randomly assigned to the intervention or wait-listed groups. Both groups received the QI interventions at different time points. The main outcome was the adherence to the CDRs. Four hundred fifty-four patients’ evaluation forms had complete follow-up data and were classified as either being adherent or non-adherent to the CDRs. The clinical outcomes were the Activities-specific Balance Confidence scale (ABC), the Dizziness Handicap Inventory (DHI), and the Global Rating of Change (GRC).
The change in adherence rates after the QI interventions was 9% and 12% for the intervention and wait-listed groups, respectively. There was a significant within group effect (p=0.008), but the between groups difference was not significant (p=0.8). The interaction effect was not significant (p=0.6). The change in the ABC score was 14 and 9 for adherent and non-adherent forms, respectively. For the ABC, there was a significant change within groups (p=<0.001) and the change was not significant between groups (p=0.8). The change in the DHI score was -16 for adherent forms and -17 for non-adherent forms. The change within and between groups for the DHI was not significant (p=0.6 and 0.7, respectively). Median GRC score was +5 for adherent forms and +4.5 for non-adherent forms. The difference in the GRC scores between adherent and non-adherent forms was not significant.
This QI project showed enhancement in adherence to the CDRs in both groups. There was no additional benefit in the clinical outcomes for adherent evaluation forms.
Quality improvement (QI) in healthcare aims for higher performance. Nonetheless, QI and guidelines implementation focus mostly on assessing the processes and less attention is given to the effect…