An innovative peer assessment program to improve evidence based practice in physical therapy.

Introduction:

The Royal Dutch Society of Physical Therapy (KNGF) promotes the development and implementation of clinical guidelines for diagnoses and treatment. However, guideline adherence in daily practice appears to be limited. Several strategies have been developed to improve guideline adherence. Peer assessment is considered a promising implementation strategy.



Aim:

In this study the effectiviness of an innovative peer assessment program to implement physical therapy guidelines will be compared to the regular program case-discussion program.



Design:

Exploratory clustered randomized controlled trial with 1) peer assessment (PA)as intervention and 2) traditional case based discussion as control.



Methods:

20 groups of Physical Therapists were randomly assigned to the intervention group (peer assessment) and the control group (case-based discussion).

Outcome measures were evidence based reasoning according to pre-set guideline quality indicators, commitment to change statements, reflection and insight, perceived guideline adherent practice.
The essence of the peer assessment method is that physical therapists assess their peers for competences in clinical reasoning and hands-on expertise for diagnosis and treatment. Moreover they judge the quality of their peers patient records.

Peer assessment, as a educational guideline implementation strategy, results in more improvement of evidence based reasoning than case based discussion.

Baseline: 01-02-2012;

Follow-up: 01-07-2012.

Intervention:

The educational program for both groups contained four meetings of 3 hours over a period of 6 months, starting in February 2012. At baseline all participants received an introductory letter, a program schedule, a program manual and a link to the Practice Guidelines. At February 8, all participants received a link to the online baseline assessment. Follow up measurement will be in July 2012.



Intervention group:

The peer groups were provided with a manual that contained a highly structured program, guidelines for giving and receiving feedback and a scoring form, based on quality indicators.

During the peer assessment meetings, participants performed in the role of physical therapist and in the role of assessor. In the physical therapist role they demonstrated diagnostic and therapeutic reasoning and skills based on written cases. Cases covered the content domain of the guidelines on shoulder complaints.

In the assessor role they observed the performance of their peers and provided them of improvement feedback.

The peer assessment meetings were tightly scheduled and discussion time was limited.
The peer assessment process was coached by a trained external assessor (n = 4) who presented short clinical cases on the spot (not in advance) accompanied by a small set of questions. The external assessor only provided additional feedback when necessary.

When the program was finalized, all participants received a written answering key to the questions by email.



Control group:

The case based discussion groups also received a program manual that was loosely structured and allowed for more discussion time. Detailed clinical cases and questions to guide the discussion process, were provided in advance to allow for preparation. There was no external coach to guide the discussion process. When the program was finalized, all participants received a written answering key to the questions by email.