Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study

<p>Abstract</p> <p>Background</p> <p>Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews.</p> <p>Methods</p> <p>We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA.</p> <p>Results</p> <p>A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching.</p> <p>Conclusion</p> <p>Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.</p

Characterizing Real-Time Systems And Tasks

easures, too, act as filters, imposing a scale of values on performance. To be useful, a performance measure must be compact. That is, it must encapsulate in a very few numbers (preferably a single number) the &quot;performance &quot; of a system. In other words, it must convey what is important about the performance of a system and leave out what is not. If, for instance, we use the mean response time of a computer to a given task as a performance measure, we are -- deliberately or unwittingly -- laying down that it is the average which is important, not the variance. Example 2.1. Consider two systems A and B. A and B have system response times with probability density functions 1 shown in Figure 2.1: system A is clearly more predictable than system B, and is only slightly slower. However, if the mean response time is our performanc

Cherry Picking in ESRD: An Ethical Challenge in the Era of Pay for Performance

In poorly designed pay-for-performance schemes in which case mix adjustments are not adequate, self-interest could lead nephrologists toward cherry picking dialysis patients. Cherry picking, however, is morally problematic. First, it may manifest itself as a subtle form of covert rationing which threatens to undermine patient trust. Second, it involves shifting the burden of caring for sicker (and less financially attractive) patients to other nephrologists and dialysis units that do not practice cherry picking, creating injustices in the health care system. Finally, it treats patients as mere means through which nephrologists achieve reimbursement instead of as persons possessing dignity and deserving of respect

Performance indicators for university libraries A practical guide

SIGLEAvailable from British Library Document Supply Centre- DSC:3608.8576(SCONUL-DOC--92/204) / BLDSC - British Library Document Supply CentreGBUnited Kingdo