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Table 2 Change objectives for the individual physical therapist (PT) and practice quality manager (PQM; selection)

From: Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain

Determinants performance objectives

Knowledge (K)

Affective factors (AF)

Attitude (ATT)

Social influence (social norm /social support (SN)

General self-efficacy/skills (SES)

Self-efficacy/skills monitoring (MO)

Motivation/advocacy Skills (MA)

Physical therapist

       

OVERALL ADHERENCE

 

AF2.1 Acknowledge that the GL can evoke feelings of pride when their actual practice meets the recommendations

ATT2.1 Confirm the benefit of the GL as a knowledge document and a frame to evaluate personal performance

SN2.1 Talk about how their colleagues and physicians think about the GL

SES2.1 Express confidence in applying guideline adherent care even when the patient prefers non adherent care

  

2. Decide to make an effort to improve their adherence to the GL

       
  

AF2.2 Acknowledge that the GL can enhance their feelings of confidence when they communicate the treatment plan with the patient

 

SN2.2 Recognize that patients are not extremely negative about the hands off policy or the activating approach

SES2.2 Express how they apply GL adherent care when their colleagues do not.

  

SELF REGULATION AND GOAL SETTING

K4.1 Explain the principles of self regulation with respect to the quality of their work

AF4.1 Recognize the affective reactions the GL evokes in them

ATT4.1 Express and discuss the importance they attach to the GL (quality tool; evidence based practice)

SN4.1 Acknowledge that the professional association approves of using the GL

SES4.1 Describe a plan for dealing with feelings of discomfort due to self-monitoring

  

4. Set goals and make plans using self-monitoring, self-judgement, self-reaction, self-evaluation and maintenance of procedure

K4.2 Explain a strategy to thoroughly reflect on the content of their work

AF4.2 Describe their affective reaction related to attainment of higher adherence rates

 

SN 4.2 Describe that the use of GL is becoming the practice ( social) standard

SES4.2 Express confidence in managing feelings of discomfort

  

QUESTIONNAIRES

K5d.1 Distinguish the purposes for which questionnaires can be applied

AF5d.1 Recognize why questionnaires evoke feelings of discomfort

ATT5d.1 Express the belief that questionnaires support diagnostics; prognostics; effectiveness assessment; and communication with the patient

SN5d.1 Adduce arguments for the application of questionnaires

SES5d.1 Express confidence in the application of questionnaires despite the available time

  

5d. Apply questionnaires

       
 

K5d.2 Give their interpretation of the questionnaires in the GL

 

ATT5d.2 Acknowledge the benefit of questionnaires for monitoring effectiveness

SN5d.2 State that it is preferable to use questionnaires

SES5d.2 Explain how they motivate their patient to complete questionnaires

  

PSYCHOSOCIAL (PS) FACTORS

K7a.1 Name the PS factors that have proven to impede recovery or play a role in transition to chronic LBP and how they do that

 

ATT7a.1 Acknowledge the importance of the assessment of PS factors

 

SES7a.2 Explain how they recognize PS factors during history taking

  

7a. PTs assess psychosocial factors

       
 

K7a3 Describe how to effectively elicit PS factors

 

ATT7a.2 Recognize the important role of questionnaires in the assessment of PS factors

 

SES7a.4 Express their confidence in the interpretation of questionnaire outcomes

  

Practice quality manager

       

2. Plan and make preparations for a quality improvement project

K2.1 Name and explain the steps of a quality improvement plan

 

ATT2.1 Demonstrate conviction to bring quality improvement/GL adherence to the attention of colleagues

SN2.1 Describe optimal quality of care as the practice standard

SES2.1 Express confidence in developing and preparing for a quality improvement project

MO2.1 Express confidence in the ability to identify and use (an) opinion leader(s) in the practice (if applicable)

MA2.1 Demonstrate ability to deliberate with colleagues about the ‘desired future vision’ to motivate the change

2.1 Provide the necessary materials and means for optimal quality of care

  

ATT2.2 Express the importance of assessing the individual ideas about/needs for quality improvement with colleagues

SN2.2 Emphasize the importance of transparency of quality for patients and health insurance companies

SES2.3 Demonstrate the ability to decide when and how to start the quality improvement project

MO2.4 Decide about the purchase and use of an EHR to monitor the quality of care

MA2.2 Demonstrate skills in ability to involve colleagues in the setting of attainable goals

    

SN2.3 Show engagement in making quality improvement a collective objective in the practice

  

MA2.3 Express confidence to deliberate with colleagues about the time investment

3. Manage the quality improvement project

       

3.1 Bring the available materials to the attention of colleagues

  

ATT3.1 Show enthusiasm about the quality improvement project

SN3.1 Engage in coaching and supporting (problem analysis; counseling) colleagues in case of problems or resistance

SES3.1 Explain how he is going to manage the quality improvement project

MO3.1 Demonstrate how monitoring of the quality improvement by means of the monitoring materials (patient record audits and feedback; EHR)

 
  1. GL = Guideline; EHR = Electronic Health Record.