Development and validity of an innovative test to assess guideline-consistent clinical reasoning by physical therapists in stroke rehabilitation
Nicoline M. Otterman, Marjo Maas, Sven K. Schiemanck, Philip van der Wees, Gert Kwakkel
Rehabilitation, Academic Medical Center Amsterdam, 1100 DD Amsterdam, The Netherlands. E-mail: firstname.lastname@example.org
Objective: To evaluate the validity of a script concordance test to assess guideline-consistent clinical reasoning by physical therapists in stroke rehabilitation, and to identify critical features of physical
therapists specializing in stroke rehabilitation.
Methods: A script concordance test was developed according to current standards. Four subgroups of physical therapists (those specializing in neurology, those focusing on neurology or geriatrics, other, and non-specialized undergraduate students) were asked to complete the test. The construct validity of the script concordance test was evaluated with 1-way analysis of variance (ANOVA) to estimate differences between subgroups. Associations between physical therapist characteristics, and script concordance test scores were analysed with bivariate regression analysis followed by multivariate analyses.
Results: The script concordance test, with 59 items, was completed by 211 physical therapists. ANOVA analysis showed statistically significant differences between the script concordance test scores of the 4 groups (p < 0.001), with higher scores by the physical therapists specializing in neurology compared with the other, non-specialized, subgroups. The multivariate analysis showed that better guideline knowledge (B = 1.07; CI = 0.48–1.65; p = <0.001), successful completion of the Dutch Neurorehabilitation course (B = 4.1; CI = 1.37–6.87; p = 0.003), and participation in professional development activities (B = 2.4; CI = 0.05–4.68; p = 0.046) were associated with higher script concordance test scores.
Conclusion: The script concordance test has good construct validity. Greater self-reported guideline knowledge, successful completion of the post-bachelor Dutch Neurorehabilitation course, as well as systematic participation in professional development activities facilitate important factors that enhance specialization. The script concordance test is a valid feedback tool for physical therapists to support professional development in the domain of stroke rehabilitation.
Adherence of physical therapists to scientific recommendations can improve care for stroke patients. This study developed a test to measure the use of scientific recommendations in the clinical care that physical therapists provide to patients with stroke. The study also identified critical features of therapists who specialize in stroke rehabilitation. It was concluded that the test could indeed distinguish therapists specializing in stroke rehabilitation. The study also found that higher knowledge levels, successful completion of the Dutch Neurorehabilitation course and systematic participation in professional development activities, such as multidisciplinary team meetings and regional case meetings, stimulate the use of scientific recommendations and thus enhance specialization. The test developed in this study is a potential tool to support improvement in continued education to promote professional development of physical therapists in stroke rehabilitation
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