Journal of Rehabilitation Medicine 51-6 | Page 24

J Rehabil Med 2019; 51: 418–425 SPECIAL REPORT DEVELOPMENT AND VALIDITY OF AN INNOVATIVE TEST TO ASSESS GUIDELINE-CONSISTENT CLINICAL REASONING BY PHYSICAL THERAPISTS IN STROKE REHABILITATION Nicoline M. OTTERMAN, PhD 1,2 , Marjo MAAS, PhD 3,4 , Sven K. SCHIEMANCK, MD, PhD 5 , Philip J. VAN DER WEES, PhD 4 and Gert KWAKKEL, PhD 6,7,8 From the 1 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, 2 Basalt Rehabilitation Centre The Hague, 3 University of Applied Sciences, HAN Arnhem, 4 Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, 5 Department of Rehabilitation, Leiden University Medical Center, 6 Department of Neurorehabilitation, Reade Centre for Rehabilitation and Rheumatology, 7 Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute, Amsterdam, The Netherlands and 8 Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA Objective: To evaluate the validity of a script con- cordance test to assess guideline-consistent clinical reasoning by physical therapists in stroke rehabi- litation, 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 dif- ferences between subgroups. Associations between physical therapist characteristics, and script concor- dance test scores were analysed with bivariate reg- ression analysis followed by multivariate analyses. Results: The script concordance test, with 59 items, was completed by 211 physical therapists. ANOVA analysis showed statistically significant differen- ces between the script concordance test scores of the 4 groups (p  < 0.001), with higher scores by the physical therapists specializing in neurology compa- red 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 Neurorehabilita- tion 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-bac- helor Dutch Neurorehabilitation course, as well as systematic participation in professional develop- ment activities facilitate important factors that en- hance specialization. The script concordance test is a valid feedback tool for physical therapists to support professional development in the domain of stroke rehabilitation. Key words: stroke; clinical competence; script concordance test; physical therapy. Accepted May 3, 2019; Epub ahead of print May 17, 2019 J Rehabil Med 2019; 51: 418–425 LAY ABSTRACT Adherence of physical therapists to scientific recom- mendations can improve care for stroke patients. This study developed a test to measure the use of scienti- fic recommendations in the clinical care that physical therapists provide to patients with stroke. The study also identified critical features of therapists who specia- lize 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 multi- disciplinary 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 con- tinued education to promote professional development of physical therapists in stroke rehabilitation. Correspondence address: Gert Kwakkel, VU University Medical Center Department of Rehabilitation, De Boelelaan 1117, 1081 HV Amster- dam The Netherlands. E-mail: [email protected] S everal systematic reviews have shown that the evi- dence and underlying key assumptions for applying neurological treatment approaches, such as Bobath, are weak (1–3). Up to 2008, several professional debates were held in the Netherlands to encourage a more eclectic, evidence-based treatment approach, using the International Classification of Functioning (ICF) as a framework and based on the current understanding of mechanisms that drive stroke recovery and functional prognosis. This eclectic approach allows us to apply new interventions (3) and innovative treatment stra- tegies, based on recently developed theories about sensorimotor recovery for which evidence has been found in the field of stroke rehabilitation (4, 5). The growing and ever-changing amount of evidence in the field of stroke rehabilitation covers approximately 53 different interventions (2), indicating that stroke re- habilitation is a continuum of complexity, with highly complex and specific post-stroke treatments (1). This complexity challenges the use of evidence in the clini- cal reasoning process of physical therapists (PTs). We This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2562 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977