Current use of measurement instruments by physiotherapists working in Germany: a cross-sectional online survey

Braun et al. BMC Health Services Research https://doi.org/10.1186/s12913-018-3563-2 (2018) 18:810 RESEARCH ARTICLE Open Access Current use of measurement instruments by physiotherapists working in Germany: a cross-sectional online survey Tobias Braun* , Alina Rieckmann, Franziska Weber and Christian Grüneberg Abstract Background: The use of measurement instruments in physiotherapy has been recommended in clinical practice guidelines to improve evidence-based practice. The aims of the study were (a) to describe the current use of measurement instruments by physiotherapists working in Germany and (b) to investigate the facilitators and barriers to use measurement instruments. Methods: This cross-sectional study used a nationwide online survey, which was accessible to all physiotherapists working in Germany. Results: In total, 522 adult physiotherapists working in Germany completed the questionnaire. The mean age of the respondents was 38 years, 63% were female, and 53% had >10 years of work experience. Thirty-one percent of the respondents used measurement instruments in ≥80% of their patients, and 26% used measurement instruments in ≤20%. Measurement instruments were used for diagnostic and prognostic purposes by 69% and 22% of respondents, respectively. The three most frequently reported measurement instruments were “goniometer” (n = 254), some kind of a “visual/numeric analogue scale” (n = 139), and the “manual examination of muscle-strength” (n = 54). Seven of the 13 most stated measurement instruments measure activities or participation. The most important facilitator was physiotherapists’ positive attitudes towards measurement instruments. Two out of three respondents reported having sufficient knowledge and skills to apply measurement instruments in clinical practice. The most pronounced barriers were insufficient additional financial compensations and requiring extra time to document test scores. Seventy-eight percent of the respondents could imagine using an electronic device for a user-friendly patient health record system in clinical practice. Conclusions: The limited use of measurement instruments reported by physiotherapists working in Germany appears to be due to organisational issues, in combination with a lack of knowledge and skills needed to apply the measurement instruments, rather than due to individual or managerial reasons. To support the use of measurement instruments, sufficient time resources and adequate financial compensation are required. Educational approaches should focus on imparting patient-centred and patient-reported outcomes to quantify activities and participation. Electronic patient health record systems have potential to facilitate the application of standardised measurement instruments if the barriers identified in this survey are addressed properly. Keywords: Measurement instrument, Outcome measurement, Physical therapy, Physiotherapy, Rehabilitation, Evidence-based practice, Cross-sectional survey * Correspondence: Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Gesundheitscampus 6-8, 44801 Bochum, Germany © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Braun et al. BMC Health Services Research (2018) 18:810 Background Measurement instruments (MI) are tools for measuring various aspects of a person’s health status, such as impairments, activity limitations, participation, and quality of life [1]. MI can be used for diagnostic purposes, for measuring the outcome of health care interventions, and for determining prognoses. Thus, the use of MI is an inherent part of evidence-based practice, and MI are considered to be tools that support the clinical decision-making process [2–5]. The use of MI, either self-reported or performance-based, has been recommended for rehabilitation professionals in many clinical practice guidelines [6–8]. In the literature, the term “outcome measure” is used frequently for a MI that is used to determine the change in ability from before to after an intervention [9, 10]. Jette et al. reported that “measures, in general, are standardised in that they use closed-ended questionnaire formats or specific protocols for implementation, provide scores that allow quantitative assessment of ability, and have been evaluated for their psychometric properties” [10]. However, cumulative evidence from various studies conducted in different countries, such as New Zealand [11], Canada [12, 13], The Netherlands [14, 15], Switzerland [16], Austria [17], Saudi Arabia [18], the U.S. [10, 19], Ireland [20] and Australia [21], indicate limited use of MI by physiotherapists [9]. The most relevant barriers reported in the scientific literature are physiotherapists’ level of knowledge and competence in the use of MI; problems related to changing behaviour; structural restrictions, such as a lack of time; and the unavailability and limited feasibility of MI [9]. Therefore, there is an urgent need for effective strategies to implement and facilitate the use of MI in physiotherapy, especially since there is evidence that most therapists have a positive attitude towards MI and are convinced of their advantages in clinical care [2, 9]. Some approaches to facilitate the use of MI in physiotherapy have been proposed and examined. For example, van Peppen et al. (2009) [22] and Gutierrez Panchana et al. (2018) [23] reported positive effects of tutor-guided educational sessions on the actual use of instruments by physiotherapists who were involved in stroke management. Another important approach is the development of core outcome sets, which can be used for certain groups of patients [24]. The implementation of electronic patient health record systems is a new and promising approach to reinforce the use and communication of MI [25]. It has been reported that physiotherapists with an university-based professional degree are more likely to use MI than therapists with a non-academic or lower education level [9, 11, 18]. In Germany, an academic level of physiotherapy education is not required and most physiotherapists graduate from a vocational school (polytechnic level; so called “Berufsfachschulen”) [26]. However, the number of physiotherapists in Germany with a higher education Page 2 of 16 increases with 3% of approximately 192.000 physiotherapists having a Bachelor’s or a Master’s degree in 2018 [26, (...truncated)