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M. van Doormaal1, E. Mutubuki2, D. Conijn1, S. Toonders3,4, R. Ostelo2,5
1Royal Dutch Society For Physical Therapy, Amersfoort, Netherlands, 2Amsterdam UMC, Amsterdam, Netherlands, 3Leidsche Rijn Julius Gezondheidscentra, Utrecht, Netherlands, 4Fontys University of Applied Sciences, Eindhoven, Netherlands, 5VU Amsterdam, Amsterdam, Netherlands
Background: Self-management support is important for all patients who visit a physiotherapist (PT) to preserve effects of physiotherapy treatment on long term. Despite this importance, recommendations regarding self-management support by PTs are inconsistently scattered in different guidelines on specific medical conditions, and general recommendations on this topic do not exist. This leads to unwarranted variation in physiotherapy healthcare. Recommendations regarding self-management, independent of the underlying medical condition of a patient, should be developed in line with personalized healthcare to improve quality of care.
Purpose: The purpose of the Royal Dutch Society of Physical Therapy (KNGF) was to develop an evidence-based guideline Self-management which can be used in all patients who are treated by a PT, independent of their medical condition.
Methods: International standards for guideline development (GRADE, AGREE II and GIN) were followed to develop the guideline. In 2020, a guideline panel with PTs, patient representatives, researchers and self-management experts was composed and key questions were formulated based on perceived barriers in daily practice. In order to answer the key questions, systematic reviews were performed and quality of the evidence was assessed if applicable. Recommendations were formulated by the guideline panel based on the evidence and relevant considerations as described in the GRADE evidence to decision framework. The concept guideline was externally reviewed before publication by a group of PTs, researchers, patients and other stakeholders.
Results: Based on the perceived barriers, the guideline panel formulated three key questions regarding
1) the facilitators and barriers for self-management which are important to take into account,
2) self-management support in the general population visiting a PT, and
3) strategies to be applied in patients with specific dominant barriers regarding self-management.
All key questions were answered with one or more recommendations, resulting in a clinical practice guideline. The most important recommendations in this guideline included:
1) the appraisal of important facilitators and barriers regarding self-management,
2) the use of the 5A framework for self-management support, and
3) the consideration to use strategies such as Motivational Interviewing,
Problem Solving Therapy, Acceptance and Commitment Therapy, and Solution-Focused Brief Therapy, related to specific dominant barriers of a patient. Last but not least, recommendations were developed how to communicate with patients with limited health literacy.
1) the facilitators and barriers for self-management which are important to take into account,
2) self-management support in the general population visiting a PT, and
3) strategies to be applied in patients with specific dominant barriers regarding self-management.
All key questions were answered with one or more recommendations, resulting in a clinical practice guideline. The most important recommendations in this guideline included:
1) the appraisal of important facilitators and barriers regarding self-management,
2) the use of the 5A framework for self-management support, and
3) the consideration to use strategies such as Motivational Interviewing,
Problem Solving Therapy, Acceptance and Commitment Therapy, and Solution-Focused Brief Therapy, related to specific dominant barriers of a patient. Last but not least, recommendations were developed how to communicate with patients with limited health literacy.
Conclusions: A KNGF-guideline Self-management has been developed conform international standards for guideline development and was published in 2022. This guideline will help PTs in making decisions regarding self-management support.
Implications: The final version of the guideline was formally authorized by the boards of the KNGF and relevant stakeholders. As a result, the recommendations are part of the professional standard of PTs in the Netherlands. To improve quality of care, adherence to the guideline is important. Implementation strategies included workshops and e-learning for PTs and the development of information materials for patients about the importance of self-management. Future physiotherapy guidelines can refer to this guideline to enhance self-management in patients independent of their medical condition. An English translation of the guideline is available at the end of 2022, which could lead to international adoption or adaptation of the guideline.
Funding acknowledgements: The Netherlands Organisation for Health Research and Development (ZonMw) on behalf of the Dutch governement
Keywords:
Self-management
Guideline
Recommendations
Self-management
Guideline
Recommendations
Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? No
Reason: Ethical approval is not applicable in guideline development.
All authors, affiliations and abstracts have been published as submitted.
