Lamsens L1, Janssens L2, Peers K1, Caluwé K1, Kiekens C1, Van Eldere J1, Vandersmissen J1, Vanhaecht K1, Bruyneel L1
1University Hospital and University Leuven, Leuven, Belgium, 2Hassselt University, Rehabilitation Sciences, Diepenbeek, Belgium
Background: The International Classification of Functioning, Disability and Health (ICF) is a landmark for physiotherapy to describe the full spectrum of human functioning. In contrast, physiotherapeutic patient records are mainly limited to the description on 'body functions and structures'. However, standardized documentation in health care is needed. Improving information exchange between physicians expedites for example patients' return-to-work.
Purpose: Therefore, the aim was to investigate the effect of supervised teaching and personalized feedback on physiotherapists' completion of physiotherapeutic patient records and reporting of the components of the ICF:
(1) body functions and structures,
(2) activities,
(3) participation,
(4) environmental factors, and
(5) personal factors.
Methods: The intervention group (n= 10 physiotherapists) received supervised teaching and four rounds of personalized feedback on reporting of ICF components in electronic patient records (n= 670 records). The control group (n= 5 physiotherapists) received no intervention (n= 140 records). Patient records from 10 randomly selected patients per physiotherapist were reviewed for completion and reporting of ICF. In the intervention group, this review was performed at seven occasions: at baseline, after teaching, after each of four rounds of personalized feedback, and at long-term follow-up. In the control group, this review was performed at three occasions: at baseline, after the intervention group had received their third round of feedback, and at long-term follow-up. 670 and 140 patient records from 729 unique patients were reviewed for the intervention and control group, respectively.
Results: After the third round of feedback (95% vs 72%, β 2.68, 95% CI 0.62 to 4.74) and at long-term follow-up (99% versus 72%, β 4.71, 95% CI 1.48 to 7.94), patient record completion was significantly higher in the intervention group. This was also true for reporting of ICF components 'activities', 'participation', and 'personal factors'. For 'environmental factors', the significant difference after feedback disappeared at long-term follow-up. Reporting of 'body functions and structures' improved similarly across groups.
Conclusion(s): Supervised teaching and personalized feedback improved completion and reporting of ICF components in physiotherapeutic patient records. It was in particular effective on continued reporting of the ICF components of 'activities', 'participation' and 'personal factors'.
Implications: Our findings on long-term follow-up however showed that continuous monitoring is needed to evaluate that the intervention has been well delivered and that objectives are met. Research into the benefits associated with ICF reporting in physiotherapeutic patient records should be expanded. It could be investigated whether and how complete patient records facilitate communication within and across teams and guarantee the continuity and quality of physiotherapeutic health care. Also, further alignment of multidisciplinary electronic patient records would be beneficial.
Keywords: patients records, ICF, communication
Funding acknowledgements: Not applicable
Purpose: Therefore, the aim was to investigate the effect of supervised teaching and personalized feedback on physiotherapists' completion of physiotherapeutic patient records and reporting of the components of the ICF:
(1) body functions and structures,
(2) activities,
(3) participation,
(4) environmental factors, and
(5) personal factors.
Methods: The intervention group (n= 10 physiotherapists) received supervised teaching and four rounds of personalized feedback on reporting of ICF components in electronic patient records (n= 670 records). The control group (n= 5 physiotherapists) received no intervention (n= 140 records). Patient records from 10 randomly selected patients per physiotherapist were reviewed for completion and reporting of ICF. In the intervention group, this review was performed at seven occasions: at baseline, after teaching, after each of four rounds of personalized feedback, and at long-term follow-up. In the control group, this review was performed at three occasions: at baseline, after the intervention group had received their third round of feedback, and at long-term follow-up. 670 and 140 patient records from 729 unique patients were reviewed for the intervention and control group, respectively.
Results: After the third round of feedback (95% vs 72%, β 2.68, 95% CI 0.62 to 4.74) and at long-term follow-up (99% versus 72%, β 4.71, 95% CI 1.48 to 7.94), patient record completion was significantly higher in the intervention group. This was also true for reporting of ICF components 'activities', 'participation', and 'personal factors'. For 'environmental factors', the significant difference after feedback disappeared at long-term follow-up. Reporting of 'body functions and structures' improved similarly across groups.
Conclusion(s): Supervised teaching and personalized feedback improved completion and reporting of ICF components in physiotherapeutic patient records. It was in particular effective on continued reporting of the ICF components of 'activities', 'participation' and 'personal factors'.
Implications: Our findings on long-term follow-up however showed that continuous monitoring is needed to evaluate that the intervention has been well delivered and that objectives are met. Research into the benefits associated with ICF reporting in physiotherapeutic patient records should be expanded. It could be investigated whether and how complete patient records facilitate communication within and across teams and guarantee the continuity and quality of physiotherapeutic health care. Also, further alignment of multidisciplinary electronic patient records would be beneficial.
Keywords: patients records, ICF, communication
Funding acknowledgements: Not applicable
Topic: Disability & rehabilitation; Professional practice: other
Ethics approval required: Yes
Institution: University Hospitals Leuven (UZ Leuven)
Ethics committee: Ethics Committee of UZ/KU Leuven (Belgium)
Ethics number: S60925
All authors, affiliations and abstracts have been published as submitted.
