Assimilating the use of accepted rehabilitation measures among physical therapists

Background: “Clalit” is the largest health organization in Israel, providing health services to a population of about 4.25 million registered insurees. The “Clalit” employs around 1100 physical therapists who provide services both in the community and in 14 general and rehabilitation hospitals.
Using reliable and valid measures is important for assessing patient outcomes during all phases of rehabilitation, measuring efficiency and making decisions regarding further treatment. However, up to now, no defined compulsory criteria regarding the use of these measures have been drawn up in “Clalit”. In addition, there was no structured supervision over the use of these measures.
Purpose: To create a unified and compulsory framework for using accepted rehabilitation measures among physical therapists working in “Clalit”.
Methods: In order to assess the need for intervention, a survey aiming to characterize the use of selected measures in their daily work was sent to 100 physical therapists. After data analysis, a comprehensive intervention was conducted. A workshop aiming to create a unified base of knowledge and utilization of accepted measures in rehabilitation such as: FIM (Functional Independence Measurement), Berg Balance Scale, Timed Up & Go test and Modified Functional Reach test was developed. The workshop included both theoretical and practical familiarity with measures, and was conducted initially as a pilot to 50 physical therapists working in a rehabilitation center. After adjustments, 350 physical therapists working in the community attended the workshop. The extent use of these measures was examined through a 4 option scale (from “not at all” to “highly used”) questionnaire prior to and 3 months after the workshop. Concurrently, clear and obligatory criteria for using such measures were defined and technical resources for the use of measures were improved. Subsequent to the workshop, an interactive online learning program was developed including case reports and films for practicing the use of these measures.

Results: Data from the pilot study revealed that 60% reported use of any measure before the workshop. This rose to 80% and 88% 3 and 6 months later, respectively. In most community districts the extent use of measures before the workshop was low-moderate. 65% rated the use of the FIM as “moderate” or “high” and 44% and 15% for the TU&G and the Berg Balance Scale, respectively (n = 325). 3 months later a rise of 22–38% in the use of the different measures was reported (n = 152).
Conclusion(s): To the best of our knowledge, no interventional program of this kind or scope has been undertaken before. This process is for great importance for the patient, the therapist, the organization and the profession. The interventional program led to an increase in the use of accepted rehabilitation measures among physical therapists working in the organization. In addition, the increase is expected to further rise following additional processes which were and are being carried out.