Comorbidity Forces Physiotherapists to Deviate from Guideline Recommendations Resulting in Various Treatments for the Same Patient: A Vignette Study

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?Rational, aims and objectives: The aim of this Vignette study was to assess whether physiotherapists (PTs) make reasoned adaptations to evidence-based treatment recommendations when co-morbidity influences single disease treatment. Method: To study the influence of co-morbidity on treatment recommendations, 3 vignettes were created based on authentic patient data. In the first vignette, a patient with a single-diseased Intermittent Claudication (IC) was described, in the second vignette, co-morbidity Chronic Obstructive Pulmonary Disease (COPD) was added. In the third vignette, Knee Osteoarthritis (OA) was additionally added. Therapists described 3 treatment plans and their decision rationale. A random selection of 100 Dutch Claudication Network members was invited to participate in this qualitative study. Results: The response rate was 61%. Thirty percent of the physical therapists did not adjust treatment despite co-morbidity. Another 30% partly adapted the treatment plan when co-morbidity was added to the vignette. The presence of co-morbidity induced 40% to abandon guideline recommendations and to create an individualised treatment plan based on the health needs of the vignette patient. Conclusion: This study showed that the majority of PTs makes adaptations to otherwise evidence-based recommendations when co-morbidity is present in order to tailor treatment to the specific needs of the individual patient. However, the same patient was treated in various ways by different PTs.
Original languageEnglish
Pages (from-to)83-89
JournalEuropean Journal for Person Centered Healthcare
Issue number1
Publication statusPublished - 1 Jan 2015

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