Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016
Tiago S. Jesus, PhD,a Christina Papadimitriou, PhD,b Ca ́tia S. Pinho, BSc,cHelen Hoenig, MD, MPHd,e
From the aGlobal Health and Tropical Medicine & World Health Organization Collaborating Center for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal; bSchool of Health Sciences, Oakland University, Rochester, MI; cISVOUGAeSuperior Institute of Entre Douro e Vouga, Santa Maria da Feira, Portugal; dPhysical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC; and eDivision of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC.
Objective: To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.
Data Sources: Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed.
Study Selection: Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility.
DataExtraction: Reported study characteristics including sutdy focus, study setting, use of inferential staistics, stated limitations, and use of improvememt clcles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved.
Data Synthesis: Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units.
Conclusions: The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics.
© Archives of Physical Medicine and Rehabilitation 2018;99:1141-8
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