A Guide to Quality Indicators in Physical Therapy

In recent years, global health organizations have increasingly recommended using quality indicators (QIs) in physiotherapy. Research supports the effectiveness of quality indicators for improving quality of care and patient outcomes, but many PTs and clinics have yet to put these into practice. That’s partly because information about what QIs are, and how to implement them, hasn’t been well-translated from research into real-world applications.

In this article, we’ll help make that bridge, so you can put this information to work for you and your patients.

Integrating research-based quality indicators can help improve communication and quality of care, which will improve the overall success of your business.

What are quality indicators?

Quality indicators (QIs) are tools that define the acceptable minimum for any healthcare treatment. They are used to assess healthcare procedures and organizational structures and to benchmark acceptable outcomes related to patient care. QIs can take the form of a simple checklist for patients and caregivers to complete throughout their relationship, or a list of If, Then, Because statements for doctors, therapists, or administrators to use to determine next steps for a patient. Either way, QIs take aspects of healthcare that are specific and measurable and use them to help everyone in the healthcare ecosystem understand what to track and what to expect.

QIs can address different aspects of physical therapy or healthcare. They outline the minimum standards for equipment and facilities, processes including communications systems, and outcomes to be expected for different conditions and procedures.

QIs are typically created by healthcare providers or research organizations using a complex model that is evidence-based and consensus generated — the AND/UCLA Appropriateness Method is the gold standard for developing QIs in healthcare. It involves panels of medical professionals and patient groups who meet in person and vote anonymously to generate potential QIs based on peer-reviewed research. These initial QIs are then analyzed and adapted over time based on their effectiveness in improving patient outcomes.

Justin Dudley is a physical therapist specializing in sports medicine who owns a private practice in Denver as well as being an Exer advisor. In Justin’s view: “Quality indicators can provide the opportunity for clinics to take a look at the interventions and the therapies they are providing and how their outcomes stack those up across competitors locally and nationally.”

According to Justin, QIs are particularly important for the current state of physical therapy: “with decreasing reimbursement and increasing productivity standards, the ability of a clinician to provide individualized care is becoming more and more challenging.” In Justin’s experience, some PTs aren’t yet using quality indicators, but they may be tracking other metrics, for example, patient and doctor referrals, online reviews, or staff retention. Using quality indicators can streamline those existing processes, so PTs and patients can measure their experience in detail throughout each stage to make sure treatment is working the way it’s supposed to and adjust as needed. Knowing what to expect can help PTs measure the success of patient outcomes and the success of their practice overall.

Examples of quality indicators for measuring patient experience

QIs tend to relate to specific conditions and how to measure the effectiveness of specific treatments, but we can look at some examples of general QIs that apply to most PT clients to understand how these can work in practice.

The patient participates in setting rehabilitation goals

Each PT in a clinic like Justin’s might be given a simple checklist of QIs around patient participation to help make sure patients feel like leaders in their own treatment. These steps have been shown to improve self-motivation and overall outcomes for programs that rely on patients doing exercises on their own at home. A subset of QIs in this category might include:

• Was the patient asked about how their condition is affecting their life?
• Did they discuss and agree to a plan?
• Did they discuss and agree to a follow-up appointment?

Care coordination

Having a few QIs for your PT clinic that focus on care coordination will help make sure your patients — and the information which all their caregivers need in order to help them — don’t fall through the cracks.

The Institute for Healthcare Improvement in the US recommends:

• A standardized process for care transition, including a standardized communication checklist and template
• “Handoff” communication between all providers
• Transfer of notes and notice of discharge

Functional change: Change in mobility

For each condition that a PT might address with a patient, there should be specific minimum health outcomes addressed and measured. General QIs around functional change might look like:

• The patient completes a self-care and mobility self-assessment before, during, and at the end of treatment and sees improvement.
• In addition to self-assessment, change in mobility is measured throughout therapy using a reliable tool.

How to decide which indicators to measure

Choosing which quality indicators to focus on can be overwhelming. There are extensive databases of QIs for all kinds of different conditions and treatments, and many are locked behind paywalls or within proprietary knowledge banks, so even choosing one can require an investment of time and money. PTs can check for established and detailed QIs available through national organizations or large providers to assess which systems apply to their clientele and which are a good fit for your administration.

Databases like that of the National Institute for Health and Care Excellence (NICE) in the UK allow PTs to delve down into QIs that are specific to different conditions and populations. For example, the NICE dataset lists QIs around the percentage of patients over 65 who have been asked about recent falls and educated about fall prevention. Keeping that percentage high would be one solid QI for a practice supporting that population.

High-level QIs for both patients and PTs have also been shared through open-access academic research portals, for example, Patient-reported quality indicators to evaluate physiotherapy care for hip and/or knee osteoarthritis and A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases. These research papers offer simple sheets of QIs that have been shown to have a positive impact on patient outcomes that can be printed up for daily use.

Whether you’re going to take a fine-grain approach to QIs or start out by tracking more general metrics, the goal should be to focus your clinic and everyone working there around quality of care.

Factors to consider:

• Is the indicator important to your patient?
• Is it backed by research and evidence?
• Can you track it or measure it?
• Will this help guide your decision-making, monitor the effectiveness of treatment, and improve care across patients?

What happens when quality indicators get ignored

Without quality indicators, PTs may find themselves spinning their wheels without knowing why, filling out reports that waste time and don’t make an impact, all because they don’t know what to measure. Without QIs, evidence-based indicators get missed, and — in the rush of seeing dozens of patients per day — important questions don’t get asked. When there is a lack of clear QIs around coordination and communication, patients can fall through cracks in the system as they try to negotiate between healthcare providers.

Patient motivation can suffer as well. As Justin told us, “One of the biggest barriers to any outcome in PT is compliance. If someone comes and sees us for an hour a week, what we do with them for one hour a week is not gonna be the difference maker. We need to be the person who educates the patient, empowers the patient to lead their own rehab.” Without a QI requiring a patient to set their own goals and participate in creating their own treatment plan, and without a clear idea of what goals to track and how to measure their progress, motivation suffers, and so does compliance.

Tech is simplifying QIs for physiotherapy and improving PT outcomes

PT-focused tech is helping to simplify the complex process of choosing and tracking QIs. Apps like Mobile Measures aim to bring contemporary research together for diverse patient populations, so PTs can have the data they need at their fingertips to help refine the process of identifying key measures for a variety of conditions.

And Exer apps like Exer Health can help PTs keep patients feeling motivated and supported around the goals they’ve set for their care. A simple app that patients can take home on their smartphone to help complete their rehab protocols, Exer Health uses AI to measure range of motion, count repetitions, recommend adjustments, and provide feedback. Once patients have their key QIs in sight, they can get consistent measurement and feedback at home — from an app on their smartphone — while they do their exercises. In Justin’s view, “the ability to track, to correct form, to simplify the process, always having a device there that can walk them through their home exercise program — all those aspects improve compliance.” Exer also reduces PT workload by simplifying the process of gathering documentation to use in QI assessment, so you can focus more of your time and energy on helping your patients feel better.