This document discusses moving evidence-based physiotherapy forward by embracing the complex, personalized nature of daily practice. It introduces the speaker's research group which aims to help physical therapists progress from good to expert. It notes that standardized research protocols often do not match the realities of clinical practice. Two example projects are described: Coach2Move, a program focusing on physical activity and self-management that optimized the diagnostic and reasoning process; and individual prognostic profiles developed by Dr. Kittelson. The challenge for the research group is to combine all essential ingredients for optimal patient care, including evidence, shared decision making, and patient-centered communication skills, by doing research with stakeholders rather than just on them.

1. Moving evidence-based
physiotherapy forward
Thomas Hoogeboom, PT, PhD
Radboud Institute for Health Sciences
Senior Researcher at IQ healthcare
ErasmusMC
22 maart 2019

2. Content of presentation
• Introducting my research group
• Philosophy behind research
• Two projects:
• Brief example Coach2Move
• Extended example Individual
Prognostic Profiles
(by dr. Kittelson)

3. Who am I?
Physiotherapist
Human movement scientist
PhD supervisor (n=9)
Lecturer on EBP
Dad

4. Our goal: Moving evidence-based physiotherapy
forward, by embracing the complex and personalized
nature of daily practice

5. In other words..
Help PTs go from good to expert

6. Easier said than done..
Practice
Research

7. Practice
Greenhalgh et al, BMJ, 2014; Macleod et al, Lancet, 2014
Research
mismatch
85%

8. PracticeResearch
Greenhalgh et al, BMJ, 2014; Macleod et al, Lancet, 2014

9. PracticeResearch
Standardized
intervention protocol
√
X

10. PracticeResearch
Standardized
intervention protocol
√
X
Study sample equivalence
and representiveness
X

11. Multimorbidity is common
Tinetti, JAMA, 2012; Barnett, Lancet, 2012; van Spall, JAMA, 2007
Typically in RCTs
Typically in not RCTs

12. PracticeResearch
Standardized
intervention protocol
√
X
Study sample equivalence
and representiveness
X
External and personal
factors controlled
X

13. Practice
Research

14. Practice
Research

15. Castrop-Rauxel, Germany
So don’t build useless bridges…

16. the Flevopolder in the Netherlands
… reclaim the land!

17. Do we need to rethink
our role as scientists?

18. Probably..

19. Which
intervention
should I use for
this particular
client?
Which
problem do I
start with?
Does
homework
make a
difference?
Is one
treatment
better than
another?
Will group or
individual
treatment
work better
for this
client?
Which
component
do I start
with?
Is this
intervention
helping my
client?
When should I
terminate?
Is there a
more
efficient way
to deliver
treatment?

20. How to achieve optimal care?
Hoffman, JAMA, 2014.

21. Hoffman, JAMA, 2014.
How to achieve optimal care?

22. Hoffman, JAMA, 2014.
Essential ingredients
for optimal care
How to achieve optimal care?

23. Jensen (2003)

24. So what does this mean for my group?
Hoffman, JAMA, 2014.
Researchers should NOT
limit themselves to the
evidence part of EBP.
Optimal patient care is the goal
Science as a means to an end

25. Evidence-based practice
EBP is just doing the right thing in the right way

26. So what does this mean for my group?
Hoffman, JAMA, 2014; Elwyn, BMJ, 2016.
Researchers should NOT
limit themselves to the
evidence part of EBP.
SDM – EBP =
Misinformation
EBP – SDM =
Evidence tyranny
SDM + EBP = 
Optimal patient care is the goal
Science as a means to an end

27. But also patient centered
communication skills need to be
addressed

28. Hoffman, JAMA, 2014.
11
seconds
Ospina, JGIM, 2019
36
percent

29. 36
percent
Hoffman, JAMA, 2014.
de Vries, JoCSM, 2016; Bosma, In Prep

30. de Vries, JoCSM, 2016; Bosma, In Prep
*A percentage >70% was deemed sufficient
Quality indicator Percentage met*
Interviewing 36%
Diagnostics 56%
Analysis 12%
Treatment plan 51%
Treatment 60%
Evaluation 31%

31. So the challenge for my group is:
Hoffman, JAMA, 2014; Elwyn, BMJ, 2016.

32. So the challenge for my group is:
Hoffman, JAMA, 2014; Elwyn, BMJ, 2016.

33. So the challenge for my group is:
Hoffman, JAMA, 2014; Elwyn, BMJ, 2016; Schork, Nature, 2015.
Combining all essential
ingredients to have PTs
deliver optimal care.
Not doing research on,
but doing research with
stakeholders
Live together
on the
reclaimed
land
Approach every
patient-therapist
interaction as a N-
of-1.

34. Two examples:
1. Coach2Move program
2. Individual Prognostic Profile
(by dr. Andrew Kittelson)

35. Wish list:
- Focus on physical activity and self-management
- Physiotherapist is autonomous
- Optimize diagnostic & clinical reasoning process

36. Hoffman, JAMA, 2014.

37. Fried (2001); Faber (2001); Morley (2013); Hubbard (2009); de Vries (2012); Glasziou (2005); de Vries
(2011); Fisher (2005); Schenkman (2006); Jensen (2003); Bastian (2009); Knight (2006)
Intake: 1.5 hours

38. Did it work?
de Vries, JoCSM, 2016; Bosma, In Prep
*A percentage >70% was deemed sufficient
Quality indicator Regular PT Coach2Move PT
Interviewing 36% 79%
Diagnostics 56% 85%
Analysis 12% 71%
Treatment plan 51% 78%
Treatment 60% 85%
Evaluation 31% 70%

39. Moderate physical activity increased
0
10
20
30
40
50
60
70
Coach2Move PT (n=64) Regular PT (n=65)
Baseline
3 months
6 months
de Vries, JoCSM, 2016

40. Physical frailty decreased
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Coach2Move PT (n=64) Regular PT (n=65)
Baseline
3 months
6 months
de Vries, JoCSM, 2016

41. Coach2Move saved..
850 euro per patient in 6 months
de Vries, JoCSM, 2016; Bosma, In Prep

42. Example 2