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Table 2 Change objectives for the individual physical therapist (PT) and practice quality manager (PQM; selection)

From: Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain

Determinants performance objectives Knowledge (K) Affective factors (AF) Attitude (ATT) Social influence (social norm /social support (SN) General self-efficacy/skills (SES) Self-efficacy/skills monitoring (MO) Motivation/advocacy Skills (MA)
Physical therapist        
OVERALL ADHERENCE   AF2.1 Acknowledge that the GL can evoke feelings of pride when their actual practice meets the recommendations ATT2.1 Confirm the benefit of the GL as a knowledge document and a frame to evaluate personal performance SN2.1 Talk about how their colleagues and physicians think about the GL SES2.1 Express confidence in applying guideline adherent care even when the patient prefers non adherent care   
2. Decide to make an effort to improve their adherence to the GL        
   AF2.2 Acknowledge that the GL can enhance their feelings of confidence when they communicate the treatment plan with the patient   SN2.2 Recognize that patients are not extremely negative about the hands off policy or the activating approach SES2.2 Express how they apply GL adherent care when their colleagues do not.   
SELF REGULATION AND GOAL SETTING K4.1 Explain the principles of self regulation with respect to the quality of their work AF4.1 Recognize the affective reactions the GL evokes in them ATT4.1 Express and discuss the importance they attach to the GL (quality tool; evidence based practice) SN4.1 Acknowledge that the professional association approves of using the GL SES4.1 Describe a plan for dealing with feelings of discomfort due to self-monitoring   
4. Set goals and make plans using self-monitoring, self-judgement, self-reaction, self-evaluation and maintenance of procedure K4.2 Explain a strategy to thoroughly reflect on the content of their work AF4.2 Describe their affective reaction related to attainment of higher adherence rates   SN 4.2 Describe that the use of GL is becoming the practice ( social) standard SES4.2 Express confidence in managing feelings of discomfort   
QUESTIONNAIRES K5d.1 Distinguish the purposes for which questionnaires can be applied AF5d.1 Recognize why questionnaires evoke feelings of discomfort ATT5d.1 Express the belief that questionnaires support diagnostics; prognostics; effectiveness assessment; and communication with the patient SN5d.1 Adduce arguments for the application of questionnaires SES5d.1 Express confidence in the application of questionnaires despite the available time   
5d. Apply questionnaires        
  K5d.2 Give their interpretation of the questionnaires in the GL   ATT5d.2 Acknowledge the benefit of questionnaires for monitoring effectiveness SN5d.2 State that it is preferable to use questionnaires SES5d.2 Explain how they motivate their patient to complete questionnaires   
PSYCHOSOCIAL (PS) FACTORS K7a.1 Name the PS factors that have proven to impede recovery or play a role in transition to chronic LBP and how they do that   ATT7a.1 Acknowledge the importance of the assessment of PS factors   SES7a.2 Explain how they recognize PS factors during history taking   
7a. PTs assess psychosocial factors        
  K7a3 Describe how to effectively elicit PS factors   ATT7a.2 Recognize the important role of questionnaires in the assessment of PS factors   SES7a.4 Express their confidence in the interpretation of questionnaire outcomes   
Practice quality manager        
2. Plan and make preparations for a quality improvement project K2.1 Name and explain the steps of a quality improvement plan   ATT2.1 Demonstrate conviction to bring quality improvement/GL adherence to the attention of colleagues SN2.1 Describe optimal quality of care as the practice standard SES2.1 Express confidence in developing and preparing for a quality improvement project MO2.1 Express confidence in the ability to identify and use (an) opinion leader(s) in the practice (if applicable) MA2.1 Demonstrate ability to deliberate with colleagues about the ‘desired future vision’ to motivate the change
2.1 Provide the necessary materials and means for optimal quality of care    ATT2.2 Express the importance of assessing the individual ideas about/needs for quality improvement with colleagues SN2.2 Emphasize the importance of transparency of quality for patients and health insurance companies SES2.3 Demonstrate the ability to decide when and how to start the quality improvement project MO2.4 Decide about the purchase and use of an EHR to monitor the quality of care MA2.2 Demonstrate skills in ability to involve colleagues in the setting of attainable goals
     SN2.3 Show engagement in making quality improvement a collective objective in the practice    MA2.3 Express confidence to deliberate with colleagues about the time investment
3. Manage the quality improvement project        
3.1 Bring the available materials to the attention of colleagues    ATT3.1 Show enthusiasm about the quality improvement project SN3.1 Engage in coaching and supporting (problem analysis; counseling) colleagues in case of problems or resistance SES3.1 Explain how he is going to manage the quality improvement project MO3.1 Demonstrate how monitoring of the quality improvement by means of the monitoring materials (patient record audits and feedback; EHR)  
  1. GL = Guideline; EHR = Electronic Health Record.