Quality indicators for Spanish hospital-based physical therapy units: a feasibility and inter-rater reliability study.
Daniel Ángel-García, Nicolás Ibarra-Meneses, Beatriz Alonso-Cortés Fradejas and 1 others
PMID 42556207WHAT IT FOUND
Of 22 quality indicators tested in three Spanish hospitals, 13 worked and 9 could not be reliably measured.
Where measurable, compliance was often very low. For example, fewer than 10% of stroke patients had their rehabilitation need assessed within 48 hours at two of three sites.
Key findings
01Of 22 quality indicators, 17 were feasible in at least two hospitals and 13 in all three; 9 indicators could not be measured reliably in any site.
02Inter-rater reliability was acceptable for most indicators (median PABAK 0.95, IQR 0.91–1), but one criterion ('at least one therapeutic objective') had a PABAK of 0.0 due to disagreement over what counted as a complete objective.
03Compliance was below 5% for four indicators in Hospital 1, four in Hospital 2, and five in Hospital 3; the highest compliance was 86.05% (±10.36%) for setting objectives from the first visit at Hospital 2.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Three hospitals chosen by convenience; the authors acknowledge they may not represent all Spanish public hospitals, though they span three regions with different IT systems. Feasibility results depend heavily on the specific information systems in place at each site; an indicator that worked here may not work in a hospital with different records. Management indicators were self-reported by department heads, introducing potential subjectivity. The study is cross-sectional and descriptive; it measures what is happening, not whether any intervention improves quality. Inter-rater agreement for one criterion was zero, meaning that particular measurement is unreliable until the definition is clarified. The sample of 60 cases per indicator is adequate for estimating compliance proportions but does not allow subgroup analyses or causal inference.
Declared interests
The authors declared no potential conflicts of interest. No funding source is named in the supplied text.
The easy way to misread this
Do not read the 13 'validated' indicators as evidence that the hospitals meeting them are providing good care. The study only confirms the indicators can be measured consistently. The compliance figures are descriptive snapshots, not outcomes of any intervention, and the three hospitals differ so much in IT infrastructure and staffing that a low score at one site may reflect a data-recording gap rather than a clinical one.