(2000) showed that the therapist's age, a specialization in manual therapy, and practice size were associated with fewer treatment sessions, but it remained unclear to what extent the amount of variation was explained and how it was distributed over the different levels. The variance may be on different levels, including patient level, therapist level and practice level.įew investigations have been made as yet into the reasons for the variation in the number of treatment sessions and none of these distinguished between variation at patient level, variation at therapist level and variation at practice level. ![]() Elimination of inappropriate variation is necessary for quality improvement in physical therapy practice and it is important to know exactly where variance is located if proper quality measures are to be implemented. ![]() As a consequence, the variation is appropriate when it occurs due to 'need' factors like the patient's clinical health status, but it is questionable whether the variation is appropriate when it occurs due to factors like social structure, health beliefs, or enabling resources (such as accessibility). On grounds of equity, an 'ideal' situation is one where health status is the main determinant of treatment choice and hence of variation. Greater understanding will increase the transparency of care and can provide novel insights into the quality of care. It is well-known that the number of physical therapy treatment sessions varies over treatment episodes and it is important for health care policy makers, physical therapists and patients to gain greater understanding of the sources of this variation.
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