Objective: To validate clinical vignettes as measure of physiotherapists’ activity and work recommendations given to patients with non-specific low back pain.
Design:Validation study comparing two methodsfor measuring aspects of health providers’ clinical management: clinical vignettes and unannounced visits of standardized patients (the gold standard).
Setting:Outpatient physiotherapy clinics
Subjects:Physiotherapists (N = 59)who consented to see unannounced standardized patients in their clinical practice.
Main measures: Clinical vignettes were used to initially measure physiotherapists’ self-reported activity and work recommendations. Subsequently, actors performing as standardized patients visited physiotherapists in their clinical practice and rated the advice given by the physiotherapist regarding activity and work. Twenty-three standardized patients were randomly scheduled to physiotherapists.Physiotherapists were blinded towards the standardized patients. To test whether standardized patients were detected, physiotherapists reported if they suspected that theyhad treated an actor.
Results: The 23 standardized patients visited 22 different physiotherapists.Physiotherapistsdetected12of 23 unannouncedstandardized patients (detection rate: 52%).Theestimated agreement betweenthe two measureswas poor, for both activity and work recommendations(weighted kappa: 0.29 resp. -0.21).
Conclusion:The poor concordance between clinical vignettes and standardized patients indicates the potentially limited validity of clinical vignettes as measure of health providers’ activity and work recommendations in low back pain practice.