A proactive design of self-regulatory programs is of strong public interest as it can contribute to legitimising the value of therapeutic services to insurance agencies and public entities.
The European Region of the World Confederation of Physiotherapy presented 2002/3 Core Standards for Physiotherapy Practice (CS) with their Patient Feedback questionnaire (PFQ). Inter alia, these standards were developed as tools to analyze the interaction between physiotherapist and patient.

The goal of this case-study was to determine if implementation of the CS and its PFQ in an outpatient clinic in Tyrol causes a change in quality in the patient-therapist-relationship.
The investigation was done in the outpatient clinic PKA Innsbruck.
Mixed methods were used: The PFQ (combinded with a PFQ from Scascighini (2008)) was introducted. In addition, a process documentation and interviews with
patients, therapists and the medical director were conducted. For 3 months patients were invited to evaluate their sessions using this PFQ. 95 questionnaires were compiled. Then half of the therapists (5) (randomly selected) received a training in implementing the CS. Non-trained therapists (6) did not receive any information about the content. Patients were blinded and randomly assigned to trained and non-trained therapists and also invited to compile the PFQ at the end of their therapy-series. 59 responded using the questionnaire.
The quantitative investigation was based on the data of the questionnaires (t-tests and regression analyses), the qualitative investigation results of the content analysis of the interviews and process documentation.
The analyses of the PFQ did not show that the implementation of the CS and the questionnaire increased the quality of physiotherapy service. However, it did identify points of potential improvement in the patient-therapist-relationship. The qualitative investigation also highlighted deficiencies that have to be resolved in the future and determined that mutuality, in the sense of mutual appreciation and mutual confidence, was a central concern of patients as well as service providers. Furthermore the introduction of the time-limited control mechanism, interviews, and therapists’ intense discussion of the topic in focus groups initiated many positive mind-changing processes.
The implementation of the European CS and the PFQ can be recommended as an instrument to improve the quality of the patient-therapist-relationship in the physiotherapy practice.

Ursula Danner
Freelance and university hospital Graz