Background:
High quality clinical practice guidelines (CPGs) deliver recommendations based on systematic reviews of the literature and consensus methodology. This systematic review and content analysis of CPGs seeks to inform the establishment of evidence-based standards for inpatient physiotherapy services. Establishing standards that can be used to measure service performance is critical to service design and successful business cases.

Method:
Between July and September 2021 scholarly databases (Web of Science, CINAHL and Scopus, PEDro) and grey literature (Guideline databases (NICE, SIGN, ECRI guideline trust, Guidelines International Network (GIN)) were searched for CPGs related to conditions and therapy approaches commonly encountered by physiotherapists working in a secondary care setting. Inclusion: Conditions commonly encountered by physiotherapists in a secondary care setting or physiotherapy treatment approaches in a guideline or recommendation. Exclusion: Mental health conditions, paediatrics, covid-19 and conditions common to tertiary care such as burns, spinal cord injury and cardiothoracic surgery. A pragmatic approach was taken to group the guidelines aligned with common physiotherapy services and select only the most recent and comprehensive guidelines for final analysis. Thirty-two CPGs were selected, and quality was assessed using the Appraisal of Guidelines for Research and Evaluation Instrument (AGREEII). Content analysis of guideline recommendations grouped data into themes covering dosage and content. Statements were drafted to represent the data gathered for each group of guidelines.

Results:
The recommendations of thirty- two CPGs yielded twenty-seven statements.

Conclusion:
Twenty-seven statements represent a distillation of the best evidence-based practice recommendations from CPGs in inpatient physiotherapy.

Implications:
Recommendations for dosage (frequency, intensity, and duration) of physiotherapy are not available for many areas of practice; researchers and clinical practice guideline groups should consider the importance of these data for service commissioning.

Background
A quality framework for hospital-based physiotherapy is lacking. This study aims to design a framework, building on the currently available literature, to improve the quality of hospital-based physiotherapy.

Purpose
To gain insight into which quality improvement methods (QI) could form the design of a QI framework, as a foundation to improve and steer the quality of Dutch hospital-based physiotherapy, by combining the insights of hospital-based physiotherapists and their key stakeholders.

Methods
A multidisciplinary panel of six representatives of hospital-based physiotherapy and their key stakeholders (patients, medical specialists, hospital management, and professional association) was set up. We used brainwriting to sample ideas and the ‘decision-matrix’ to select the best ideas.

Results
The first round of brainwriting with an online panel of six experienced participants yielded consensus on seven possible methods for quality improvement of hospital-based physiotherapy: (1) continuing education, (2) feedback on patient-reported experience measures and patient-reported outcome measures, (3) a quality portfolio, (4) peer observation and feedback, (5) 360-degree feedback, (6) a management information system, and (7) intervision with intercollegiate evaluation. Placing these methods in a decision matrix against four criteria (measurability, acceptability, impact, accessibility) resulted in a slight preference for a management information system, with an almost equal preference for five other methods immediately thereafter. The least preference was given to a 360-degree feedback.

Conclusion
In the design of a framework for improving the quality of hospital-based physiotherapy, all seven suggested methods were perceived as relevant but differed in terms of advantages and disadvantages. This suggests that, within the framework, a mixture of these methods may be desirable to even out respective advantages and disadvantages.

Implications
The results of this study, summarised in a graphical model for a framework on quality of hospital-based physiotherapy provide a foundation to steer quality of hospital-based physiotherapy more optimal.