• Emanuel Brunner, Michel Probst, André Meichtry, Hannu Luomajoki, and Wim Dankaerts.
• School of Health Professions, Zurich University of Applied Sciences (ZHAW), Institute of Physiotherapy, Winterthur, Switzerland Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven (KU Leuven), Leuven, Belgium Institute of Physiotherapy, Kantonsspital Winterthur (KSW), Winterthur, Switzerland emanuel.brunner@zhaw.ch.
• Clin Rehabil. 2016 Jan 1; 30 (1): 85-94.

ObjectiveTo validate clinical vignettes as a measure of physiotherapists' activity and work recommendations given to patients with non-specific low back pain.DesignValidation study comparing two methods for measuring aspects of health providers' clinical management: Clinical vignettes and unannounced visits of standardized patients (the gold standard).SettingOutpatient physiotherapy clinics.SubjectsPhysiotherapists (N = 59) who consented to see unannounced standardized patients in their clinical practice.Main MeasuresClinical 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. A total of 23 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 they had treated an actor.ResultsThe 23 standardized patients visited 22 different physiotherapists. Physiotherapists detected 12 out of 23 unannounced standardized patients (detection rate: 52%). The estimated agreement between the two measures was poor, for both activity and work recommendations (weighted kappa coefficients: 0.29 resp. -0.21).ConclusionThe poor concordance between clinical vignettes and standardized patients indicates the potentially limited validity of clinical vignettes as a measure of health providers' activity and work recommendations in low back pain practice.© The Author(s) 2015.

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