Background
Methods
Study design
Quantitative methods
Participants and setting
Qualitative methods
Data analysis
Results
n | % | |
---|---|---|
Number of physiotherapists | 195 | |
Gender, female | 106 | 54 |
Agea | 41 | 12 |
Years practised at clinic (experience) | ||
0–5 years | 71 | 36 |
6–15 years | 46 | 24 |
15 + years | 78 | 40 |
Training and education the past five yearsb | ||
0 | 11 | 6 |
1–5 | 92 | 47 |
6–10 | 63 | 32 |
11+ | 29 | 15 |
Specialization | 57 | 29 |
Direct access patients | 152 | 78 |
Management decisions
Quantitative results
PT | PT but encourage GP contact | No PT and GP referral | Correct MD | 100% correct MDb | |
---|---|---|---|---|---|
Musculoskeletal conditions | 42%a | 42% | |||
Man with leg pain | 74% | 24% | 2% | 98% | |
Woman with neck pain | 88% | 11% | 1% | 99% | |
Woman with pain around sternum | 6% | 39% | 55% | 45% | |
Girl with knee pain | 51% | 40% | 9% | 91% | |
Man with knee pain | 77% | 22% | 1% | 99% | |
Non-critical medical conditions | 37%a | 5% | |||
Man with bilateral leg cramps | 21% | 67% | 12% | 79% | |
Woman with foot pain | 80% | 15% | 5% | 20% | |
Woman with bilateral shoulder pain | 59% | 34% | 7% | 41% | |
Woman with intense subcostal pain | 14% | 36% | 49% | 86% | |
Critical medical conditions | 34%a | 5% | |||
Man with swollen and red knee | 14% | 37% | 49% | 49% | |
Woman with intense low back pain | 57% | 27% | 15% | 15% | |
Man with thoracic back pain | 8% | 36% | 56% | 56% |
Qualitative results
“That probably agrees very well with our knowledge as physiotherapists. This (the musculoskeletal area) is the area we’re specialists in. And then there is perhaps more of a knowledge gap in the differential diagnostics.” [Male, 5 years of experience]
“Perhaps it is an indication of uncertainty among physiotherapists that we answer differently in the medical area. Whereas we know what we are talking about or agree in the musculoskeletal area.” [Female, 3 years of experience]
“It actually does (surprise me)… Basically we ought to know more on these medical conditions so we could answer more similar.” [Female, 11 years of experience]
Explanatory variables
Quantitative results
Musculoskeletal conditions | Non-critical medical conditions | Critical medical conditions | ||||
---|---|---|---|---|---|---|
ORa | 95% CI | ORa | 95% CI | ORa | 95% CI | |
Experience over 5 years | 1.49 | (0.80;2.76) | 1.07 | (0.57;2.01) | 2.73 | (1.33;5.57) |
Specialization | 1.28 | (0.66;2.42) | 1.32 | (0.68;2.57) | 1.90 | (0.94;3.82) |
Direct-access patients | 1.04 | (0.52;2.07) | 1.24 | (0.60;2.54) | 1.15 | (0.54;2.46) |
Passed quality audit | 1.09 | (0.60;1.98) | 1.89 | (1.03;3.48) | 2.90 | (1.50;5.58) |
Qualitative results
“ We had this one (vignette) with pain around the thoracic spine and many would maybe think that if it is the thoracic area there’s probably nothing there. Now, I’ve treated a patient where there actually weren’t any red flags but after a long time we sent the patient back because nothing happens and it turns out to be spinal cancer… So you have that experience with you the next time… No matter how and how much you are educated and how much supervision you have, there are some things, you just can’t. It’s not until you are in it and you treat those patients you learn the clinical reasoning in these conditions.” [Female, 4 years of experience]
“I think that perhaps 50% of our patients are insurance cases. Most often they don’t have a referral. Maybe I’m a little more thorough asking questions and thinking possible differential diagnostic.” [Male, 5 years of experience]
“That’s a surprise to me. I think it’s a positive that you get more attention on some things. But I’m actually surprised it means so much.” [Male, 1 year of experience]
“We’ve been through this process and I can see afterwards in our clinic we’ve all made more of an effort with the patient record. I think, we have become much more structured and we have included an item on clinical reasoning and hypothesis… I think we have become much more sharp.” [Female, 14 years of experience]