The influence of education level, post-professional training, and experience on physical therapists' (PTs) diagnostic reasoning is unknown. The purpose of this study was to examine the influence of education, training, and experience on PTs' diagnostic reasoning through a series of musculoskeletal case-based surveys. While literature supports quality of care's influence on health care costs, the factors influencing PTs' quality of care are unclear. Literature suggests that surgeons with post-professional training and more experienced Emergency Room physicians demonstrate better patient outcomes, diagnostic accuracy, and efficiency.
Five hundred and twenty-nine licensed PTs participated in this study. A series of 5 case-based electronic surveys assessed participants' diagnostic reasoning in orthopedic presentations. Response rates ranged from 55% to 40%. Accuracy, efficiency, and hypothesis-generation strategies were analyzed to examine diagnostic reasoning. Strength of associations, diagnostic accuracy, and hypothesis-generation strategies were examined via odds ratios; efficiency of determining the accurate diagnosis was examined via t tests.
Hypothetico-deductive reasoning by systematically eliminating competing diagnoses (funneling) demonstrated significant correlation with accuracy in 4 of the 5 cases (odds ratio [OR] 2.46 [1.19–5.10] to 13.9 [6.12–31.5]). Physical therapists with any American Board of Physical Therapy Specialities (ABPTS) certification demonstrated significantly greater diagnostic accuracy (OR 2.1 [1.41–3.807] to 3.00 [1.22–7.36]) and efficiency (P < .05) in 3 of the 5 cases compared to those without ABPTS certification. Board-Certified Orthopedic Clinical Specialists (OCS) demonstrated significantly greater diagnostic accuracy (OR 1.90 [1.08–3.34] to 3.42 [1.42–8.40]) and efficiency (P < .05) compared to those without ABPTS OCS certification. Residency-trained PTs demonstrated significantly greater diagnostic accuracy (OR 2.02 [1.03–3.96] to 2.84 [1.38–5.82]) and efficiency (P < .05) compared to those without residency training. Degree level, experience, and fellowship training were not related to accuracy, efficiency, or funneling hypotheses (P > .05).
American Board of Physical Therapy Specialities certification and American Board of Physical Therapy Residency and Fellowship Education training's significant association with both diagnostic accuracy and efficiency suggests the importance of PTs' pursuit of ABPTS certification and/or formal post-professional training in developing diagnostic reasoning and expertise. These post-professional endeavors may lead to appropriate care more quickly, improving patient outcomes, and decreasing health care costs.
Courtney Souter is a physical therapist associated with Division of Physical Therapy, at Shenandoah University, 1775 North Sector Court, Suite 219, Winchester, VA 22601 (Csouter14@gmail.com). Please address all correspondence to Courtney Souter.
Emily Musy is a physical therapist in the Division of Physical Therapy, Children's National Medical Center.
Aaron Hartstein is an assistant professor in the Division of Physical Therapy at the Shenandoah University.
Arthur Lievre is an assistant professor in the Division of Physical Therapy at the Shenandoah University.
Andrea Fergus is a professor in the Division of Physical Therapy at the Shenandoah University.
The authors declare no conflicts of interest.
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Received May 06, 2018
Received in revised form January 06, 2019
Accepted January 15, 2019