Is keep/refer decision making an integral part of national guidelines for the physiotherapy profession within Europe? A review

Core competencies for first contact physiotherapists in a direct access model of care for adults with musculoskeletal disorders: A scoping review

INTRODUCTION

To optimise the management of Musculoskeletal disorders (MSKDs), many countries have implemented direct access to physiotherapy; however, the core competencies required for first contact physiotherapists (PTs) have not been precisely defined. The aim of this scoping review is to identify and describe the core competencies required for first contact PTs treating adults with MSKDs.

METHODS

We conducted a scoping review of the literature by searching eight databases and grey literature up to July 2023. We performed a thematic analysis of the competencies identified based on predefined themes relevant to first contact physiotherapy in direct access models in primary or emergency care settings.

RESULTS

Sixty-five articles were included. Seventeen core competencies were identified and grouped into 5 themes: (1) Assessment and examination; (2) Management and interventions; (3) Communication; (4) Cooperation and collaboration; and (5) Professionalism and leadership.

CONCLUSIONS

Our findings provide an international perspective on the core competencies required for first contact PTs.

Diagnostic and decision-making abilities of Swiss physiotherapists in a simulated direct access setting

BACKGROUND

Direct access to physiotherapy requires physiotherapists to recognize red flags and determine adequate management plans.

PURPOSE

Investigate Swiss physiotherapists' ability to diagnose and triage patients in a simulated direct access setting and whether their characteristics were associated with correct diagnoses and decision-making.

METHODS

We conducted a national online survey using a questionnaire containing 12 first-contact case scenarios. A linear mixed model estimated scores for correct diagnoses and management decisions, differences between musculoskeletal (MSK), non-critical medical (non-CrM), and critical medical (CrM) case scenarios, and the estimated effects of physiotherapists' characteristics.

RESULTS

The linear mixed model of data from 1492 participants estimated 55.0% correct diagnoses (62.7% for non-CrM, 61.7% for MSK, and 40.5% for CrM scenarios) and 71.2% correct management decisions (78.1% for non-CrM, 73.0% for MSK, and 62.3% for CrM scenarios). For correct diagnoses, the 'academic education/continuing education' variable showed significant estimated effects for the MSK and CrM scenarios, as did 'professional experience' for the non-CrM scenarios, and the '≥ 50% musculoskeletal patients in consultations' variable for all scenario groups. For correct management decisions, 'academic education/continuing education' variable showed significant estimated effects in CrM scenarios, as did 'professional experience' in non-CrM and CrM scenarios, and the '≥ 50% musculoskeletal patients in consultations' variable in MSK scenarios.

CONCLUSION

The estimated effects of physiotherapists' characteristics on correct diagnoses and management decisions showed substantial heterogeneity. Improving Swiss physiotherapists' screening abilities remains important. Further research is required to develop innovative educational concepts and improve training for screening for red flags.

Evaluation of an educational intervention that aims to improve the keep/refer decision-making abilities of Austrian undergraduate physiotherapy students: a randomised pilot study

Background/Aims

An ongoing discussion about direct access to physiotherapy for patients with musculoskeletal pain disorders in Austria requires the development of a curriculum that educates physiotherapy students to make autonomous decisions to treat the patient without the need for medical referral (keep), to treat the patient with additional medical check-up (keep and refer) or to send the patient for medical evaluation without physiotherapeutic management (refer), and to recognise the presence of serious pathologies. The aim of this study was to examine the feasibility, acceptability and potential effectiveness of an educational intervention that was provided to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree.

Methods

An educational intervention was given to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree, which consisted of a single, 1-hour face-to-face case-based lecture on the principles of differential diagnosis, screening for possible red flag pathologies and review of the body systems. A control group did not receive the intervention, but both groups completed 11 validated vignettes.

Results

Half of Austrian universities (n=6/12) and 116 final year Austrian undergraduate physiotherapy students took part in the study. All students from the intervention group were satisfied with the intervention and 77.6% found the intervention beneficial for making keep/refer decisions based on clinical vignettes. Overall, 89.7% did not find the intervention too time consuming. A potential effectiveness of the intervention could not be demonstrated.

Conclusions

Future similar studies need to investigate if more teaching hours and/or if different educational methods are capable of improving the keep/refer decision-making abilities of Austrian undergraduate physiotherapy students.