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Reynolds K, Mueller S, Horn M. Predicting performance in a doctor of physical therapy gross anatomy course based on an exploratory factor analysis of the anatomical self-efficacy instrument. ANATOMICAL SCIENCES EDUCATION 2024. [PMID: 38984713 DOI: 10.1002/ase.2488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
Measuring self-efficacy can be a valuable means for instructors to predict student performance. However, it is crucial to measure self-efficacy within specific contexts to effectively gauge students' perceptions of their capabilities. This study evaluated the factors comprising the Anatomical Self-Efficacy Instrument (ASEI) and determined whether these factors could predict performance in gross anatomy. Three cohorts of Doctor Physical Therapy (DPT) students completed the ASEI at the start of gross anatomy. An exploratory factor analysis (EFA) analyzed the ASEI's dimensionality, and Cronbach's alpha evaluated the internal consistency of the extracted factors. Linear regression was used to determine whether ASEI's total or subdomain scores predicted final anatomy course performance scores. In total, 142 of 287 (49.5%) DPT students completed the ASEI. EFA revealed three distinct factors, including "cognitive," "psychomotor," and "clinical anatomy self-efficacy", and explained 44.9%, 13.7%, and 5.2% of the total variance, respectively. Only cognitive self-efficacy predicted final gross anatomy course performance (β = 0.34; R2 = 0.071; F(3,138) = 3.51; p < 0.05). Overall, the ASEI's 3-factor solution implies its multidimensionality, a finding that could inform the development of more comprehensive self-efficacy measures. Notably, "cognitive self-efficacy" was the only subdomain that predicted DPT student performance in anatomy, suggesting its potential as a tool for identifying students in need of additional learning support. The ASEI's practical usability should be further explored through additional psychometric testing.
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Affiliation(s)
- Kelly Reynolds
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shani Mueller
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maggie Horn
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina, USA
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Hoekstra F, Gainforth HL, Broeksteeg R, Corras S, Collins D, Eleftheriadou E, Gaudet S, Giroux EE, Kuipers LS, McCallum S, Ma JK, de Passillé E, Rakiecki D, Rockall S, van den Berg-Emons R, van Vilsteren A, Williamson M, Wilroy J, Martin Ginis KA. The co-development and evaluation of an e-learning course on spinal cord injury physical activity counselling: a randomized controlled trial. BMC MEDICAL EDUCATION 2024; 24:240. [PMID: 38448881 PMCID: PMC10916033 DOI: 10.1186/s12909-024-05141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course. METHODS Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n > 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants. RESULTS Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p <.001). Participants reported above average usability scores, positive learning experiences, and high levels of satisfaction when completing the course. CONCLUSION We used a systematic, multi-step, theory-informed approach to co-develop and evaluate an evidence-based e-learning course on SCI physical activity counselling to support professionals to promote physical activity in their daily practices. The overall positive findings demonstrate that the e-learning course is feasible and ready for further implementation in various health and community settings. Implementation of the e-learning course can help professionals improve the physical activity support they provide to their clients, and subsequently increase physical activity participation in people with SCI.
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Affiliation(s)
- Femke Hoekstra
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada.
| | - Heather L Gainforth
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | | | - Stephanie Corras
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Delaney Collins
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Electra Eleftheriadou
- Centre for Teaching and Learning, The University of British Columbia, Kelowna, BC, Canada
| | - Sonja Gaudet
- Spinal Cord Injury British Columbia, Vancouver, BC, Canada
- The Thompson Okanagan Tourism Association, Vernon, BC, Canada
| | - Emily E Giroux
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | | | - Shannon McCallum
- Therapeutic Recreation Program, St. Lawrence College, Kingston, ON, Canada
| | - Jasmin K Ma
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica de Passillé
- Horizon Health Network, Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada
| | - Diane Rakiecki
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada
| | - Shannon Rockall
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Access Community Therapists, Vancouver, BC, Canada
| | - Rita van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | - Jereme Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Division of Physical Medicine & Rehabilitation, The University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, The University of British Columbia, Kelowna, BC, Canada
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Cross-Cultural Adaptation, Reliability, and Validity of a Hebrew Version of the Physiotherapist Self-Efficacy Questionnaire Adjusted to Low Back Pain Treatment. Healthcare (Basel) 2022; 11:healthcare11010085. [PMID: 36611544 PMCID: PMC9818982 DOI: 10.3390/healthcare11010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinician self-efficacy may be an important factor in the success of treatment for low back pain (LBP), which has unique clinical features and a high prevalence rate. Therefore, it is important to assess clinicians' self-efficacy in this particular condition. The Physiotherapist Self-Efficacy (PSE) questionnaire was designed to measure self-efficacy of physiotherapy students. OBJECTIVES To translate and trans-culturally adapt the PSE into Hebrew, to adjust the questionnaire to assess clinicians' self-efficacy in the treatment of LBP, and to assess the construct validity and reliability of the PSE in the Hebrew version. METHODS After adjustment for LBP and cross-cultural adaptation, test-retest reliability was assessed with 140 physiotherapists. The analyses used included exploratory factor analysis for structural validity, Cronbach's alpha for internal consistency, and intraclass correlation coefficients (ICC) for test-retest reliability. RESULTS Factor analysis revealed a unidimensional structure with an acceptable model fit. The PSE translated into Hebrew exhibited a very high internal consistency (α = 0.93) and excellent test-retest reliability (ICC = 0.94). The standard error of measurement (SEM) and minimal detectable change (MDC) were 1.75 and 4.85, respectively. CONCLUSIONS The Hebrew-translated PSE showed adequate validity and excellent reliability, indicating its suitability to measure clinician self-efficacy in treating patients with LBP.
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O'Donoghue G, McMahon S, Holt A, Nedai M, Nybo T, Peiris CL. Obesity bias and stigma, attitudes and beliefs among entry-level physiotherapy students in the Republic of Ireland: a cross sectional study. Physiotherapy 2021; 112:55-63. [PMID: 34051594 DOI: 10.1016/j.physio.2021.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore entry-level physiotherapy students' attitudes and beliefs relating to weight bias and stigmatisation in healthcare. DESIGN Cross sectional survey of physiotherapy students. METHODS All final year physiotherapy students (n = 215) enrolled in entry-level physiotherapy programmes in the Republic of Ireland were invited to participate. Each received a questionnaire, consisting of 72 questions, within four key sections. Descriptive statistics and frequencies were used to analyse the data. RESULTS A response rate of 83% (179/215) was achieved. Whilst physiotherapy students, overall, had a positive attitude towards people with obesity, 29% had a negative attitude towards people with obesity, 24% had a negative attitude towards managing this population and most (74%) believed obesity was caused by behavioural and individual factors. Over one third of students (35%) reported that they would not be confident in managing patients with obesity and more than half (54%) felt treating patients with obesity was not worthwhile. CONCLUSION This study provides preliminary findings to suggest that weight stigma-reduction efforts are warranted for physiotherapy students. Helping students to understand that obesity is a complex, chronic condition with multiple aspects requiring a multi-faceted approach to its management might be the first step towards dispelling these negative attitudes towards patients living with obesity. Inclusion of a formal obesity curriculum should perhaps now be part of the contemporary physiotherapy students' education.
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Affiliation(s)
- G O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland.
| | - S McMahon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland.
| | - A Holt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland.
| | - M Nedai
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland.
| | - T Nybo
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland.
| | - C L Peiris
- La Trobe University, School of Allied Health, Human Services and Sport, Physiotherapy, Melbourne, Victoria, Australia.
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DaLomba E, Mansur S, Bonsaksen T, Greer MJ. Exploring graduate occupational and physical therapy students' approaches to studying, self-efficacy, and positive mental health. BMC MEDICAL EDUCATION 2021; 21:124. [PMID: 33622314 PMCID: PMC7901197 DOI: 10.1186/s12909-021-02550-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Occupational and physical therapy academic programs are rigorous. Increased rates of student anxiety and depression may impact learning. Data on student study skills, self-efficacy, and mental health is limited. This study explored relationships between students' self-efficacy, mental health factors, and approaches to studying. METHOD A cross-sectional study was designed. Seventy-three students completed the Approaches and Study Skills Inventory for Students-Short Form, General Self-Efficacy Scale, and Mental Health Continuum-Short Form. Associations between predictors (education program, general self-efficacy and mental health) and ratings on the study approach scales were analyzed with multiple linear regression. RESULTS Multiple regression models revealed associations between higher self-efficacy and higher ratings on the deep (β = 0.49, p < 0.01) and strategic (β = 0.34, p < 0.05) scales, and lower ratings on the surface scale (β = - 0.29, p < 0.01). Compared to OT students, PT students had higher surface approach ratings (β = - 0.36, p < 0.001). Poorer mental health scores were associated with higher surface approach ratings (β = - 0.41, p < 0.001). CONCLUSIONS To support productive study strategies among occupational and physical therapy students it may be useful to promote their general self-efficacy and positive mental health.
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Affiliation(s)
- Elaina DaLomba
- Samuel Merritt University, 3100 Telegraph Ave, Oakland, CA, 94609, USA.
| | - Saji Mansur
- Student Health Coordinator, Samuel Merritt University, Oakland, USA
| | - Tore Bonsaksen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Faculty of Health Studies, VID Specialized University, Sandnes, Norway
| | - Mary Jan Greer
- Occupational Therapist, Rapides Parish School District, 619 6th St, Alexandria, LA, 71301, USA
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Roberts F, Cooper K. Effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skill development in pre-registration physiotherapy students: a systematic review. ACTA ACUST UNITED AC 2020; 17:1229-1255. [PMID: 30964770 DOI: 10.11124/jbisrir-2017-003931] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to evaluate the effectiveness of high fidelity simulation (HFS) versus low fidelity simulation (LFS) on practical/clinical skill development in pre-registration physiotherapy students. INTRODUCTION Evidence suggests that improved skill development in university can reduce anxiety in practice, improving performance of skills and overall learning at clinical placement for health professions students. However, evidence indicates that the clinical environment is most effective for learning. As a result, there has been increased interest in the use of HFS where students can test knowledge and skills in an increasingly self-directed way. No previous reviews on the effectiveness of HFS on skill development in physiotherapy students were identified. INCLUSION CRITERIA Experimental and quasi-experimental studies comparing HFS (simulated person, manikin, virtual simulation, video case-studies) to LFS (peer role-play, paper-based case-studies) in pre-registration physiotherapy education were included. Primary outcomes were objective measures of skills performance; secondary outcomes were students' perceptions of the impact of simulation on learning measured using quantitative outcomes. METHODS A three-step search strategy was employed. Following an initial search of MEDLINE and CINAHL and analysis of text words, MEDLINE, CINAHL, ERIC, AMED, EThOS and Google Scholar were searched in November 2017. Reference lists of studies included at critical appraisal stage were hand-searched. Studies published in English from 1978 onwards were included. Title/abstract screening, critical appraisal and data extraction were conducted by two independent reviewers; conflicts were resolved by discussion. RESULTS Meta-analysis was not possible due to heterogeneity; therefore, results were presented in narrative form. Three randomized controlled trials (RCT) and three quasi-experimental studies (310 participants) were included. They were conducted in the USA and Australia, and evaluated standardized patients (people who take on the role of a real patient), near-peers, computerized manikins and virtual simulation in pre-registration Bachelor of Science (Honors), Master of Science and Doctor of Physiotherapy students. One RCT was considered high quality, with the remainder moderate quality. The findings related to five main areas: i) In terms of motor skills performance, an increased number of safety fails were found with HFS (HFS = 13.5% safety fails, HFS plus video feedback = 15.4% safety fails, control [LFS] = 8.1% safety fails); ii) In terms of clinical performance, the Assessment of Physiotherapy Practice (APP) tool indicated no significant improvement in mean APP scores at week 6 of clinical placement (HFS mean APP score = 60.7 [9.1], control mean APP score = 58.7 [8.4]; P = 0.35); iii) In terms of self-efficacy, only one of two studies showed a statistically significant difference with HFS, as measured by the Acute Care Confidence Survey (P = 0.001); however, became non-significant once students were on clinical placement (P = 0.328); iv) Students did not perceive a significant difference in their communication skills with HFS, as measured on a visual analogue scale (simulation = 9.05 [1.27]; control 8.75 [1.2]; P = 0.482); and v) In terms of general perceptions, students were significantly more positive about HFS for increasing awareness of safety issues (P = 0.002), patients' emotional status (P = 0.002), handling skills (P < 0.0001) and ability to provide instructions to patients (P < 0.0001). CONCLUSIONS Currently, there is no high quality evidence that HFS improves motor skill performance in pre-registration physiotherapy students. There is a small amount of moderate-quality evidence it may improve students' perception of their self-efficacy but no evidence that it improves communication skills. However, a lack of studies and variation in outcome measures meant that meta-analysis was not possible. At present, no recommendations can be made regarding the use of HFS to improve skill performance in this population.
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Affiliation(s)
- Fiona Roberts
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland.,The Scottish Centre for Evidence-based, Multi-professional Practice: a Joanna Briggs Institute Centre of Excellence
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van Lankveld W, Maas M, van Wijchen J, Visser V, Staal JB. Self-regulated learning in physical therapy education: a non-randomized experimental study comparing self-directed and instruction-based learning. BMC MEDICAL EDUCATION 2019; 19:50. [PMID: 30736785 PMCID: PMC6368688 DOI: 10.1186/s12909-019-1484-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a concern that traditional instruction based methods of learning do not adequately prepare students for the challenges of physical therapy practice. Self-directed learning is considered to be the most appropriate educational approach to enhance life-long learning as it enhances self-efficacy. This study compares outcomes in two educational approaches: self-directed learning (SDL), and traditional instruction based learning (IBL). METHODS In this non-randomized experimental study two groups of second year physiotherapy students were compared using pre-post-test assessments. Study results (both knowledge and physiotherapy performance), and self-reported self-efficacy were used as outcome variables. Study results from the end of year 1 and the end of year two were retrieved form the student information system. Self-reported variables including general and physical therapy self-efficacy were assessed using an online questionnaire which was completed at the start and the end of year two. Changes in self-efficacy were analysed using a repeated measures multivariate ANOVA. RESULTS A total of 174 students were enrolled in the second year, of which 108 (62%) agreed to participate in the online questionnaire. The online questionnaire at baseline (September 2015) was completed by 27 students in the SDL condition compared to 81 students in the IBL condition. There were no statistical differences at baseline between both educational approaches on any of the variables in the study. At the end of year two, there was no difference between both conditions in indicators of study results: knowledge and performance. Perceived self-efficacy in functioning as a physical therapist increased between both assessments. However, this increase was observed in both condition, and the difference between both conditions was not statistically significant. CONCLUSIONS Self-directed learning and traditional instruction based learning result in equal study outcome and self-efficacy at the end of year two. More research is needed to determine the long term outcome that is most relevant for lifelong learning, and which students will benefit most from this approach. Nonetheless, self-directed learning might be an important alternative for instruction-based l education.
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Affiliation(s)
- Wim van Lankveld
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands.
| | - Marjo Maas
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
| | - Joost van Wijchen
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands
| | - Volcmar Visser
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands
| | - J Bart Staal
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
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van Lankveld W, Jones A, Brunnekreef JJ, Seeger JPH, Bart Staal J. Assessing physical therapist students' self-efficacy: measurement properties of the Physiotherapist Self-Efficacy (PSE) questionnaire. BMC MEDICAL EDUCATION 2017; 17:250. [PMID: 29233154 PMCID: PMC5727928 DOI: 10.1186/s12909-017-1094-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/04/2017] [Indexed: 05/20/2023]
Abstract
BACKGROUND Apart from skills, and knowledge, self-efficacy is an important factor in the students' preparation for clinical work. The Physiotherapist Self-Efficacy (PSE) questionnaire was developed to measure physical therapy (TP) students' self-efficacy in the cardiorespiratory, musculoskeletal, and neurological clinical areas. The aim of this study was to establish the measurement properties of the Dutch PSE questionnaire, and to explore whether self-efficacy beliefs in students are clinical area specific. METHODS Methodological quality of the PSE was studied using COSMIN guidelines. Item analysis, structural validity, and internal consistency of the PSE were determined in 207 students. Test-retest reliability was established in another sample of 60 students completing the PSE twice. Responsiveness of the scales was determined in 80 students completing the PSE at the start and the end of the second year. Hypothesis testing was used to determine construct validity of the PSE. RESULTS Exploratory factor analysis resulted in three meaningful components explaining similar proportions of variance (25%, 21%, and 20%), reflecting the three clinical areas. Internal consistency of each of the three subscales was excellent (Cronbach's alpha > .90). Intra Class Correlation Coefficient was good (.80). Hypothesis testing confirmed construct validity of the PSE. CONCLUSION The PSE shows excellent measurement properties. The component structure of the PSE suggests that self-efficacy about physiotherapy in PT students is not generic, but specific for a clinical area. As self-efficacy is considered a predictor of performance in clinical settings, enhancing self-efficacy is an explicit goal of educational interventions. Further research is needed to determine if the scale is specific enough to assess the effect of educational interventions on student self-efficacy.
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Affiliation(s)
- Wim van Lankveld
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation, Kapittelweg 33, Nijmegen, The Netherlands
| | - Anne Jones
- College of Health Care Sciences, James Cook University, Douglas, Australia
| | - Jaap J. Brunnekreef
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation, Kapittelweg 33, Nijmegen, The Netherlands
| | - Joost P. H. Seeger
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation, Kapittelweg 33, Nijmegen, The Netherlands
| | - J. Bart Staal
- HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation, Kapittelweg 33, Nijmegen, The Netherlands
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
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