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

Abstract

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.