Morris Abby, Cook Chad, Hassen Amy
Walsh University, North Canton, OH U.S.A.
Duke University, Durham, NC, USA.
Int J Sports Phys Ther. 2014 Oct;9(5):674-90.
A strong understanding of diagnostic imaging has been advocated for physical therapists. There have been recent changes in physical therapy curricula and increased opportunities to utilize imaging during clinical practice.
The aim of this study was to explore the ability of practicing clinicians to accurately identify selected musculoskeletal conditions on plain-film radiograph (X-ray), magnetic resonance imaging (MRI), and computed tomography scan (CT scan). Further, to determine whether improvements in identification of pathology occur when the clinical scenario is added to the imaging and whether there are related training/exposure factors.
A cross- sectional electronic survey was sent out to physical therapists in the state of Ohio. Participants were asked to identify conditions (cervical fracture, anterior cruciate ligament tear, and avascular necrosis of the femoral head) first given diagnostic images only, and then given the images and a clinical scenario.
Eight hundred sixty-six surveys of the 7537 sent out were eligible for analysis. With clinical scenarios, 61.3% of respondents were correct with the ACL injury identified on MRI, 36.4% for identification of the cervical spine fracture on CT and 25.6% for identification of avascular necrosis on plain film. The accuracy significantly improved (p<0.01) with the addition of the clinical information for all three of the diagnoses. The most remarkable improvement was seen with the AVN diagnosis on plain film radiograph (365.5% improvement), followed by the ACL injury on MRI (27.2% improvement) and cervical fracture diagnosis on CT scan (17.8% improvement). Finally, formal and informal training, board certification through the APTA and to a lesser extent, degree level, all improved diagnostic accuracy.
A clinical scenario paired with images notably improved identification of pathology. Physical therapists were better at identifying the ACL pathology that was presented on MRI. This is a common diagnosis to physical therapists and was paired with a relatively common imaging modality. This study suggests that physical therapists can improve accuracy with identifying pathologies on diagnostic images through a physical therapy curriculum or post-graduation through certifications and continuing education.
Level 4.
一直倡导物理治疗师深入了解诊断成像技术。近期物理治疗课程发生了变化，临床实践中利用成像技术的机会也有所增加。
本研究旨在探讨执业临床医生在普通X线片、磁共振成像（MRI）和计算机断层扫描（CT扫描）上准确识别选定肌肉骨骼疾病的能力。此外，确定在成像中加入临床病例后，疾病识别能力是否有所提高，以及是否存在相关的培训/接触因素。
对俄亥俄州的物理治疗师进行了一项横断面电子调查。参与者首先仅根据诊断图像识别疾病（颈椎骨折、前交叉韧带撕裂和股骨头缺血性坏死），然后再根据图像和临床病例进行识别。
发出的7537份调查问卷中，有866份符合分析条件。在有临床病例的情况下，61.3%的受访者能正确识别MRI上的前交叉韧带损伤，36.4%能识别CT上的颈椎骨折，25.6%能识别X线片上的缺血性坏死。对于所有这三种诊断，加入临床信息后准确性显著提高（p<0.01）。在X线平片上对缺血性坏死的诊断改善最为显著（提高了365.5%），其次是MRI上的前交叉韧带损伤（提高了27.2%）和CT扫描上的颈椎骨折诊断（提高了17.8%）。最后，正式和非正式培训、通过美国物理治疗协会的委员会认证以及在较小程度上的学位水平，均提高了诊断准确性。
临床病例与图像相结合显著提高了疾病的识别能力。物理治疗师更擅长识别MRI上显示的前交叉韧带病变。这是物理治疗师常见的诊断，且与相对常见的成像方式相关。本研究表明，物理治疗师可以通过物理治疗课程，或毕业后通过认证和继续教育来提高在诊断图像上识别疾病的准确性。
4级。
