Cunningham Shala, McFelea Joni
Department of Physical Therapy, Radford University , Roanoke, VA , USA.
Department of Physical Therapy, University of Evansville , Evansville, IN , USA.
Front Public Health. 2017 Mar 20;5:55. doi: 10.3389/fpubh.2017.00055. eCollection 2017.
The purpose of this study was to describe the influence of a post-graduate orthopedic manual therapy residency program in Kenya on the development of physical therapists' (PTs) knowledge and clinical reasoning related to the performance of a musculoskeletal examination and evaluation as compared to an experience-matched control group of PTs waiting to enter the program.
A cross-sectional design was utilized in which 12 graduating residents and 10 PTs entering the residency program completed a live-patient practical examination to assess the knowledge, clinical reasoning, and psychomotor skills related to the examination and evaluation of musculoskeletal conditions. The assessment utilized was based on the tasks, procedures, and knowledge areas identified as important to advanced clinicians in the US as outlined by the Orthopaedic Description of Specialty Practice. Inclusion criteria included participation in or acceptance to the residency program, practice as a PT between 3 and 25 years, and 50% of workday being involved in direct patient care. Overall pass rates were analyzed using the Pearson chi-square and Fisher's exact tests to determine if the graduating residents achieved significantly higher scores than experience-matched controls consisting of PTs entering the residency program.
PTs completing a post-graduate orthopedic manual therapy residency in Nairobi, Kenya, achieved higher scores and passing rates compared to their colleagues who had not completed a residency program as determined by a live-patient practical examination. Graduating residents demonstrated statistically significant higher scores in the categories of examination, evaluation, and diagnosis. The average live-patient practical examination score for PTs without residency training was 38.2%, and their pass rate was 0.0%. The average live-patient practical examination score for residency-trained PTs was 83.4%, and their pass rate was 92.3%. These findings are statistically significant ( < 0.001).
The study results suggest that the residency program had a positive influence on the residents' ability to perform musculoskeletal examination and evaluation and to determine a treatment diagnosis. Future studies should be performed to determine if the improvements in assessment have a positive impact on clinical practice.
本研究的目的是描述肯尼亚的一个骨科手法治疗研究生住院医师培训项目，与等待进入该项目的经验匹配的物理治疗师（PT）对照组相比，对物理治疗师在肌肉骨骼检查和评估方面的知识发展及临床推理能力的影响。
采用横断面设计，12名即将毕业的住院医师和10名即将进入住院医师培训项目的PT完成了一次活体患者实践考试，以评估与肌肉骨骼疾病检查和评估相关的知识、临床推理及操作技能。所采用的评估基于美国骨科专科实践描述中确定的对高级临床医生重要的任务、程序和知识领域。纳入标准包括参与或被接受进入住院医师培训项目、从事PT工作3至25年，以及工作日50%的时间用于直接患者护理。使用Pearson卡方检验和Fisher精确检验分析总体通过率，以确定即将毕业的住院医师的得分是否显著高于由即将进入住院医师培训项目的PT组成的经验匹配对照组。
通过活体患者实践考试确定，在肯尼亚内罗毕完成骨科手法治疗研究生住院医师培训的PT，与未完成住院医师培训项目的同事相比，得分和通过率更高。即将毕业的住院医师在检查、评估和诊断类别中表现出统计学上显著更高的分数。未经住院医师培训的PT的活体患者实践考试平均得分为38.2%，通过率为0.0%。经过住院医师培训的PT的活体患者实践考试平均得分为83.4%，通过率为92.3%。这些结果具有统计学意义（<0.001）。
研究结果表明，住院医师培训项目对住院医师进行肌肉骨骼检查和评估以及确定治疗诊断的能力有积极影响。未来应开展研究以确定评估方面的改进是否对临床实践有积极影响。
