Shavit Ron, Kushnir Talma, Nudelman Yaniv, Springer Shmuel
The Neuromuscular & Human Performance Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.
Department of Psychology, Ariel University, Ariel, Israel.
J Multidiscip Healthc. 2025 Jan 6;18:29-39. doi: 10.2147/JMDH.S493650. eCollection 2025.
Direct access to physical therapy (PT) requires PTs to act as primary care providers, making differential diagnosis a critical component of patient assessment. We investigated how participation in postgraduate training in differential diagnosis and medical screening influences PTs' confidence, self-efficacy, attitudes and beliefs about treating patients with low back pain (LBP).
This prospective, two-arm study involved 49 PTs in an intervention group and 70 in a control group. The intervention included 40-hours of training on medical screening and differential diagnosis, focusing on red flags, clinical reasoning and referral pathways, while the control group received no intervention. Clinical confidence, self-efficacy, attitudes and beliefs were measured before, immediately after, and 6-months after training. Outcomes included the Primary Care Confidence Scale (PCCS), which assesses confidence in primary care practice, detection of serious pathology, and medical screening; the Physiotherapy Self-Efficacy (PSE) questionnaire, evaluating clinical self-efficacy in assessing and treating patients with LBP; and the Attitudes to Back Pain Scale for Musculoskeletal Practitioners (ABS-mp), which measures clinicians' attitudes and beliefs about LBP.
The intervention group showed significant immediate improvements in PCCS scores (40.26 ± 5.23 to 45.24 ± 4.20, = 1.08, ) and PSE scores (51.06 ± 6.46 to 54.65 ± 5.78, = 0.6, ). At six-month, significant interaction effects were observed for PCCS ( = 17.49, Partial η² = 0.131, ) and PSE scores ( = 5.87, Partial η² = 0.06, ) and PSE scores (55.32 ± 6.09, ), with the intervention group maintaining improvements while the control group showed no significant changes. No significant changes were observed in ABS-mp scores.
This study highlights the positive impact of training in medical screening and differential diagnosis on reducing concerns and increasing clinical confidence and self-efficacy.
直接获得物理治疗（PT）服务要求物理治疗师充当初级保健提供者，因此鉴别诊断成为患者评估的关键组成部分。我们调查了参与鉴别诊断和医学筛查研究生培训如何影响物理治疗师对治疗腰痛（LBP）患者的信心、自我效能、态度和信念。
这项前瞻性双臂研究纳入了49名干预组物理治疗师和70名对照组物理治疗师。干预措施包括40小时的医学筛查和鉴别诊断培训，重点是警示信号、临床推理和转诊途径，而对照组未接受任何干预。在培训前、培训后立即以及培训后6个月测量临床信心、自我效能、态度和信念。结果指标包括初级保健信心量表（PCCS），该量表评估对初级保健实践、严重病理检测和医学筛查的信心；物理治疗自我效能量表（PSE）问卷，评估评估和治疗LBP患者的临床自我效能；以及肌肉骨骼从业者对背痛量表（ABS-mp），该量表测量临床医生对LBP的态度和信念。
干预组的PCCS评分（从40.26±5.23提高到45.24±4.20，t = 1.08，p < 0.05）和PSE评分（从51.06±6.46提高到54.65±5.78，t = 0.6，p < 0.05）立即有显著改善。在六个月时，观察到PCCS（F = 17.49，偏η² = 0.131，p < 0.05）和PSE评分（F = 5.87，偏η² = 0.06，p < 0.05）有显著的交互作用，干预组保持改善，而对照组无显著变化。ABS-mp评分未观察到显著变化。
本研究强调了医学筛查和鉴别诊断培训对减少担忧、增强临床信心和自我效能的积极影响。
