Shavit Ron, Kushnir Talma, Nudelman Yaniv, Weisman Asaf, 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.
BMC Prim Care. 2025 May 6;26(1):147. doi: 10.1186/s12875-025-02850-w.
Low back pain (LBP) is a common musculoskeletal disorder with distinct clinical features. Direct access to physiotherapy (PT), with physiotherapists (PTs) acting as primary care providers, can improve the management of individuals with LBP. However, clinician confidence may affect their willingness to provide primary care as well as their performance as primary care providers. The objectives of this study were: (1) to develop the Primary Care Confidence Scale (PCCS), and (2) to evaluate PTs' confidence in managing LBP in primary care.
The PCCS questionnaire was developed through a seven-stage Delphi process involving experts who modified an existing self-confidence scale. The questionnaire was completed by 314 PTs, 140 of whom completed it again after 2 weeks. Structural validity was evaluated using exploratory and confirmatory factor analysis. Reliability was assessed with Cronbach's alpha for internal consistency and intraclass correlation coefficients (ICC) for test-retest reliability. Spearman tests assessed correlations between background characteristics and PCCS scores. Two independent t-tests estimated the effects of gender and post-graduate education. One-way ANOVA was used to evaluate the impact of the workplace.
The PCCS had a multidimensional structure with three factors demonstrating an acceptable model fit and good reliability (α = 0.83, ICC = 0.78). The mean confidence level was 75% (PCCS = 45 ± 6/60), with moderate positive correlations observed between PCCS scores and both age (r = 0.42, p < 0.001) and years of experience (r = 0.33, p < 0.001). PTs working in public or private outpatient clinics had significantly higher scores (PCCS = 45.3 and 47.0, respectively) compared to PTs working in an inpatient hospital or in rehabilitation centers (PCCS = 40.6 and 40.3, respectively, p < 0.009).
The newly developed PCCS demonstrated adequate validity and high reliability, suggesting that it is suitable for measuring confidence in treating patients with LBP in primary care settings. PTs demonstrated confidence levels indicative of their perception to manage patients in primary care. Health policy makers and educators could incorporate the PCCS into training and evaluation programs to assess clinicians' confidence and perceived readiness to treat LBP in primary care.
腰痛（LBP）是一种常见的肌肉骨骼疾病，具有独特的临床特征。直接接受物理治疗（PT），由物理治疗师（PTs）担任初级保健提供者，可以改善对腰痛患者的管理。然而，临床医生的信心可能会影响他们提供初级保健的意愿以及他们作为初级保健提供者的表现。本研究的目的是：（1）开发初级保健信心量表（PCCS），（2）评估物理治疗师在初级保健中管理腰痛的信心。
PCCS问卷通过七阶段德尔菲法制定，涉及修改现有自信量表的专家。问卷由314名物理治疗师完成，其中140名在2周后再次完成。使用探索性和验证性因素分析评估结构效度。使用Cronbach's alpha评估内部一致性的信度，使用组内相关系数（ICC）评估重测信度。Spearman检验评估背景特征与PCCS分数之间的相关性。两个独立样本t检验估计性别和研究生教育的影响。单向方差分析用于评估工作场所的影响。
PCCS具有多维结构，三个因素显示出可接受的模型拟合和良好的信度（α = 0.83，ICC = 0.78）。平均信心水平为75%（PCCS = 45 ± 6/60），PCCS分数与年龄（r = 0.42，p < 0.001）和工作年限（r = 0.33，p < 0.001）之间均观察到中度正相关。与在住院医院或康复中心工作的物理治疗师（PCCS分别为40.6和40.3）相比，在公立或私立门诊诊所工作的物理治疗师得分显著更高（PCCS分别为45.3和47.0，p < 0.009）。
新开发的PCCS显示出足够的效度和高信度，表明它适用于测量在初级保健环境中治疗腰痛患者的信心。物理治疗师表现出的信心水平表明了他们对在初级保健中管理患者的认知。卫生政策制定者和教育工作者可以将PCCS纳入培训和评估计划，以评估临床医生在初级保健中治疗腰痛的信心和自我认知的准备程度。
