TO REFER OR NOT TO REFER: A SURVEY OF AUSTRIAN PHYSIOTHERAPISTS FOCUSSED ON RECOGNISING SERIOUS PATHOLOGIES

J. Janssen¹, S. Gasselich¹, C. Keip¹, M.E. Lickel², R. Beikircher¹, M. Wieser², W. Lackenbauer¹

¹IMC University of Applied Sciences Krems, Department of Health Sciences, Institute of Therapeutic and Midwifery Sciences, Krems an der Donau, Austria, ²Karl Landsteiner University of Health Sciences, Human Medicine, Krems an der Donau, Austria

Background: It is important that serious pathologies, affecting the musculoskeletal (MSK) system, are recognised at the early stage of a disease, however recognition is challenging. Due to a close physiotherapist-patient relationship, sometimes over a prolonged period of time, physiotherapists are ideally placed to play a valuable role in the recognition of serious pathologies. International literature on recognition on serious pathologies is available from several countries including the USA, Germany, Switzerland, Denmark. However, it is currently unknown how accurately Austrian qualified physiotherapists can detect the presence of serious pathologies affecting the MSK system and therefore determine whether physiotherapy management is indicated (keep patient), or not (refer patient to a medical doctor).

Purpose: The main purpose of this study was to investigate the current ability of Austrian qualified physiotherapists to recognise serious pathologies using validated clinical vignettes. The secondary aim was to identify which additional information physiotherapists would need in clinical vignettes to make an accurate keep-refer decision.

Methods: This mixed-methods cross-sectional survey was conducted between April and June 2022. Physiotherapists working in private practices or institutions/hospitals were included. Participants completed twelve validated clinical vignettes, in which they were asked to make a clinical decision: keep; keep-refer; refer. Open ended questions enquired about possible missing information within the vignettes for making accurate keep-refer decisions. Quantitative data was analysed descriptively, qualitative data was analysed using framework analysis.

Results: In total 479 physiotherapists completed the survey. Physiotherapists answered 70,1% of the MSK vignettes (keep or keep-refer), 79,5 % of the medical non-critical vignettes (keep-refer or refer) and 53,5% of the medical critical vignettes (only refer) correctly. The vignettes were 100% answered correctly in 11,3 % of the MSK, 37,0% of the medical non-critical, and 14,3% of the critical clinical categories. Qualitative feedback on additional information encompassed the domains of the referral information, case history, and physical examination, which the majority requested more information on pain and additional clinical tests.

Conclusions: This study investigated the ability of Austrian qualified physiotherapists to make keep-refer decisions. Compared to the literature, Austrian physiotherapists chose more often to refer the MSK cases to a medical doctor, taking a more cautious approach than their international colleagues. This also aligns within the current health system in Austria. In the medical critical category only 14% answered all cases correctly, indicating there is a potential for improving accurate keep-refer decision making in Austrian physiotherapists.

Implications: The results show that educational efforts to improve the keep-refer decision making capability of Austrian physiotherapists is needed. These efforts could include learning with in depth clinically relevant cases, in or outside of existing curricula.

Funding acknowledgements: The Gesellschaft für Forschungsförderung Niederösterreich m.b.H. (GFF) funded this project.

Keywords:
red flags
clinical reasoning
referral

Topics:
Education: continuing professional development
Education: clinical

Did this work require ethics approval? Yes

Institution: Karl Landsteiner Private University

Committee: Commission for Scientific Integrity and Ethics

Ethics number: Project nummer:1021/2022