Effects of Physical Therapist Training on Outcomes of Patients With Chronic Low Back Pain or Chronic Shoulder Pain

Abstract

No studies to date were found investigating the impact of clinical reasoning on physical therapy outcomes. Previous research has focused on specific physical therapy interventions versus the entire scope of physical therapy practice. The purpose was to investigate whether a long-term post graduate course with emphasis in clinical reasoning enhances physical therapy outcomes in patients with chronic low back pain and chronic shoulder pain. In two outpatient clinics, patients with chronic low back pain and chronic shoulder pain were assigned to participating physical therapists. Therapists who had attended a long-term course with an emphasis on development of clinical reasoning skills (Group 1) were compared to therapists who had not attended the long-term course (Group 2). Patients completed the Revised Disability Pain Questionnaire (Oswestry) or the Shoulder Rating Questionnaire on the initial and final visits. Data collected on subjects included: age, initial questionnaire score, discharge questionnaire score, and number of visits. A critical alpha level of 0.05 was set for all statistics. This study used a prospective, mixed design. The independent variables were therapist training and time of measurement. The dependent variables were functional tool scores, number of visits, and efficiency ratio (change in functional tool score/number of visits). The mean ± SE number of visits for patients with chronic low back pain in therapists in Group 1 (5.3 ± 0.4) was statistically fewer than for therapists in Group 2 (7.6 ± 0.4); (p<0.001). Likewise there was a greater efficiency ratio (p<0.001) for therapists in Group 1 (5.6 ± 0.6) compared to therapists in groups 2 (1.8 ± 0.3). An interaction existed between therapist training and time of measurement (p<0.001) with a greater effect for therapists in group 1 (26.2± 2.3) versus group 2 (13.4 ±2.1). For patients with chronic shoulder pain, therapists in groups 1 again demonstrated significantly fewer number of visits (6.3± 1.2) versus group 2 (10.8 ±1.2); p=0.026. Therapists in Group 1 also demonstrated a greater efficiency ratio (3.9 ± 0.7) vs. therapists in group 2 (1.9 ± 0.3); p=0.026. No significant interaction was found between therapist group and measurement in patients with chronic shoulder pain (p=0.834). The results suggest therapists completing the long-term course emphasizing clinical reasoning have better effectiveness (change in functional tool scores) for patients with chronic low back pain and better efficiency for patients with chronic low back pain and chronic shoulder pain than therapists who have not completed the long-term course. For both diagnoses and therapist groups, a significant improvement was evident in patients' functional tool scores, indicating the overall positive effect of physical therapy.