Physiotherapy diagnosis in clinical practice: a survey of orthopaedic certified specialists in the USA

Abstract

Diagnosis is a complex process that involves clinical decision-making along several dimensions, culminating in the assignment of a label or labels which inform(s) treatment decisions. Much of the attention given to physiotherapy diagnosis has been devoted to specific, disparate classification systems for low back pain. The purpose of the present study was to investigate how physiotherapists view and approach diagnosis in clinical practice in the USA. A survey was developed to collect both quantitative and qualitative data related to diagnostic process and classification in orthopaedic practice. Subjects comprised 253 Board-certified orthopaedic physiotherapy practitioners. A total of 850 surveys were administered; 253 surveys were completed, representing a return rate of 30%. Eighty-four per cent of the respondents report patient care as their primary professional practice area. Seventy-six per cent of the subjects utilized a diagnostic classification system distinct from the medical diagnosis when managing patients with low back pain. Of those, the largest percentage (38%) utilized a general pathophysiological classification system, 32% utilized the McKenzie system and, in decreasing order of frequency, treatment-based classification (9%) and movement impairment classification (7%). Qualitative data suggest considerable variation in how orthopaedic specialists view diagnosis in patient management, with several common themes emerging: physiotherapy diagnosis may incorporate the medical diagnosis, but moves beyond it; physiotherapy diagnosis occurs across multiple levels or systems; physiotherapists tend to view diagnosis as being process-oriented with its primary purpose being to guide treatment decisions. As physiotherapy evolves from a profession that treats by prescription to a doctoring profession it should give serious attention to diagnosis, the foundation of evidence-based practice. Striving for consensus on the role of diagnosis in patient management should become a priority, as well as developing a more standard taxonomy with consistent terminology.