Musculoskeletal Physiotherapists Research Articles

Current use of patient-reported outcome measures by musculoskeletal physiotherapists in Portugal.

Musculoskeletal conditions are the leading cause of disability, requiring continuous outcome measurement, including the utilization of patient-reported outcome measures (PROMs). The aims of the study were a) to characterize the use PROMs by Portuguese physiotherapists in patients with musculoskeletal conditions; b) to analyze the associated factors of their use and; c) to identify the barriers and facilitators to their implementation. A cross-sectional online survey was carried out with musculoskeletal physiotherapists working in Portugal. Closed questions were used to describe the use of PROMs. The factors associated with the non-use of PROMs were analysed through logistic regression models (p= 0.05). Barriers and facilitators were assessed through open questions and analyzed using thematic analysis. One hundred and fifty-six physiotherapists answered the online survey. Most physiotherapists do not use outcome measures consistently and physical tests are often chosen (70.5%) over PROMs (17.3%). The work sector (p= 0.01; p= 0.015; p= 0.009). the workplace stimulus (p= 0.001) and the physiotherapists' knowledge about PROMs (p= 0.017) were identified as factors associated with the non-use of PROMs. Barriers and facilitators to the use of PROMs are related to physiotherapists' skills, the patients' characteristics, the workplace conditions, and the instruments' characteristics. This study showed the poor use of PROMs by musculoskeletal physiotherapists and identified the associated factors, barriers, and facilitators that should be considered to increase its future use by musculoskeletal physiotherapists in Portugal.

Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders: ‘eHealth: it's TIME’

Objective This study aimed to co-design and develop a user-centred, theory-based eHealth-mediated self-management support follow-up prototype for adults with musculoskeletal disorders. Design A three-step system development cycle was employed. Step 1 involved creating intervention features and content, with two focus groups reviewing prioritised eHealth intervention elements based on earlier research. Step 2 involved heuristic testing using Nielsen's 10 heuristic principles. Step 3 incorporated qualitative think-aloud interviews and the System Usability Scale. Setting Republic of Ireland. Participants Step 1 included adults with musculoskeletal disorders (n = 12). Step 2 involved five reviewers. Step 3 included people with musculoskeletal disorders (n = 5) and musculoskeletal physiotherapists (n = 5). Results Participants in step 1 approved four main intervention components, which map to recognised theoretical frameworks, and suggested increased use of visual and interactive elements. Heuristic testing in step 2 identified design and navigation issues. In Step 3, usability testing, additional navigation, content and design recommendations were identified. The overall median system usability score (interquartile range) was 75 (0) out of 100 for adults with musculoskeletal disorders and 77.5 (2.5) out of 100 for musculoskeletal physiotherapists, indicating good usability. Conclusion A theory-based, user-centred eHealth-mediated follow-up self-management support prototype has been developed for people with musculoskeletal disorders, with the next steps focusing on feasibility testing in clinical practice, with a more diverse population.

Patient experience and barriers of using a mHealth exercise app in musculoskeletal (MSK) Physiotherapy.

Digital transformation has led to an abundance of digital health technologies (DHTs) readily available for Physiotherapists. In July 2020, the Physiotherapy department at a London NHS Trust implemented a mobile health (mHealth) exercise application (app), Physitrack. This service evaluation aims to evaluate patient experience and identify any barriers to using Physitrack/PhysiApp in musculoskeletal (MSK) Physiotherapy. An online experience survey was sent to 10,287 MSK Physiotherapy patients who had appointments between January 17th and April 9th 2022.The survey received 1,447 responses (response rate: 14.07%), with 954 (65.93%) respondents previously provided PhysiApp as part of their Physiotherapy management. Most participants used PhysiApp (83.06%), found it easy to use (82.20%) and had positive perceptions on how it added value to their Physiotherapy treatment through its functionality. However, negative impacts on patient-centred care and practical exercise demonstration were apparent in the qualitative results. Key barriers to use included suboptimal explanation, digital exclusion, registration/ login issues and opinion that PhysiApp was superfluous to Physiotherapy treatment. These differed to the main barriers of why participants stopped using/ used PhysiApp less: if they were confident exercising without it, their condition improved/ resolved, loss of motivation, their exercise programme ended or if they found their exercise programme was unsuitable. Despite multiple interdependent factors influencing patient experience and barriers of using PhysiApp, the survey results revealed the significant influence that is exerted by MSK Physiotherapists. The patient-physiotherapist interaction can positively or negatively impact upon many barriers of use and the subsequent potential added value of PhysiApp to MSK Physiotherapy treatment. Future research should focus on those at most risk of digital exclusion and health inequalities, exploring their barriers to using mHealth apps and other DHTs.

Assessing the knowledge of low back pain among physiotherapists in Spain: A cohort study with pre- and post-educational course evaluation

BackgroundLow back pain (LBP) is the most prevalent musculoskeletal disorder worldwide and physiotherapists are among the primary healthcare professionals assessing and treating the condition. However, scientific knowledge regarding the management of LBP amongst physiotherapists is largely unknown. ObjectivesTo evaluate the level of evidence-based knowledge among Spanish physiotherapists in LBP management and assess knowledge enhancement following the completion of an e-learning course. DesignSingle-arm cohort study with pre-post evaluation. MethodsThis single-arm pre-post study involved 1350 physiotherapists practicing in Spain. Initially, participants underwent a 22-question test on evidence-based LBP knowledge, covering socio-economic impact, characteristics of LBP, rehabilitation goals, psychosocial factors, and high- and low-value interventions. After completing the course, participants took a final test with the same 22 questions in randomized order. ResultsOut of the 1350 physiotherapists enrolled, 857 completed the course. The initial responses demonstrated that almost half of the participants considered medical imaging essential before starting physiotherapy treatment, perceived glucocorticoids as recommended for chronic low back pain, and considered ergonomic adjustments crucial for managing the condition. Individuals who completed their education more than 10 years ago showed a minor improvement in evidence-based knowledge compared to those who recently finished their university degree. Following the course, participants displayed improved knowledge, narrowing prior disparities in error percentages across questions. ConclusionDue to existing gaps in physiotherapists’ evidence-based knowledge of LBP, particularly among those who have worked longer time as physiotherapists, e-learning initiatives may be a feasible approach to support continuous training of physiotherapists.

Task shifting for musculoskeletal disorders in Norwegian primary care: a qualitative interview study of general practitioners and specialist musculoskeletal physiotherapists

Objective To explore the views of general practitioners and physiotherapists on the current model of care for patients with musculoskeletal disorders in Norwegian primary care, and if the English First Contact Practitioner model, where patients have access to multiple professional groups with musculoskeletal health expertise, could inform service development. Design, setting, and subjects We analysed interviews with five GPs and 11 physiotherapists and used Lipsky’s theories about street-level bureaucracy and Foucault’s theories of mechanisms of power and institutional structures to explore task shifting and cooperation between different professions. Results and interpretation The empirical material reflected a multi-faceted discourse about skill-mix in primary care, where financial factors, perceptions about competence, and task preferences moderated attitudes to task shifting. Competition and cooperation coexist between the professions, and the seemingly gradual blurring between historical hegemony and new models of care creates both alliances and rivalries. Examples of deviations from the Choosing Wisely principles and evidence-based practice indicate that both general practitioners and physiotherapists balance the roles of patient advocate, gatekeeper, and homo economicus, in a context where task shifting is challenged by established practice. It appears that the management of patients with musculoskeletal disorders is fragmented and to some extent reflects a supply-driven system.

Work-related injuries of rehabilitation therapists and measures for prevention.

Rehabilitation therapists often perform physically demanding treatments that may result in work-related injuries, yet related studies are scarce. This study aimed to investigate the work-related injuries of rehabilitation therapists and provide feasible preventive measures. A cross-sectional study was carried out in 34 regions across China using an online questionnaire. The survey gathered responses primarily from 1,198 rehabilitative therapists working in 120 health institutes. Following data collection, descriptive analysis, chi-square tests, logistic regression, and receiver operating characteristic (ROC) curves were employed to analyze the data. In this study, the incidence of work-related injuries was reported to be 87% (n = 1,041). The top three musculoskeletal issues reported were low back pain (12%), neck pain (10%), and shoulder pain (9%). Logistic regression and ROC curve analysis identified that working as a physiotherapist and years of work experience (OR [95% CI]: 1.03 [0.99-1.07]) were significant contributors to the incidence of work-related injuries. Specifically, neuro-physiotherapists (OR [95% CI]: 3.04 [1.56-5.92]), musculoskeletal physiotherapists (OR [95% CI]: 2.46 [1.16-5.18]), and intensive care physiotherapists (OR [95% CI]: 4.70 [1.24-17.88]) were at higher risk. Furthermore, five factors were proven to be associated with injury prevention as reported by therapists: patient engagement (OR [95% CI]: 0.38 [0.23-0.62]), improving techniques (OR [95% CI]: 0.59 [0.39-0.90]), maintaining exercise habits (OR [95% CI]: 0.59 [0.40-0.86]), utilizing instruments (OR [95% CI]: 0.80 [0.53-1.19]), and strengthening education (OR [95% CI]: 0.43 [0.21-0.90]). The present study investigated the factors contributing to work-related injuries among rehabilitation therapists, with a focus on identifying both risk and preventive measures. These findings offer new perspectives on decreasing injury risk.

Informing low back pain care from the ground up: Survey of national musculoskeletal triage physiotherapists in Ireland

BackgroundHealthcare is changing to meet the challenge of a rising musculoskeletal burden associated with the expanding, aging population. Clinicians, important stakeholders in healthcare provision, have crucial insights into service improvement, but clinician consultation is a shortcoming in healthcare development. In Ireland, specialist physiotherapist-led musculoskeletal (MSK) triage services operate at the primary-secondary care interface to expedite patient care. ObjectivesTo inform future development of low back pain (LBP) care in Ireland through profiling the operationalisation of the national MSK triage service for LBP, including access, referral management, clinical investigations, onward referral options, access to multidisciplinary team (MDT) services and integration with primary healthcare services. DesignCross-sectional observational study using a bespoke, anonymous electronic survey. ParticipantsThirty-eight clinical specialist physiotherapists working in national programme Irish MSK triage services. ResultsThirty-eight MSK Triage physiotherapists submitted responses (response rate 72%). There was considerable site-dependent variation in LBP service provision, with discrepancies in access to triage services, wait times, referral processing and prioritisation, access to clinical investigations and onward referral options. Most respondents (81%) reported wait times exceeding the three-month target; 75% reported that the level of clinical autonomy associated with their role limited service efficiency; 75% were dissatisfied with primary-secondary care service integration. Respondents identified insufficient availability of primary care multidisciplinary services. ConclusionLack of standardisation of LBP services exists in Ireland. Services would benefit from improved standardisation, reduced wait times, national accreditation and a defined scope of advanced physiotherapy practice and the development of nationwide community multidisciplinary infrastructure with enhanced interservice communication.

CSP2023: 51 - The experiences of uncertainty amongst Musculoskeletal Physiotherapists in First Contact Practitioner roles within Primary Care

CSP2023: 51 - The experiences of uncertainty amongst Musculoskeletal Physiotherapists in First Contact Practitioner roles within Primary Care

CSP2023: 243 - A qualitative meta-synthesis of musculoskeletal physiotherapist and patient views on person-centredness

CSP2023: 243 - A qualitative meta-synthesis of musculoskeletal physiotherapist and patient views on person-centredness

Musculoskeletal physiotherapists’ experiences of using remote consultations during the COVID-19 pandemic: A qualitative study

BackgroundThe coronavirus (COVID-19) pandemic resulted in the rapid implementation of remote consultations to maintain musculoskeletal physiotherapy services. However, little is known about UK musculoskeletal physiotherapists' experiences of providing services during the COVID-19 pandemic. ObjectivesTo explore musculoskeletal physiotherapists’ experiences of using remote consultations in one area of England during the COVID-19 pandemic. DesignQualitative study using hermeneutic phenomenology based on the approach of Gadamer. MethodsSemi-structured interviews with twelve musculoskeletal physiotherapists were conducted online using Microsoft Teams. Data were analysed using frameworks based on the philosophical concepts of Gadamer's hermeneutics. FindingsMusculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic was framed by three concepts: therapeutic relationship, transformational change, and uncertainty. These concepts are underpinned by four main themes capturing their experiences: (1) Disconnection: Difficulties building a rapport and reduced non-verbal communication affected building an effective therapeutic relationship, (2) Necessity: Transformation of services to remote consultations was positive, although technology and connectivity issues had a negative impact, (3) Loss of control: Diagnostic uncertainty, being unprepared, and experience affected physiotherapists' clinical practice, (4) Protection: Peer support and the use of technology facilitated a feeling of protection for physiotherapists. ConclusionThe findings of this study contribute to a better understanding of musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic. Implications for practice include the need to provide training for all musculoskeletal physiotherapists and undergraduates to enable the effective delivery of remote physiotherapy. Furthermore, digital infrastructure should be optimised to support future delivery of remote musculoskeletal physiotherapy services.

Use of cervical traction for managing neck pain: A cross-sectional survey of physiotherapists in India

BackgroundNeck pain remains the fourth leading cause of disability and work loss, and a multimodal treatment approach is effective in reducing neck pain and disability. PurposeThe purpose of this study is to examine the use of cervical traction for managing neck pain by Physiotherapists in India, including how and when the traction is used, the modes and parameters of traction, any additional interventions given with traction, and the influence of professional demographic characteristics in decision making in traction usage. Study designA cross-sectional survey. MethodologyA random sample of approximately 2500 musculoskeletal physiotherapists was surveyed, and the data was presented in a descriptive form. Chi-square analyses were used to identify the association between responders’ qualifications and traction usage. ResultsFrom the total physiotherapist approached 18.52% (n = 463) responses were obtained, and 62% (n = 287) respondents reported that they would use traction in their clinical practice. Out of 92.3% of responders indicated using traction for radiculopathy, 78.7% of respondents used traction for patients with neck pain without radiculopathy. It is used as a combination therapy by 58.8% for radiculopathy and 52.2% for stiffness. There was no association between the responder's qualification and traction usage (χ2 = 0.707, p = 0.40). Traction is used in combination with other physiotherapeutic techniques. ConclusionTraction use was consistent with the proposed criteria identifying patients likely to benefit. However, disregarding current guidelines, physiotherapists also use traction for non-radicular neck pain. Various traction delivery modes and parameters were used within a comprehensive plan of care incorporating multiple interventions.

Improving musculoskeletal physiotherapists’ confidence in patient-centred care informed by acceptance and commitment therapy: A descriptive study

BackgroundPatient-centred care is essential for high quality musculoskeletal care, however, few evidence-based opportunities exist that address the barriers to implementation for clinicians. ObjectiveTo develop and evaluate a simulation-based educational strategy for musculoskeletal physiotherapists to increase knowledge and confidence in patient-centred care. MethodsRepeated-measures, single-group educational interventional descriptive study. Primary outcome was participant-reported knowledge and confidence in patient-centred care. Customized survey data was collected at baseline (T1) (N = 22), immediately after a face-to-face workshop (T2) (N = 22), and six weeks after the workshop (T3) (N = 17). Secondary outcomes included sustained implementation using the Normalization Measure Development (NoMAD) tool. Repeated-measures ANOVA was used to analyse primary outcomes. ResultsOur participants were typically female (72%), early career (mean 3.3 years post-graduate) and culturally diverse (67%). Significant increases in participant confidence were noted at all time points on all five learning outcomes (repeated measures ANOVA, p < 0.001 to p = 0.009). Participants had very high baseline knowledge and no further increases were found following the intervention (p > 0.05). Normalization Measure Development data indicated high coherence, high cognitive participation, and high reflexive monitoring, with neutral results for collective action. ConclusionA novel, psychologically-informed, simulation-based educational strategy is effective in improving musculoskeletal physiotherapist confidence in patient-centred care. Participants reported implementation of skills learnt in the workshop into subsequent clinical practice.

Musculoskeletal physiotherapists' discharge practices for people treated with low back pain: A United Kingdom survey.

Persistent low back pain (LBP) is the leading cause of disability, and a major burden on the healthcare system globally. Many people with LBP experience recurrent pain flares and receive repeated appointments and re-referrals to services such as physiotherapy. However, it is not clear what the criteria are for discharging people with LBP from physiotherapy services. This study aims to describe the current practices for discharging people from physiotherapy for LBP in the United Kingdom (UK). A cross-sectional study using an anonymous online national (UK) survey was conducted among qualified physiotherapists who treat people with LBP in UK musculoskeletal out-patient services. A total of 104 surveys were completed. The majority of respondents reported using (i) a shared decision-making (77%) and (ii) person-physiotherapist goal attainment (74%) approach to discharging people with LBP. Sixty-three percent of respondents reported using a patient-initiated follow-up (PIFU) approach. Only 8% of respondents reported using a graded discharge approach with 'booster' appointments. A PIFU or graded discharge approach was considered most pertinent for people at higher risk of a pain flare (97%; 86%) and with low self-efficacy to self-manage their LBP. This UK survey established that discharge practices for people with LBP after physiotherapy vary. Whilst the majority of people are currently discharged with a PIFU appointment, a graded discharge approach may be more beneficial for people who are less likely to initiate a PIFU appointment. Further consideration on the development of such a pathway is now required.

‘What should we teach?’ A U.K. survey comparing clinician and academic views on content of the pre-registration musculoskeletal physiotherapy curriculum

Evolving evidence underpinning musculoskeletal physiotherapy challenges the definitions of contemporary clinical practice and pre-registration curricula. This research uses an online national survey to compare clinician (272) and lecturer (61) views on the Chartered Society of Physiotherapy’s four pillars of practice (manual therapy and therapeutic handling; exercise, movement, and rehabilitation; therapeutic and diagnostics technologies; and allied approaches, including psychologically informed approaches) with the aim of establishing their clinical and educational utility. Findings indicate that close alignment exists between practising U.K. musculoskeletal physiotherapists and U.K. pre-registration physiotherapy lecturers on the ongoing relevance of exercise therapy and psychologically informed approaches to behaviour change. The paper also shows that a mismatch exists in the clinical and educational use of both manual therapy and electrotherapy between practising physiotherapists and physiotherapy lecturers. Future research should focus on the highlighted need to continue to align pre-registration musculoskeletal curricula with both the evidence base and clinical practice for the curricular areas of electrotherapy and manual therapy. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0 .

Correlation Between Severity of Symptoms and Quality of Life in Patellofemoral Pain Syndromes: A Cross-Sectional Study.

Background Patellofemoral pain syndrome(PFPS) is one of the conditions frequently encountered by musculoskeletal physiotherapists. The intensity and severity of pain and symptoms seen in PFPS affect the quality of life (QOL). This concept has not yet been investigated with the use of reliable and valid scales. Hence, the objective of this study is to find out the correlation between the severity of symptoms and QOL in patients with PFPS. Methodology In this cross-sectional study, 63 patientswith PFPS, aged between 40 and 60 years, who visited Sir Sayajirao General Hospital, Vadodara, from December 2018 to June 2019, were included. The questionnaires included in the study comprised the Numerical Pain Rating Scale (NPRS), the Knee Osteoarthritis Outcome Survey-Patellofemoral Subscale (KOOS-PF), and the Short Form-36 (SF-36). Spearman's rank correlation coefficient was used to find the correlation. Results NPRS was found to have a fairly positive correlation with the functional scale KOOS-PF, with a P-value of 0.008. Among the eight components of SF-36, Physical Function and General Health scores exhibited a fairly positive correlation with NPRS, with p-values of 0.016 and <0.001, respectively. However, no correlation was observed between NPRS and the other components of SF-36. Conclusions This study concluded that patients with PFPS with different levels of pain exhibit different functional and QOL limitations. Furthermore, studies investigating the causes of the negative correlation should be conducted to have a better understanding of QOL in PFPS.

Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - 'eHealth: It's TIME': a study protocol.

Background:Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods:A three-step, iterative system development cycle will be utilised to develop and design the "eHealth: It's TIME prototype". The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 - 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 - 5) and musculoskeletal physiotherapists (n = 3 - 5). Conclusion:The eHealth: It's TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.

Access to first contact physiotherapy appointments in primary care: A scoping review

AbstractBackgroundFirst Contact Physiotherapy (FCP) is part of the drive to increase General Practice (GP) capacity by providing access to expert musculoskeletal (MSK) Physiotherapists in GP surgeries. For the FCP model to provide effective MSK care at the start of the patient's journey, it is essential that patients are directed to FCP appointments in a timely manner. It is therefore important to know how patients are accessing FCP appointments.ObjectiveTo provide an overview of the literature regarding patient access to FCP appointments.DesignScoping review.MethodsWe reviewed studies published from January 2016 to May 2023 that focused on FCP and made a mention of patient access to FCP appointments. A search was performed using six databases as well as grey literature sources. Study selection and data extraction were independently conducted by two reviewers. Extracted data were tabulated and analysed according to our research questions.ResultsFrom 186 records identified, 24 studies and other materials were included in the review. A variety of terms were used to describe access routes to FCP appointments, the most common being ‘signposting’. These studies suggest the importance of the role of GP reception/administrative staff in enabling efficient patient access to FCP appointments.ConclusionThere is a clear gap in the literature concerning how patients access FCP appointments. Since the importance of appropriate access is acknowledged as an essential feature of the expansion of FCP in Primary Care, future research is needed to refine and implement optimal FCP access models by identifying the key components needed to ensure timely and appropriate access to FCP.

The lived experiences of musculoskeletal physiotherapists managing patient expectations for diagnostic imaging: A qualitative study using a phenomenological analysis

ObjectivesUnnecessary diagnostic imaging for musculoskeletal presentations is a pervasive phenomenon, placing a substantial weight on healthcare resources. Their overuse can lead to iatrogenic consequences associated with overdiagnosis and overtreatment. Factors which contribute to inappropriate imaging are multifactorial. Clinician-patient beliefs, behaviours, and expectations have been identified as central drivers. Physiotherapists play an important role in the utilisation of diagnostic imaging for musculoskeletal presentations throughout healthcare settings. This study aims to explore the lived experiences of physiotherapists managing patient expectations for diagnostic imaging. DesignA qualitative study using an interpretative phenomenological analysis. Five participants were purposefully recruited and took part in semi-structured individual interviews. ResultsThe central themes identified were expectations for diagnostic imaging, managing expectations, communicating imaging findings, imaging as a therapeutic tool, and risk and uncertainty. ConclusionThe findings from this study gives new insights into how musculoskeletal physiotherapists manage expectations for diagnostic imaging, the associated complexities, and the challenges encountered.

Musculoskeletal physiotherapists reasons for treatment selection and continuous professional development practices in the United Kingdom: A cross-sectional survey

PURPOSE: The aims of the study were two-fold 1) to explore the treatment modalities musculoskeletal physiotherapists are utilising and the underlying reasons why and 2) report current continuing professional development (CPD) practises and their perceived effectiveness. METHODS: Using a cross-sectional questionnaire, musculoskeletal physiotherapists in the United Kingdom (UK) were invited to complete an online survey. The survey captured respondents’ professional characteristics and their main reason for selecting a range of treatments sub-grouped into three broad categories; Manual Therapy, Treatment Modalities and Education Based Approaches. Respondents were asked to report their CPD practises and their perceived effectiveness. Data was converted into proportions with lower and upper limits of the 95% confidence interval (CI). Likert scale questions were treated as numeric variables with the mean and standard deviation (SD) calculated for combined responses. RESULTS: Of the 414 responders, 408 were eligible for analyses. The most common reason for treatment selection, based upon a combined total of 9792 responses across all treatment modalities, was content taught in ‘entry-level training’ (n = 2010, 20.5%, 85% CI 20 to 21), followed by ‘practice related courses or CPD events’ (n = 1241, 12.7%, 95% CI 12 to 13). ‘Self-reflection’ was the most common form of CPD (n = 404). All forms of CPD were considered ‘effective’ for developing knowledge and skills except ‘clinical audit’ and ‘journal clubs’ which were rated as ‘indifferent’ by respondents. CONCLUSIONS: Treatment technique depends heavily on skills taught in entry-level training. Despite research articles amongst the most utilised forms of CPD, a disconnect exists in its implementation as the main driver of treatment selection. A wide range of CPD activities were undertaken by participants and rated as ‘effective’ for acquiring and applying physiotherapy related skills.

P177 A UK survey evaluation of first contact practitioner and physiotherapist confidence, recognition and referral of suspected axial spondyloarthritis

Abstract Background/Aims Axial spondyloarthritis (axSpA) is an inflammatory disease associated with significant diagnostic delays. A previous evaluation of confidence, awareness and knowledge of axial spondyloarthritis (Steen et al, 2021) found physiotherapists lacked adequate consideration of axSpA in back pain assessments and of awareness of features that raise suspicion. Since the previous survey, professional education on axSpA has occurred. Furthermore, first contact practitioners (FCPs) are now widely established in general practice and key in supporting earlier recognition. The aims of this study were to evaluate FCP and physiotherapists' and re-evaluate musculoskeletal physiotherapists' awareness, knowledge, and confidence in recognising features of axSpA and of criteria supporting referral to rheumatology to compare to previous research which suggested the need for further professional education. Methods Using the previous strategy (Steen et al., 2021), an online survey was undertaken with a combined approach. This included back pain presentation vignettes with features of axSpA, non-specific low back pain (NSLBP) and radicular syndrome to evaluate screening knowledge, clinical reasoning and recognition, and section two with questioning on features of suspected axSpA. Analysis used descriptive statistics and content analysis informed by advocated criteria and resources, including ASAS and NICE guidance, that support recognition and referral of axSpA in clinical practice. Results There were 165 completed responses analysed. Only 73% (n = 120/165) of respondents recognised the axSpA vignette compared to NSLBP (91% [n = 80/88]) and radicular syndrome (88% [n = 68/77]). A trend towards improvement in axSpA recognition was demonstrated compared with previous data. FCPs performed slightly better, with 77% (n = 67/87) of respondents recognising the axSpA vignette. Adequate awareness of national referral guidance was evident in only 55% of ‘clinical reasoning’ and 6% of ‘further subjective screening’ responses. There was reduced awareness of NICE guidelines on spondyloarthritis compared with back pain guidelines; however, more awareness of all guidelines was found amongst FCPs. More knowledgeable responses were associated with familiarity with the NICE spondyloarthritis guidance (2017) and National Back and Radicular Pain Pathway (2017), CPD on LBP and spondyloarthritis, NHS employment, FCP role, ≥60% LBP caseloads, GP referrals and professional experience. There is still misplaced confidence in recognising clinical features of axSpA and when to refer compared to knowledge levels demonstrated. High importance is still given to inflammatory markers, HLA B27 positivity; however, appropriately, less emphasis is given to gender. Conclusion Musculoskeletal physiotherapists demonstrated some improved knowledge and awareness of axSpA compared with previous findings. Consideration of axSpA is still not universal in musculoskeletal physiotherapists' or FCPs' approaches to persistent back pain assessments, along with a lack of awareness of national referral guidance for suspected axSpA. This study highlights the need for ongoing professional education to make screening and referral criteria for suspected axSpA core knowledge in musculoskeletal clinical practice to support earlier diagnosis and better outcomes. Disclosure E. Steen: None. M. Cairns: None. C. McCrum: None.