Continuing Education Courses for Orthopedic and Sports Physical Therapists in the United States Often Lack Supporting Evidence: A Review of Available Intervention Courses

Low Back Pain Information on Austrian Healthcare Websites: Often Inaccurate, Biomedically Oriented, and Not Aligned With Clinical Guidelines-A Cross-Sectional Study

BACKGROUND

Low back pain (LBP) presents a substantial burden on individuals and society, with far-reaching personal, social, and economic consequences. Although the biopsychosocial model was introduced decades ago as a more holistic and human-centred framework for managing chronic pain, the biomedical model continues to dominate clinical reasoning and therapeutic strategies. The way LBP is communicated to patients significantly influences outcomes: biomedical language has been associated with increased anxiety, demand for imaging and invasive interventions, and reduced treatment efficacy. Moreover, early exposure to non-guideline-concordant treatments or unnecessary imaging in acute LBP is linked to higher risk of chronification, increased healthcare costs, greater disability, and prolonged absence from work. Given the rising use of the internet for health information, websites of official institutions-such as physiotherapy and medical practices, hospitals, national health agencies, and medical universities-play a key role in shaping patients' beliefs and behaviours.

METHODS

We conducted a systematic, population-wide website content analysis in Austria to evaluate guideline adherence and the framing of LBP. Specifically, we assessed whether websites promoted guideline-concordant treatments, adopted a biomedical versus biopsychosocial perspective, and included inaccurate or misleading information.

RESULTS

Using the JAMA benchmark, the German national LBP guideline, and validated checklists, we analysed 125 websites. Overall, 80.2% (n = 97/121) recommended at least one non-guideline-conform treatment; 76.8% (n = 96/125) were classified as mostly inaccurate. Biomedical framing dominated with 85.6% of websites adopting this perspective.

CONCLUSION

These findings highlight widespread misinformation and a lack of evidence-based communication on LBP across official Austrian healthcare websites.

Exploring the personal and professional outcomes of pursuing fellowship training in orthopedic manual physical therapy: a mixed-methods analysis

OBJECTIVE

Post-professional education in orthopedic manual physical therapy (OMPT) provides a unique pathway for clinicians to refine clinical skills and reasoning in pursuit of professional excellence. Despite these benefits, fellowship training demands significant personal and financial investment. Therefore, understanding whether fellowship education promotes professional growth, job satisfaction, and return on investment is essential. The aim of this study was to explore fellowship-trained OMPTs' self-reported perceptions of pursuing fellowship education in the United States (US), while identifying predictors that may be associated with career success following fellowship education.

METHODS

A convergent parallel mixed-methods design via online survey and one-on-one semi-structured interviews was used. A thematic coding process was implemented for qualitative analysis. Descriptive statistics were calculated for demographic data. Binary logistic regression models assessed relationships between demographic variables and the personal and professional impact of fellowship training.

RESULTS

One hundred and nine participants completed the survey, and 23 underwent focused interviews, meeting data saturation. Merging of analyses revealed five themes related to personal and professional impacts of fellowship including clinical outcomes, job satisfaction, barriers, clinical excellence, and professional opportunities. Board-certified clinicians had greater odds (OR = 4.47, 95% CI 1.17-15.93, p = .03) of reporting fellowship training enhancing their application of current research. Those with a doctorate degree reported greater odds (OR = 9.18, 95% CI 2.31-36.56, p = .002) of establishing impactful mentors through fellowship. PTs with < 10 years of practice were more likely to report fellowship training positively affecting their salary (OR = 4.28, 95% CI 1.50-12.24, p = .01) and self-perception as expert clinicians (OR = 7.29, 95% CI 1.65-32.22, p = .01).

DISCUSSION/CONCLUSION

This study is the first to examine personal and professional outcomes among US fellowship-trained clinicians, highlighting the positive impact on clinical reasoning, mentorship, and compensation - especially among novice clinicians. Fellowship enhances job satisfaction, career growth, and clinical excellence, offering insights for prospective fellows and future research directions.

Exploring the Impact of Self-Leadership on Evidence-Based Practice Beliefs Among Physical Therapists and Doctor of Physical Therapy Students

INTRODUCTION

This study explored the self-leadership and evidence-based practice (EBP) beliefs among Doctor of Physical Therapy (DPT) students and licensed physical therapists (PTs).

REVIEW OF THE LITERATURE

Evidence-based practice offers health care professionals a systematic approach to applying research to improve patient outcomes. Despite positive attitudes toward EBP, PTs often struggle to translate scientific knowledge into clinical practice. While many frameworks emphasize the importance of organizational leadership in EBP, self-leadership, directing oneself toward personal goals, remains underexplored.

SUBJECTS

The study included 860 participants: 158 DPT students, 235 early-career PTs with less than 10 years of clinical experience, and 467 late-career PTs with 10 or more years of experience.

METHODS

A cross-sectional online survey explored the relationship and group differences between Revised Self-Leadership Questionnaire scores and Evidence-Based Practice (EBP) Beliefs Scale scores among physical therapists and DPT students. The statistical analysis approaches included Spearman's Rank Correlations, Kruskal-Wallis H tests, and multiple stepwise regressions.

RESULTS

Weak correlations existed between self-leadership and EBP beliefs in DPT students and late-career PTs, while a moderate correlation was observed in early-career PTs. Although self-leadership and EBP beliefs varied between groups, the differences were minor. Intrinsic DPT student and physical therapist characteristics showed minimal predictive value for EBP beliefs, highlighting the continued complexity of understanding EBP beliefs and implementation within the physical therapy profession.

DISCUSSION AND CONCLUSION

A persistent gap exists in understanding the clinician-specific factors influencing EBP beliefs in physical therapy. These findings emphasize the need to identify and cultivate factors positively affecting EBP adoption and self-leadership among physical therapists and students. Future research should look to understand the complex interplay between personal attributes and organizational dynamics to enhance EBP implementation in clinical practice.

Navigating complexities: clinicians' experiences and systemic challenges in the implementation of evidence-based practice for chronic low back pain - a qualitative study

PURPOSE

Implementation of evidence-based practice (EBP) for chronic low back pain (CLBP) is poor. This study aimed to investigate the factors that influence exercise-based clinicians' implementation of EBP for people with CLBP.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 40 clinicians (20 physiotherapists and 20 accredited exercise physiologists). Interviews explored clinicians' definition of EBP, understanding of EBP in CLBP management, barriers and enablers to EBP, and the impact of these factors on EBP implementation. Interviews were analysed using reflexive thematic analysis.

RESULTS

A complex interplay among clinician factors, systemic factors, and patient interactions was identified. Clinicians encountered challenges stemming from their misconceptions about EBP, which influenced their perspective(s) on its implementation. Clinicians expressed the challenges of implementing EBP when navigating patient expectations and beliefs, experiencing external pressures from funders and business models, and the subsequent impacts on their well-being. Continuing professional development, support from community, and workplaces that prioritised EBP enhanced clinicians' ability to make decisions that accommodate for the complexities of CLBP and better align with EBP.

CONCLUSION

A variety of factors impact exercise-based clinicians' implementation of EBP. The interaction between these factors greatly influences clinicians' ability to engage in and implement EBP in clinical practice.

Trends and Practices on Blood Flow Restriction Training Are Not Largely Aligned With the Contemporary Evidence

OBJECTIVE

To evaluate trends and current clinical practice of physiotherapists on blood flow restriction training (BFRT) application.

METHODS

An online survey was conducted to assess: a) demographics and professional characteristics, b) specifics of BFRT application, and c) safety and adverse events. We tested using Pearson's Chi-square test whether the physiotherapist's characteristics were independent of their years of experience and formal BFR education.

RESULTS

Most respondents reported having much confidence (n=47, 44.6%) in using BFRT, and they used it for a mean of 2.6±1.7 years. Significant variability among respondents was found in devices used, limb occlusion pressure calculation methods, the reperfusion scheme, the number of exercises implemented, and the percentage of complete occlusion pressure used for exercising. Most used BFRT in musculoskeletal conditions of the upper and lower limb (n=88, 86.3%), aiming improvements in strength and muscle volume (n=93, 90.3%), by using external load (n=82, 79.6%). The majority of the respondents (n=69, 67.0% attended a short course for BFRT, of which 55.1% (n=56) believed it was not evidence-based. No significant associations were found between the years of experience or attendance in a BFRT course with practices and perceptions of the surveyed physiotherapists (all p>0.05).  Conclusion: Current BFRT practices are largely not aligned with contemporary scientific evidence and recommendations.

Is there a correlation between length of employment and receiving a post-professional certification or residency in physical therapy? A pilot study

BackgroundVarious factors in recent years have been shown to negatively impact the physical therapy (PT) workforce in the United States, including decreased reimbursement, burnout, student debt, work-life balance, and more.ObjectiveTo determine if there is a correlation between length of employment and receiving a post-professional certification or residency training in PTMethodsA convenience sample of 121 PTs completing a post-professional certification or residency program, or none, was obtained from a large multi-clinic PT group with an accompanying educational department. Data for each of the employed PTs in the cohort was obtained regarding the hire date, duration of employment before certification/residency, since certification/residency, and overall.ResultsOnly one certification, the pain certification, was correlated to longer employment versus no formal post-professional certification/residency training (p = 0.02). Results show that the mean duration of employment before the start of a pain certification (3.67 years) was significantly longer than sports physical therapy residency (0.52 years; p = 0.001), orthopedic physical therapy residency (1.13 years; p = 0.006)) and manual therapy certification (0.81 years; (p = 0.001). Following training, employment duration produced a less pronounced difference.ConclusionEnrollment in a post-professional pain certification occurs later in the employment tenure compared to other certifications and residencies. Additional research is needed to explore the correlation between post-professional education and longevity of employment and other confounding variables.

Self-Efficacy and Self-Management in Musculoskeletal Rehabilitation: Strategies and Challenges Among Brazilian Physiotherapists

OBJECTIVES

This study aimed to investigate the knowledge and strategies used by Brazilian physical therapists in assessing and promoting self-efficacy and self-management in musculoskeletal rehabilitation.

METHODS

A nationwide cross-sectional online survey was conducted with licenced physical therapists recruited through professional networks and social media. The questionnaire, developed based on the CHERRIES checklist, assessed participants' knowledge, clinical strategies, and perceived barriers related to self-efficacy and self-management interventions. Data were analysed using descriptive statistics and logistic regression models.

RESULTS

A total of 348 responses were analysed. While 97.7% of respondents acknowledged self-efficacy as a key factor in treatment adherence, only 43.6% frequently applied strategies to enhance it in clinical practice, as per Bandura's theory. The most commonly cited interventions were self-management education and exercises (81.2%). However, limited professional training and low patient adherence emerged as major barriers. Logistic regression analysis revealed that therapists who engaged more frequently with literature on the subject were 3.48 times more likely (95% CI: 1.6-7.4) to implement self-efficacy strategies in practice compared with those who engaged less frequently.

CONCLUSION

Despite acknowledging the importance of self-efficacy, Brazilian physical therapists face challenges in applying structured strategies in practice. Enhancing education and integrating behavioural approaches into curricula may facilitate the implementation of evidence based self-efficacy interventions.

Japanese Clinical Physical Therapists With the Mechanical Diagnosis and Therapy License Are More Competent and Confident in Pain Management Than Those Without It: A Cross-Sectional Study

Background The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) has long been misunderstood as a biomedical approach. In fact, it is a biopsychosocial approach with an up-to-date evidence-based educational curriculum. Recently, it has become possible to partially measure competence in clinical decision-making based on contemporary pain understanding and confidence in pain management using the Pain Understanding and Confidence Questionnaire (PUnCQ). The primary aim of this study was to compare the following outcomes between physical therapists with and without credential license in MDT (Cred.MDT) and the PUnCQ as well as attitudes toward the biopsychosocial perspective, adherence to evidence-based management for low back pain (LBP), and knowledge of modern pain science. The secondary aim was to explore relevant factors in the PUnCQ. Methodology Clinical physical therapists who were managing patients with pain were recruited from two associations (the Japanese Society of Allied Health and Rehabilitation and the Japan Branch of the International McKenzie Institute, who had all acquired at least the Cred.MDT). The following outcomes were measured: (1) the PUnCQ-1 for partial competence in evidence-based clinical decision-making for pain management; (2) part 2 scores of the PUnCQ for confidence in pain management; (3) the Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT) biopsychosocial/biomedical ratio for treatment perspectives; (4) the Knowledge and Attitudes of Pain (KNAP) for knowledge of modern pain science; and (5) a questionnaire for adherence to LBP practice guidelines. Two group comparisons were conducted for the primary aim and a multiple regression analysis for the independent variable of the PUnCQ-1 was conducted for the secondary aim. Results Data from 122 physical therapists (63 and 59 participants with and without the Cred.MDT, respectively) were analyzed. Statistically significantly higher scores were detected for physical therapists with Cred.MDT compared to those without (all p<0.05) for all of the above outcomes. The multiple regression analysis demonstrated that statistically significant contributors to the PUnCQ-1 were part 2 scores of the PUnCQ for the pain management factor (p = 0.016) and acquisition of the Cred.MDT (p = 0.038) (R2 = 0.12). Conclusion Competence and confidence in pain management, attitudes toward biopsychosocial approaches, knowledge of modern pain science and guideline adherence are higher in physical therapists with the Cred.MDT than those without it. Confidence in pain management and acquisition of the Cred.MDT contributed to competence in evidence-based clinical decision-making for pain management.

The Blind Men, the Elephant, and the Continuing Education Course: Why Higher Standards Are Needed in Physical Therapist Professional Development

SYNOPSIS: Evidence-based practice and implementing clinical practice guidelines are familiar themes for musculoskeletal rehabilitation clinicians. Yet, many clinicians continue to eschew recommended treatments. One explanation could be that physical therapists largely rely on continuing education courses-not research reports or standardized postprofessional education-to learn new treatments and update their practice patterns. However, continuing education courses in physical therapy have a much less rigorous review process, and interventions taught in these courses often conflict with high-quality evidence. The lack of rigor in continuing education may contribute to unwarranted variability in practice, which is a major threat to physical therapy. The current continuing competence paradigm in the United States, of which continuing education is a part, needs an overhaul to ensure clinicians learn current best evidence. Now is the time for change in professional development. We offer 3 suggestions to improve the current system of continuing competence in physical therapy. J Orthop Sports Phys Ther 2022;52(10):642-646. Epub: 27 July 2022. doi:10.2519/jospt.2022.11377.