Keep/refer decision making abilities of European final year undergraduate physiotherapy students: a cross-sectional survey using clinical vignettes

Abstract

Purpose: The recognition of pathological processes, which are not appropriate for physiotherapy, is a crucial part of the clinical reasoning process. Over recent years, there have been several research efforts investigating qualified physiotherapists and doctoral students’ capability in making precise clinical decisions on whether a patient’s condition is suitable for physiotherapy intervention (keep), or rather requires medical check-up (refer). No study so far has examined the keep/refer decision making abilities of final year undergraduate physiotherapy students within Europe.

Materials and methods: A survey containing 12 validated vignettes was distributed among 2238 final year undergraduate physiotherapy students from 15 different member countries of the European Network of Physiotherapy in Higher Education (ENPHE).

Results: Seventy-three respondents were included in the final analysis. Only slightly more than half (mean: 53%; median: 67%) of the medical critical vignettes were answered correctly. Just eight respondents (11%) correctly identified all three medical critical vignettes.

Conclusion: European final year undergraduate physiotherapy students are not sufficiently equipped with enough knowledge and skills to make very precise keep/refer decisions (based on clinical vignettes) and, most importantly, seem insufficiently trained to accurately identify more critical medical conditions which need a timely referral to another health care professional.

Keywords:

• Keep/refer decision
• differential diagnosis
• red flags
• physiotherapy
• medical referral

Acknowledgements

The authors would like to thank Dr Michael Weber for his statistical advice during the preparation of this manuscript. The authors are also grateful to Dr Ursula Eckler for her efforts to advertise the project during an ENPHE conference in 2015.

Disclosure statement

The authors report no declarations of interest.