A COMPARISON BETWEEN CIVILIAN AND MILITARY PHYSICAL THERAPISTS' KNOWLEDGE IN MANAGING MUSCULOSKELETAL CONDITIONS: A DESCRIPTIVE STUDY

Abstract

Background: Military physical therapists have been shown to have the necessary knowledge in musculoskeletal medicine in order to practice as a direct access provider. However, research about musculoskeletal knowledge in the civilian physical therapist (non-military) population is lacking.

Purpose: The purpose of the current study was to compare the knowledge in managing musculoskeletal conditions between civilian and military physical therapists using a validated and standardized musculoskeletal competency examination. Furthermore, this study aims to investigate the potential factors that may lead to increased musculoskeletal competency.

Study design: Cross-sectional, electronic survey.

Methods: This study involved a cross-sectional, electronic survey completed in August and September of 2014 in order to assess licensed physical therapists' knowledge in identifying and managing musculoskeletal conditions. Only physical therapists practicing in orthopedics were permitted to be involved in the study. Descriptive statistics of the participants, and logistic regressions analyzing variables correlated with passing the musculoskeletal exam were calculated using SPSS 22.0. Frequencies were produced for multiple variables. Binary logistic regressions were used to correlate the frequency variables with performing at competency level on the musculoskeletal exam.

Results: A total of 22,750 surveys were sent to physical therapists in Arizona, Ohio, Texas, Maine and Wyoming. Two thousand sixty-five surveys were returned for a response rate of 10.6%. Of the 2,065 surveys completed, 408 responses were included for analysis. The average score for the respondents on the exam was 65.08% and only 28.2% of all respondents met the competency cutoff score (previously established to be 73.1%). Respondents who were orthopedic certified specialists (OCS) or sports certified specialists (SCS) were 3.091 times more likely to perform at the competency level on the examination with a p-value of < 0.001 and a confidence interval >95%.

Conclusion: The current study utilized the results from a previous study for a comparison between the civilian and military physical therapist populations. The results indicate that civilian physical therapists in the current study (65.08%) scored lower than their military counterparts in the previous study (75.9%) on the musculoskeletal exam. Potential reasons for this include less autonomous practice responsibilities and a disparity in educational experiences. Board certifications may enhance civilian physical therapists ability to practice with greater autonomy as primary care clinicians when managing musculoskeletal conditions.

Level of evidence: Level 4.

Keywords: Board certifications; direct access; musculoskeletal competency.

Figure 1.

Depiction of the overall scores on the musculoskeletal competency examination among civilian physical therapists in the present study along with comparison data from previous studies for military physical therapists, physical therapist students, physician interns, residents, medical students, and a multitude of physician subspecialties. Military physical therapists and physical therapist students’ data were derived from Childs et al. The physician data were derived from Matzkin et al. Physician intern data were derived from Freedman and Bernstein. PT = physical therapist, Phys = physician, OCS = Orthopedic Clinical Specialist, SCS = Sports Clinical Specialist, DPT = doctoral physical therapist program trained, Masters = Masters physical therapist program trained, FP = family practice, GS = general surgery, Res = resident, Peds = pediatrics, Med = internal medicine, Med stu = medical student, OB = obstetrics-gynecology, Psy = psychiatry.