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Ohio Physical Therapists’ Accuracy in Identifying Abnormalities on Diagnostic Images with and without a Clinical Vignette.

Authors: Morris AT, Cook C, Hassen A

A strong understanding of diagnostic imaging has been advocated for physical therapists. As such, there have been recent changes in physical therapy curricula and increased opportunities to utilize imaging during clinical practice. The aim of this study was to explore the ability of practicing clinicians to accurately identify selected musculoskeletal conditions on plain-film radiograph (X-ray), magnetic resonance imaging (MRI), and computed tomography scan (CT scan).  Additionally, the authors attempted to determine whether improvements in identification of pathology occur when the clinical scenario is added to the imaging and whether there are related training/exposure factors.  Eight hundred sixty-six surveys of the 7537 sent out were returned and used for analysis. With clinical scenarios, 61.3% of respondents were correct with the Anterior Cruciate Ligament (ACL) injury identified on MRI, 36.4% for identification of the cervical spine fracture on CT, and 25.6% for identification of avascular necrosis of the hip on the plain film. The accuracy significantly improved (p<0.01) with the addition of the clinical information for all three of the diagnoses. The most remarkable improvement was seen with the AVN diagnosis on plain film radiograph (365.5% improvement), followed by the ACL injury on MRI (27.2% improvement) and cervical fracture diagnosis on CT scan (17.8% improvement). Finally, formal and informal training, board certification through the APTA and to a lesser extent, degree level, all improved diagnostic accuracy.  The authors concluded that a clinical scenario paired with images notably improved identification of pathology. Physical therapists were better at identifying the ACL pathology that was presented on MRI. This is a common diagnosis to physical therapists and was paired with a relatively common imaging modality. This study suggests that physical therapists can improve accuracy with identifying pathologies on diagnostic images through a physical therapy curriculum or post-graduation through certifications and continuing education.

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