Clinical reasoning in managing chronic hip pain: One in two Australian and New Zealand physiotherapists diagnosed a case vignette with clinical criteria for hip OA as hip OA. A cross-sectional survey

• Published in: Musculoskeletal care 2023-09, Vol.21 (3), p.763-775
• Main Authors: Haber, Travis, Hinman, Rana S, Dobson, Fiona, Vicenzino, Bill, Darlow, Ben, Kayll, Sam, Hall, Michelle
• Format: Article
• Language: English
• Subjects: Adult; Arthralgia; Australia; Clinical Reasoning; Cross-Sectional Studies; Humans; New Zealand; Osteoarthritis, Hip - therapy; Pain; Patient assessment; Physical Therapists; Surveys and Questionnaires; Weight Loss
• ISSN: 1478-2189; 1557-0681; 1557-0681
• DOI: 10.1002/msc.1751

Using a case vignette of an adult (George) presenting with hip pain consistent with hip OA, this study aimed to describe: (a) whether physiotherapists make diagnoses and identify bodily structures using either patient history and/or physical examination findings; (b) which diagnoses and bodily structures physiotherapists attribute to the hip pain; (c) how confident physiotherapists were in their clinical reasoning using patient history and physical examination findings; (d) what treatments physiotherapists would offer to George. We conducted a cross-sectional online survey of physiotherapists in Australia and New Zealand. We used descriptive statistics to analyse closed questions and content analysis for open-text responses. Two hundred and twenty physiotherapists completed the survey (39% response-rate). After receiving the patient history, 64% diagnosed George's pain and 49% of these as hip OA; 95% attributed George's pain to a bodily structure(s). After receiving the physical examination, 81% diagnosed George's hip pain and 52% of these as hip OA; 96% attributed George's hip pain to a bodily structure(s). Ninety-six percent of respondents were at least somewhat confident in their diagnosis after the patient history, and 95% were similarly confident after the physical examination. Most respondents offered advice (98%) and exercise (99%), but fewer offered treatments for weight loss (31%), medication (11%), and psychosocial factors (