The aim of this study was to assess the level of musculoskeletal knowledge and ability to identify red flags among physical therapists, and compare this with PCPs in Saudi Arabia. Overall, the majority of physical therapist and PCP participants demonstrated a moderate level of musculoskeletal knowledge, with family medicine physicians outperforming both physical therapists and general practitioners. Physical therapists were more proficient in differential diagnosis case scenarios, but less so in red flags case scenarios.
Most of previous studies examined the level of knowledge between physical therapists and other physicians across LBP cases only. However, our findings contrast with those of Ross and colleagues (2014, 2018), who reported similar knowledge levels between these groups in managing patients with LBP [16, 17]. This discrepancy may be due to… This discrepancy may be due to the broader assessment of musculoskeletal knowledge in our study versus the focus on LBP in the previous research.
Family medicine physicians were more able to recognize red flags, with the exception of those specifically related to LBP, where both groups (physical therapists and PCPs) showed high knowledge. This contradict previous studies [20, 21, 24] where the ability of physical therapists to detect red flags was lower, but differences in the assessment tools used make direct comparison challenging.
Findings from the current study and previous research showed that physical therapists demonstrated a moderate ability to recognize signs and symptoms of serious medical conditions but, chose to continue with physical therapy rather than referring the patient for more medical investigations and deferring physical therapy interventions[19–21]. This suggests a hesitance in referring patients for further investigation, which may originate from a potential deficiency in screening for referral skills and knowledge of red flags among physical therapists. It is plausible that entry-level education might not adequately prepare therapists in these areas. Additionally, therapists may rely on physician referrals without independently verifying the accuracy of the diagnosis. For that reason patient safety is often cited as the reason to maintain medical referral due to a perceived association with patient self-referral. Other studies however showed positive result contradicting this assumption[25]. In UK for example, a study concluded that patient self-referral to physical therapy within their health systems was safe and that physical therapists are competent to practice in this way[26].
This study had a number of limitations including the small, convenience sample from the Ministry of Health facilities in Riyadh city only. These limitations may impact the generalizability of our findings. Future research should include larger samples across various regions of Saudi Arabia to enhance the representativeness of the study population.
Our findings underscore the need for improved training among first-contact practitioners, including physical therapists, to improve their skills in differential diagnosis and ability to identify red flags. It is recommended that undergraduate physical therapy training be expanded to include more comprehensive education on musculoskeletal conditions and, in particular, the screening for red flags. The use of red flag screening tools such as the Optimal Screening for Predicting Referral and Outcome-Review of Systems [27] may enhance patient safety.
Furthermore, continuous education programs should be considered to improve core competencies of healthcare practitioners dealing with musculoskeletal conditions. Future research could explore the impact of such programs on knowledge levels and patient outcomes.