An exploration of keep/refer decision making abilities of Austrian undergraduate physiotherapy students in a changing practice environment

Lackenbauer, Wolfgang (2019) An exploration of keep/refer decision making abilities of Austrian undergraduate physiotherapy students in a changing practice environment. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Background: This thesis was initiated in the light of developments within the Austrian health care sector with physiotherapists being included for the first time as part of the planning for how the national health care system should be developed (Physio Austria, 2014). In addition, there is of an ongoing effort from the Austrian physiotherapy association to implement a direct access system to physiotherapy in Austria (Baumgartner, 2013; Bauer-Horvath, 2015; Sorge, 2017). This warrants the development of an evidence based curriculum that properly prepares Austrian physiotherapy students and newly qualified physiotherapists to make autonomous keep/refer decisions and to recognise the presence of serious pathologies which require a medical referral. Aim: The aim of this thesis was to provide recommendations for keep/refer decision making and the identification of serious pathologies for undergraduate physiotherapy curricula in Austria. Methods: An explanatory mixed methods study which consisted of a survey among European final year undergraduate physiotherapy students (chapter 5), a survey among Austrian medical doctors (chapter 6) and a mixed methods randomised pilot study among Austrian final year undergraduate physiotherapy students (chapter 7) was carried out. Results:  In comparison to students from other European countries (e.g. the Netherlands, Estonia), Austrian final year undergraduate physiotherapy students are currently insufficiently trained to detect serious pathologies which require a medical referral based on clinical vignettes. Austrian physiotherapy students believed that screening for serious pathologies is not exclusively the task of physicians and making independent keep/refer decisions should be mandatorily taught as independent lectures during the undergraduate curriculum (chapter 5).  The majority of responding Austrian physicians deemed the ability to make autonomous keep/refer decisions to be highly relevant for the physiotherapy education and profession in Austria as a whole. Austrian physicians suggested a wide range of different examination procedures which should be included in the undergraduate curriculum (chapter 6). A single-hour CBL educational intervention which aimed to improve the keep/refer decision making abilities of Austrian undergraduate physiotherapy students was found to be feasible and acceptable. A potential effectiveness of a single hour, CBL educational intervention could however not be demonstrated (chapter 7). Implications: Based on the results of this thesis, several recommendations for future research and education for keep/refer decision making and the identification of serious pathologies for undergraduate curricula in Austria are made (chapter 9).