A 69-year-old man was referred to physical therapy by his primary care physician for an insidious onset of right medial knee pain that had been present for over 4 weeks. Due to the disproportionate response following initial management, he was referred to an orthopaedist for imaging. Magnetic resonance imaging revealed medial femoral condyle osteopenia, bone marrow edema, and subchondral bone collapse, and subsequently the patient was diagnosed with spontaneous osteonecrosis of the knee. J Orthop Sports Phys Ther 2018;48(10):824. doi:10.2519/jospt.2018.7923

Introduction. Effective clinical decisionmaking (CDM) skills are essential for physical therapist practice. e purpose of this study was to compare the effects of virtual reality (VR) patient simulation with those of a traditional standardized patient simulation on the CDM of student physical therapists (SPTs). Review of Literature. Authentic experiential learning opportunities are needed to promote CDM. e effects of VR simulation on the CDM of SPTs are unknown. Subjects. Fifty-nine first-year SPTs participated in this study.Methods. A randomized controlled trial compared the effects of VR with those of standardized patient simulation on several aspects of CDM in 59 first-year students after an upper extremity orthopedic unit. Perceived CDM abilities and metacognitive awareness were assessed before and after allocated instruction. Diagnostic accuracy and diagnostic efficiency were measured during instruction. Student engagement was assessed immediately after instruction and psychomotor skill was assessed 1 week later. Results. Statistically significant withingroup differences in CDM were noted after both VR and standardized patient instruction, but no between-group differences were found. Although effect sizes were considered large with either learning experience, the observed experimental effect was greater after a VR experience. No between-group differences were found between metacognitive awareness, diagnostic accuracy, or psychomotor skill assessment. Diagnostic efficiency was statistically significantly greater in the standardized patient condition, while engagement was significantly greater in the VR condition. Discussion and Conclusion. Measures of perceived CDM improved regardless of instructional method; however, the effect size was greater after VR. ese findings reveal 2 effective experiential learning options to promote CDM. ese results exemplify the normative trajectory of CDM development and recommendations for differentiated curricular instruction. Although resource intensive initially, VR technology appears capable of advancing CDM skills in an efficient manner that may minimize future cost and the faculty facilitation associated with standardized patient instruction.

Introduction. The influence of education level, post-professional training, and experience on physical therapists' (PTs) diagnostic reasoning is unknown. The purpose of this study was to examine the influence of education, training, and experience on PTs' diagnostic reasoning through a series of musculoskeletal case-based surveys. While literature supports quality of care's influence on health care costs, the factors influencing PTs' quality of care are unclear. Literature suggests that surgeons with post-professional training and more experienced Emergency Room physicians demonstrate better patient outcomes, diagnostic accuracy, and efficiency. Methods. Five hundred and twenty-nine licensed PTs participated in this study. A series of 5 case-based electronic surveys assessed participants' diagnostic reasoning in orthopedic presentations. Response rates ranged from 55% to 40%. Accuracy, efficiency, and hypothesis-generation strategies were analyzed to examine diagnostic reasoning. Strength of associations, diagnostic accuracy, and hypothesis-generation strategies were examined via odds ratios; efficiency of determining the accurate diagnosis was examined via t tests. Results. Hypothetico-deductive reasoning by systematically eliminating competing diagnoses (funneling) demonstrated significant correlation with accuracy in 4 of the 5 cases (odds ratio [OR] 2.46 [1.19–5.10] to 13.9 [6.12–31.5]). Physical therapists with any American Board of Physical Therapy Specialities (ABPTS) certification demonstrated significantly greater diagnostic accuracy (OR 2.1 [1.41–3.807] to 3.00 [1.22–7.36]) and efficiency (P < .05) in 3 of the 5 cases compared to those without ABPTS certification. Board-Certified Orthopedic Clinical Specialists (OCS) demonstrated significantly greater diagnostic accuracy (OR 1.90 [1.08–3.34] to 3.42 [1.42–8.40]) and efficiency (P < .05) compared to those without ABPTS OCS certification. Residency-trained PTs demonstrated significantly greater diagnostic accuracy (OR 2.02 [1.03–3.96] to 2.84 [1.38–5.82]) and efficiency (P < .05) compared to those without residency training. Degree level, experience, and fellowship training were not related to accuracy, efficiency, or funneling hypotheses (P > .05). Discussion and Conclusion. American Board of Physical Therapy Specialities certification and American Board of Physical Therapy Residency and Fellowship Education training's significant association with both diagnostic accuracy and efficiency suggests the importance of PTs' pursuit of ABPTS certification and/or formal post-professional training in developing diagnostic reasoning and expertise. These post-professional endeavors may lead to appropriate care more quickly, improving patient outcomes, and decreasing health care costs.

Background Physical therapy education benefits from innovative and authentic learning opportunities. However, factors that influence the acceptance of educational technology must be assessed prior to curricular adoption. The purpose of this study was to assess the perceived ease of use and perceived usefulness of a virtual reality (VR) learning experience developed to promote the clinical decision-making of student physical therapists. Methods A VR learning experience was developed, and an established two-stage usability test assessed player experience as well as the user’s perception of both ease of use and usefulness. Two experts evaluated the VR learning experience and provided feedback. Six student physical therapists and five faculty members completed the VR experience, responded to two questionnaires, and participated in a semi-structured interview to further assess ease of use and utility. Results High levels of perceived ease of use, perceived usefulness, and positive player experiences were reported by both faculty and student users. Faculty users perceived a significantly greater amount of educational and clinical utility from the VR simulation than did student users. Semi-structured interviews revealed themes related to ease of use, benefits, modeling of professional behaviors, and realism. Conclusion Quantitative data supported faculty and student users’ perceptions of ease of use, utility towards learning, practical application, and several constructs related to user experience. Qualitative data provided recommendations to modify design features of the VR experience. This study provides a template to design, produce, and assess the usability of an immersive VR learning experience that may be replicated by other health professions educators where current evidence is limited.