Using the diagnostic thinking inventory in musculoskeletal physiotherapy: a validity and reliability study

Abstract

Background Development of clinical reasoning is an essential aspect in musculoskeletal physiotherapy practice that is linked to better outcomes. The measurement of clinical reasoning has placed an emphasis on diagnostic reasoning using different types of examinations. The Diagnostic Thinking Inventory (DTI) is a self‐assessment tool developed to measure two aspects of diagnostic reasoning: flexibility in thinking (FT) and structure in memory (SM). DTI is valid and reliable that has been used extensively in medical field. Objective To investigate the validity and reliability of DTI in musculoskeletal physiotherapy practice. Methods Two groups of musculoskeletal physiotherapists completed DTI. Expert musculoskeletal physiotherapists assessed face and content validity. Data from the second group of musculoskeletal physiotherapists were used to assess test–retest reliability. Internal consistency was calculated using Cronbach's alpha. Construct validity was assessed by comparing both groups. Data were analyzed using the IBM SPSS statistics 25.0 version. Results The experts agreed that DTI measures diagnostic reasoning. For test–retest reliability, average intraclass correlation coefficient was 0.91, 0.92 and 0.90 (p < 0.001) for DTI, FT and SM scores, respectively. Cronbach's alpha was 0.909, 0.919 and 0.897 (p < 0.001) for DTI, FT and SM, respectively. The independent samples t‐test demonstrated that the experts group achieved higher and statistically significant score (p < 0.001). Conclusion DTI is valid and reliable in measuring diagnostic reasoning in the context of musculoskeletal physiotherapy practice. It can be used to assess the impact of continuing education on musculoskeletal physiotherapists' diagnostic reasoning.

Evaluation of development of clinical reasoning skills in dental students through diagnostic thinking inventory

“…The instrument was primarily designed for medical students, but it was also used in physiotherapy subjects and the correlation plots indicated a significant positive relationship between scores on test and retest (r=0.779, p<0.001), while it had internal consistency with an overall alpha value of 0.846. 7 The inventory has 41 questions following a scenario. These questions require the most suitable answer to be marked on a 6-point, semantic differential scale.…”

“…5 Similar results were reported in physiotherapy students with positive correlation plots (r=0.779, p<0.001) and good consistency with an overall alpha value of 0.846. [6][7][8][9] The emphasis on how to teach clinical reasoning started in medical education and to assess the results, diagnostic thinking inventory (DTI) was used for rating Standardized patients (SP). 10,12 In dentistry, a few studies exist on clinical reasoning skills demonstrating them through clinical scenarios, but none shows a definite pattern/ definite tool to assess.…”

Do intolerance of uncertainty and resource consumption actually influence the therapeutic strategies chosen by physiotherapists?

“…However, there are few pedagogical tools intended for physiotherapists and fewer tools for assessing their clinical reasoning 2 (Cowell et al, 2023). From the literature on this subject, it seemed to us that research on physiotherapists' clinical reasoning was focused on the identification and classification of the steps of the reasoning process (especially within the framework of the evaluation of students' clinical reasoning skills) with no relation to the relevant resulting variables, namely the diagnosis considered as the most probable for a given situation and above all the therapeutic strategy offered to the patient (Elvén et al, 2018;Hamzeh et al, 2021;Langridge et al, 2015). In addition, these studies overlooked the impact of contextual factors and factors related to the physiotherapist on clinical decision-making, such as confidence in one's judgment and IU (Holdar et al, 2013;Simmonds et al, 2012).…”

“…2 Some tools can be used to assess diagnostic reasoning in musculoskeletal physiotherapy contexts such as the Diagnostic Thinking Inventory (DTI; Hamzeh et al, 2021) and the multidimensional Clinical Reasoning Form (CRF; Cowell et al, 2023).…”

Corrigendum

“…In Hamzeh et al. (2021), the following corrections have been made to the author byline, and both the Ethical approval and Acknowledgments sections. Marianne Hensman has been included as the last author. Ethical approval statement has been corrected and should read as follows: “This study was approved by an ethics committee at University of Birmingham, United Kingdom (SR 05/09/14). This approval covered data collection in the UK.…”