Diagnostic uncertainty in physiotherapy; implications for physiotherapy education and educators

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This article is currently under peer review and has not yet been accepted for publication. While it may still be referenced at this web address, please bear in mind that amendments to the article may occur as a result of the review process.


Background: Diagnostic uncertainty in musculoskeletal pain presents as a frequent and challenging dilemma encountered by physiotherapists. Current literature indicates that diagnostic uncertainty impacts the clinical decision making of experienced and new graduate physiotherapists, highlighting a need for training and support in this space. Aim: This paper outlines considerations for diagnostic uncertainty in physiotherapy practice. It outlines four key strategies to help student and novice physiotherapists experiencing and navigating diagnostic uncertainty when managing individuals with musculoskeletal pain. These strategies include applying a critical lens to diagnostic certainty; recognising and normalising uncertainty; utilising direct practice and authentic experiences, and Balint groups as a strategy for sharing. Conclusion: New graduate physiotherapists frequently experience diagnostic uncertainty within musculoskeletal practice and are commonly challenged by this dilemma. There is a need to focus on acknowledging and managing diagnostic uncertainty in physiotherapy education and workplace support to address the ethical and emotional reactions associated with uncertainty. Physiotherapy educators and professionals can lead by example, acknowledging and sharing uncertainty and exploring this with students to build their capacity and self-efficacy to manage the complex and multidimensional nature of pain.


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Conflict of interest statement

The authors report no conflicts of interest.

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