Thank you for the opportunity to review this article reporting on the findings of a survey of digital confidence, experience and motivation among physiotherapists in the United Kingdom. The article is clearly written and succinct, and presents a useful contribution to understanding the readiness of the physiotherapy profession to incorporate digital technologies into physiotherapy practice in meaningful ways in one jurisdiction (UK).
There are a few grammatical issues to be addressed, but the article accomplishes its stated goals in its current form. One point I was left wondering about was the broader implications of the digital transformation of health care on a profession that so prominently incorporates touch. To what extent will the digital transformation affect physiotherapy practice? What would be a “good” amount of digital transformation in physiotherapy? How would that vary by practice setting? For example, it’s like that an inpatient rehabilitation physiotherapist would have less need for virtual visit technology than would an outpatient musculoskeletal physiotherapist. Addressing this point could strengthen the sophistication of the discussion section. I would suggest that the digital transformation will have a more substantial effect on certain practice settings, but that physiotherapists will need to enhance their digital literacy across care settings in order to remain attuned to an increasingly digitizing system.
Abstract
The abstract reports levels of confidence in using digital devices on a numeric scale, but does not present anchors to help the reader understand the results. For example, “moderate-high levels of confidence in the use of digital devices (7.6 ±1.77)”.
Introduction
Paragraph 1 uses semicolons in ways that are not grammatically correct. This occurs at locations throughout the manuscript. I would suggest reviewing the correct uses of semicolons and then doing a search and find within the document to correct their uses.
In paragraph 1 there are no end brackets on the title of Topol review.
Subjects
Could this section be referred to as “participants”? The term “subjects” comes across as outdated.
Which allied health professional designations were included in the sample? I see this information is provided in the results section, but this is also a methodological decision. Why were these designations included?
Respondent Profile
What is “professional banding” and “Agenda for Change Band”? As a reviewer not located in the United Kingdom, I’m not sure what these refer to.
Do the authors have a sense for why physiotherapists are so prominently represented in the final sample? Does that respondent profile match the distribution of these health human resources across the UK?
Table 2
Could table 2 please include percentages of respondents in each category? That would make it much easier to contextualize the number provided in each cell.
I also think it might be easier to interpret for the read if Table 1 was present with the first three columns of results being all those pertaining to physiotherapists, and the final three columns of results being all those pertaining to AHPs.
Regarding Figure 4c, communication via Whatsapp, was it clarified in the survey that this question refers to communication about work, as opposed to only while at work? Is communicating about patient care via Whatsapp compliant with relevant health information policy in the UK?
Discussion
The discussion section is built around “Two competency areas are deemed vital components of digital competency by the guiding literature both in UK and abroad”, identified in this case as machine learning/AI and health informatics. However, these do not strike me as a reviewer as the most fundamental elements of digital competency for clinical practice. Instead, a much more basic digital literacy seems to be the most fundamental competency to establish, enabling providers to acquire and learn to use digital applications across devices (laptops, phones, other digital interfaces). If the author would like to structure the discussion around ML/AI and health informatics, I think that is completely fine! I would just like to see further justification as to why that decision is made, as opposed to focusing on the more basic skills related to digital literacy.
The discussion section states: “The development of training standards in radiology for AI/ML is in the nascent stages. In both the USA and UK, standards require training radiologists to understand basics of imaging informatics (e.g. data privacy, post-processing imaging) (American Board of Radiology (2019). However, syllabi do not explicitly include AI/ML within the curriculum.”
However, it is very likely that syllabi are now including AI/ML across professional programs. As a reviewer I can say that this is certainly true in both faculties of public health and medicine at the University of Toronto. Please remove the final sentence in that paragraph regarding syllabi.
Please provide a sub-heading titled “Conclusion” prior to the final paragraph.
[jetpack-related-posts]
Dear Dr Shaw, Thank you for taking the time to respond to this manuscript. I apologies for the delay in completing these modifications in light of the COVID-19 pandemic and the subsequent alteration in my work schedule. I appreciate your feedback. I found the comments helpful to make the manuscript better for the reader. In light of your comments I have made changes to the manuscript.
You make a great point about the elaboration of the broader implications of digital transformation of healthcare for physiotherapists. This is an area that I considered in writing the manuscript, but subsequently removed in final drafting. A paragraph has been re-drafted in the “Competence” section of the discussion, which elaborates on the idea you suggest- e.g. that the degree or type of digital transformation may be specific to the needs of the individual speciality of physiotherapy. As we amalgamated the results of ALL physiotherapists we cannot say for sure if competence in one area was higher relevant to the professional role, however it is pertinent to include the section as requested.
ABSTRACT: A comment was made regarding the elaboration of the anchor descriptors, which has been included in the methods section.
INTRODUCTION: Your feedback regarding the grammatical misuse of semi-colons has been taken on board and the issue has been rectified throughout the manuscript. Similarly, the inverted commas to enclose the title of the Topol review has been added.
METHODS: You suggested the term “subjects” could be changed to “participants”. This has been changed. You also suggested the range of AHPs included in the survey were included in this section and a sentence has been added to clarify this.
You queried the term “Agenda for Change band”. Apologies, the Agenda for Change banding system is the UK NHS payment band system, and as such can be used to denote level of experience in practice. A brief note is included in the text to advise this fact.
A query was raised regarding why physiotherapists were so prominently represented in the final sample. This has been included as part of the limitation section. The percentage of physiotherapists was 20% higher than the percentage of physiotherapists within the larger body of registered AHPs in the UK. An allusion to the bias this may represent is included in this section.
RESULTS: You requested some changes to Table 2 to include percentages added to each value, and to present the data for Physiotherapists in the first three columns, and the AHPs in the next three columns. These changes have been made.
You posed a query as to whether the distinction was made as to whether Whats App was being used for communication about work vs whilst being at work. This distinction was not made in the survey. The use of Whats App for patient related information is not approved in the UK, although admittedly this does occur (https://innovations.bmj.com/content/3/4/238). This question was simply focused on whether the platform was used, without querying the reasons for communication. The inclusion of “at work” was though sufficient to allude to the fact that this question was related to communication with colleagues (rather than for personal reasons).
DISCUSSION: You make a fine point about the choice of elaborating on two specific areas (AI/ informatics) at some expense of more fundamental competency areas. This prioritisation for the discussion was made on the basis of the low levels of self-rating of competence, and the high priority placed on these topics in the cited literature. A sentence is added to the discussion to elaborate upon this choice, and in recognition of the fact that this does not deny the importance of other foundational digital skills and knowledge.
You requested removal of a sentence related to the inclusion of AI/ML within radiology curricula. This has been removed.
You requested the inclusion of a subheading prior to the conclusion, which has been added.
Thank you again for your review. Changes will be made to the manuscript prior to re-publication.