title: Factors associated with physiotherapists' confidence during assessment of clinical cervical and lumbar spine instability.
abstract: OBJECTIVE
  Physiotherapists commonly encounter patients with complaints of vague, indistinguishable neck and back pain, such as clinical spine instability. Since confidence is a component of expert clinical practice, we were interested in measuring expert clinicians' confidence in diagnosing and assessing clinical spine instability. The aims of the present study were to factor out the common 'identifiers' associated with physiotherapists' objective, physical diagnosis and assessment of clinical spine instability, and to determine the association of reported diagnostic confidence to these identifiers.
  
  
  METHODS
  The study used data from a Delphi instrument for the factor analysis and a survey of APTA Board-certified orthopaedic specialists for report of confidence. Using an ologit regression analysis, the identifier themes and clinical background characteristics were associated with confidence in diagnosis of clinical spine instability.
  
  
  RESULTS
  Only clinical cervical spine instability obtained significant findings. The identifier 'observable or palpable abnormalities of motion during movement assessment in clinical practice' was positively associated with reported confidence in diagnosis, as was the influence of manual therapy background models: Cyriax, Maitland, McKenzie, NAIOMPT, Osteopathic, Paris and other. Male gender yielded negative association with reported confidence. No factors were associated with reported lumbar confidence.
  
  
  CONCLUSIONS
  Multiple backgrounds of physiotherapists demonstrate confidence in detecting clinical spine instability using observable or palpable methods to detect abnormal movements.
authors.affiliation: Duke University, North Carolina, USA. chad.cook@duke.edu
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Brismée
authors.forename: Philip S
authors.initials: PS
authors.lastname: Sizer
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000503:physiopathology*; D003697:Delphi Technique; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000534:rehabilitation; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D010808:Physical Examination / Q000379:methods*; D026761:Physical Therapy Specialty; D014481:United States