title: Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain.
abstract: OBJECTIVE
  Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting.
  
  
  METHODS
  The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists' (PTs) diagnostic decisions, who participated in a 5-day, intensive continuing education session and also compared those with the diagnostic opinions of two expert physical therapists, who were blind to the original diagnostic decisions. Evaluation of the physical therapists' clinical examination of the patients was conducted by the two experts, in order to determine the accuracy and percentage agreement of the pathoanatomical diagnoses.
  
  
  RESULTS
  The percentage of agreement between the experts and PTs was 72-77%. The overall inter-examiner reliability (kappa coefficient) for the subgroup classification between the six PTs and two experts was 0.63 [95% confidence interval (CI): 0.47-0.77], indicating good agreement between the PTs and the two experts. The overall inter-examiner reliability between the two experts was 0.63 (0.49-0.77) indicating good level of agreement.
  
  
  CONCLUSIONS
  Our results indicate that PTs' were able to apply their continuing education training to clinical reasoning and make consistently accurate pathoanatomic based diagnostic decisions for patients with LBP. This would suggest that continuing education short-courses provide a reasonable format for knowledge translation (KT) by which physical therapists can learn and apply new information related to the examination and differential diagnosis of patients in acute or subacute LBP.
authors.affiliation: Faculty of Sports and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland.
authors.forename: Eira
authors.initials: E
authors.lastname: Karvonen
authors.affiliation: Faculty of Sports and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Paatelma
authors.affiliation: Faculty of Sports and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland.
authors.forename: Jukka-Pekka
authors.initials: JP
authors.lastname: Kesonen
authors.affiliation: Faculty of Sports and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland.
authors.forename: Ari O
authors.initials: AO
authors.lastname: Heinonen
keywords: Clinical examination; Clinical reasoning; Continuing education; Knowledge translation; Low back pain; Pathoanatomical classification