Musculoskeletal ultrasound imaging - an exploration of physiotherapists' interests and use in practice

Background: Musculoskeletal ultrasound imaging, (MSKUSI) is an appealing modality for many professions and professionals. There are indications that physiotherapists have tried to access MSKUSI but the evidence base exploring their interests and clinical use is extremely limited. Aim: To explore physiotherapists’ interest and use of MSKUSI in practice. Method: A questionnaire was developed and distributed to gain initial information relating to physiotherapists’ interest and use of MSKUSI. 75 responses were received, analysis informed topic-guide development for in-depth interviews and enabled a purposeful sampling strategy. 11 in-depth interviews explored physiotherapists’ interests, education and clinical use of MSKUSI. Results: Thematic analysis of the interview data identified 5 themes: 1. Professional skill set – physiotherapists’ suitability for MSKUSI 2. Factors that have impacted physiotherapists’ ability to use MSKUSI ii 3. Physiotherapists’ motivation to use ultrasound - improving patient focused care 4. Quality assurance strategies 5. Application of biopsychosocial model These themes revealed links between physiotherapists’ core skills, knowledge and professional experiences that align well to the requirements of MSKUSI. Some participants reported support whilst accessing education but many described challenges that had influenced their ability to use MSKUSI. A common challenge was accessing mentorship responsive to physiotherapists’ requirements. Participants observed the variation in their practice when compared to other professionals was not always reflected in education. Application of clinical reasoning processes to ensure scanning was responsive to individual patient’s requirements was emphasised. Conclusion: Physiotherapists are amongst a number of professional groups interested in MSKUSI. Proposed roles include verification of clinical assessment findings for diagnosis and facilitation of patient education. The potential to reduce patient attendances, streamline management pathways and optimise resource management warrants further investigation. Professional and regulatory issues need evaluation to support physiotherapists’ use of MSKUSI. Professional organisations including the Chartered Society of Physiotherapy should extend current guidance to protect professionals and patients.