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J Educ Eval Health Prof > Epub ahead of print
Choi, Oh, Oh, Lim, Lee, Han, Park, Kwon, Ahn, and Huh: Importance and utilization frequency of essential competencies of Korean physical therapists

Background/rationale

It is difficult to present a single definition of physical therapy because physical therapy is defined in different ways in various countries, depending on the length of education required and legal circumstances. However, the World Federation of Physical Therapists defines physical therapists as “persons engaged in healthcare related to providing functional enhancement, damage prevention, rehabilitation treatment, intervention, and recovery service, while maintaining and developing motion and functional capabilities when individuals’ movements and functional capabilities are impaired by age, damage, disease, disability, environmental factors, etc.” [1]. The Korean Physical Therapists Association defines physical therapy as “helping to relieve patients’ pain and further restoring normal social activities by developing and applying physical materials, such as electricity, light, water, air, sound, and exercise, and various instruments and machines for therapeutic purposes, rather than surgery and pharmacological therapy” [2]. Upon comparing the 2 definitions, the Korean Physical Therapists Association suggested that physical therapy is performed using physical materials such as exercise therapy and various instruments and machines, whereas the World Federation of Physical Therapists refers to it as encompassing various services, as well as physical materials, and as including information related to diagnosis, evaluation, and prevention. Thus, it is necessary to redefine the competencies of Korean physical therapists. Changes in the population and disease structure, changes in the medical environment (e.g., advances in medical technology), and subsequent changes in medical personnel-related policies are major factors related to the physical therapist competencies required by society [3]. Korea has become an aging society, with >14% of the population aged ≥65 years, and is expected to become a super-aging society in the near future [4]. In preparation for the upcoming super-aging society, the role of physical therapists in disease prevention and the provision of healthcare for the elderly is expected to increase. Furthermore, it is estimated that the national costs of healthcare will continue to increase according to the public’s perception of quality of life, the increase in the use of medical services, the overuse of high-tech expensive medical equipment, and the need for healthcare for the elderly and high-quality medical services. Therefore, it is necessary to improve the quality of physical therapy services to align with changes in the public’s awareness of health promotion and increasing national medical costs [3].

Objectives

To cope with the changing healthcare environment, it is necessary to investigate the essential competencies in the clinical practice of physical therapists and to reflect these results in the physical therapy training process. Therefore, in this study, we aimed to provide basic data for the training of physical therapists and policy development by analyzing perceptions of the importance of physical therapists’ competencies and the frequency of the utilization of those competencies.

Ethics statement

Informed consent was obtained from all participants.

Study design

This was a survey-based descriptive study.

Participants

We surveyed licensed physical therapists in Korea who had clinical experience in physical therapy using a Google questionnaire on mobile devices and PCs. A total of 296 (99.0%) of the 299 subjects responded to the survey questionnaires from September 16, 2019 to September 30, 2019 (Dataset 1). The characteristics of participants are shown in Table 1.

Technical information

The survey items consisted of 4 areas: basic medicine (30 questions), diagnosis and evaluation (38 questions), interventions (43 questions), and other competencies (9 questions) including communication capabilities, professional education and development capabilities, and health personnel’s ethical and interpersonal capabilities (Table 2). The 120 evaluation items are presented in Supplement 1 in Korean and in Supplement 2 in English. In addition, the Cronbach α coefficient was calculated for the reliability of the test in each subcategory, and all reliability coefficients were higher than 0.7 (Table 2). The questionnaire was prepared based on the 2012 job analysis of physical therapists, the 2015 job analysis of physical therapists, learning goals, an analysis of national test linkage, and the national test of physical therapists presented by the Korea Health Personnel Licensing Examination Institute [5,6]. The questionnaire used in the study was validated by 9 experts, including a professor of physical therapy. The subareas of each item were detailed and presented to the subjects (e.g., “Do you think this item is important and has a relatively high clinical utilization?”) The survey responses were a 5-point Likert scale ranging from 1 (not entirely important/very low utilization) to 5 (very important/very high utilization) for the importance and frequency of use of the surveyed competencies.

Statistical methods

The data were analyzed using SPSS for Windows ver. 15.0 (SPSS Inc., Chicago, IL, USA). Frequency analysis was conducted to identify the general characteristics of the research subjects, and repeated-measures analysis of variance (ANOVA) was performed to analyze the differences in the importance and frequency of utilization of competencies according to the 4 categories (basic medicine, diagnosis and evaluation, interventions, and other competencies essential to physical therapists). To examine the statistical significance of differences in scores according to category, a follow-up test was conducted using the least significant difference (LSD) method. The statistical significance level was set at 0.05.

Differences in the importance of essential competencies of physical therapists according to category

Repeated-measures ANOVA was performed to analyze the importance of essential competencies of physical therapists. First, differences in the categories of basic medicine, diagnosis and evaluation, interventions, and other competencies showed statistical significance (F=129.33, P<0.01), with the following mean and standard deviation (SD) scores: diagnosis and evaluation (4.45±0.48), interventions (4.42±0.50), other competencies (4.36±0.52), and basic medicine (4.06±0.50 ) (Table 2). The LSD post-test for the statistical significance of differences between each category showed the following significant results: basic medicine versus other competencies (mean difference [Mdiff]=0.30, P<0.01), other competencies versus interventions (Mdiff=0.06, P<0.01), and other competencies versus diagnosis and evaluation (Mdiff=0.08, P<0.01) (Table 3).

Differences in the frequency of utilization of essential competencies of physical therapists

Repeated-measures ANOVA was performed to analyze the frequency of utilization of essential competencies of physical therapists (Table 4). First, an analysis of differences according to category showed statistical significance (F=42.98, P<0.01), with mean and SD scores as follows: other competencies (4.14±0.58), diagnosis and evaluation (4.14±0.62), interventions (4.08±0.63), and basic medicine (3.89±0.50) (Table 4). The LSD post-test for the statistical significance of differences between each category showed the following significant results: basic medicine versus other competencies (Mdiff=0.30, P<0.01), other competencies versus interventions (Mdiff=0.01, P<0.01), and other competencies versus diagnosis and evaluation (Mdiff=0.03, P<0.01) (Table 4).

Interpretation and suggestions

Previously, physical therapy in Korea focused on treatment using basic medical techniques using physical materials, such as electricity, light, water, air, sound, and exercise therapy, as well as various instruments and machines, due to the limitations of the medical system wherein interventions are conducted under the guidance of doctors (Table 4). However, it is becoming increasingly important for physical therapists to focus on their diagnosis and evaluation capabilities in order to interpret patients’ status (Table 3). Therefore, for future physical therapy curricula and national exams to present reasonable educational objectives that reflect important practical job competencies of physical therapists, it is necessary to increase the number of hours of education on the subjects of diagnosis, examination and evaluation, and clinical decision-making, and to reflect that emphasis in examinations [3]. The resultant improvements in physical therapists’ diagnostic evaluation competency will increase their ability to accurately identify patients’ problems and to verify the effectiveness of interventions and treatment methods based on those results [7,8].
As the role of Korean physical therapists is based on the International Classification of Functioning, Disability, and Health, which integrates the individual and social models of disability, should be taken to identify the multidimensional effects of disease, social participation, and health status. In addition, appropriate treatment interventions and measures should be presented according to the results of analyses using more diverse approaches. Therefore, it is estimated that the frequency of utilizing competencies in the diagnosis and evaluation category and in the category of other competencies (personal and environmental factors, etc.) was higher than that of the competencies in the category of interventions (Table 3). Among the duties of physical therapists, diagnosis and evaluation-related tasks were considered to be more important and more frequently used than those related to interventions. Therefore, it is necessary to increase the proportion of diagnosis and evaluation in the Korean physical therapist training system to match the frequency of utilization of this competency.

Conclusion

It is necessary to increase the proportion of credits in university education for diagnosis and evaluation-related competencies, which were recognized to be highly important and frequently utilized, as shown in this study, and to develop evaluation criteria that can enhance physical therapy capabilities by reflecting these considerations in the standards for national examination questions.

Notes

Authors’ contributions

Conceptualization: JL, HGK, CSA. Data curation: TO, JSO, Wl, Jl, SKH, YSP. Formal analysis: TO, JL, WL. Funding acquisition: CSA. Methodology: JL, SKH, YSP. Project administration: JL, HGK, CSA. Writing-original draft: JL. Writing-review & editing: JC, TO, JSO, WL, JL, SKH, YSP, HGK, CSA.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

This study was supported by a research grant from the Korea Health Personnel Licensing Examination Insititute of Korea in 2019.

Data availability

Data files are available from Harvard Dataverses: https://doi.org/10.7910/DVN/XYM7XQ

Dataset 1. Response data from 299 subjects.

jeehp-17-24-dataset1.xlsx

Acknowledgments

None.

Supplementary materials

Data files are available from Harvard Dataverses: https://doi.org/10.7910/DVN/XYM7XQ
Supplement 1. Survey items in Korean.
jeehp-17-24-suppl1.xlsx
Supplement 2. Survey items in English.
jeehp-17-24-suppl2.xlsx

References

1. World Confederation for Physical Therapy. Member organizations [Internet]. London: World Confederation for Physical Therapy; 2020 [cited 2020 May 4]. Available from: https://www.wcpt.org/what-is-physical-therapy.

2. Korean Physical Therapy Association. National university [Internet]. Seoul: Korean Physical Therapy Association; 2020 [cited 2020 May 2]. Available from: https://www.kpta.co.kr/center/kpta/about.

3. Kang MH, Lee TH, Cha SM, Oh JS, Lee TS, Oh TY, Kim SY, Lee HS, Lee GW, Kim KS. Proposal for improving the system of physical therapy education and the Korean physical therapist licensing examination based on a comparison of the systems in World Confederation for Physical Therapy member countries. J Educ Eval Health Prof 2017;14:10. https://doi.org/10.3352/jeehp.2017.14.10
crossref pmid pmc pdf
4. Shin S. Out-of-pocket medical expenditures for care of chronic conditions among Korean elderly. J Consum Policy Stud 2019;50:33-65. https://doi.org/10.15723/jcps.50.1.201904.33
crossref
5. Korea Health Personnel Licensing Examination Institute. Second job analysis study of physical therapists. Seoul: Korea Health Personnel Licensing Examination Institute; 2012.

6. Korea Health Personnel Licensing Examination Institute. Job analysis of physical therapists, learning goals, analysis of national test linkage, and the national test of physical therapists. Seoul: Korea Health Personnel Licensing Examination Institute; 2015.

7. Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F, van der Schaaf M. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil 2015;29:1051-1063. https://doi.org/10.1177/0269215514567156
crossref pmid pmc
8. Neck pain guidelines: revision 2017: using the evidence to guide physical therapist practice. J Orthop Sports Phys Ther 2017;47:511-512. https://doi.org/10.2519/jospt.2017.0507
pmid

Table 1.
General characteristics of the respondents
Characteristic Category Person (%)
Sex Male 159 (53.7)
Female 137 (46.3)
Age (yr) 20 147 (49.7)
30 82 (27.7)
40 42 (14.2)
>50 25 (8.4)
Highest level of education College graduate 197 (22.3)
Master’s 50 (16.9)
PhD 49 (16.6)
Career (yr) <3 106 (22.6)
3-10 102 (18.9)
>10 88 (19.6)
Place of employment Primary medical institution 63 (21.3)
Secondary medical institution 100 (28.7)
Tertiary medical institution 60 (20.3)
University 47 (15.9)
Others 26 (5.1)
Specialization Musculoskeletal system 140 (47.3)
Nervous system 127 (42.9)
Cardiovascular system 8 (2.7)
Integumentary system 2 (0.7)
Others 19 (6.4)
Table 2.
Essential competency areas and subareas
Areas Reliability (Cronbach’s α) Subareas Reliability (Cronbach’s α)
Basic medicine (30) 0.933 Anatomy (10) 0.874
Kinematics  (4) 0.717
Physical agent modalities (16) 0.936
Diagnosis and evaluation (38) 0.961 Principle of diagnosis and evaluation (8) 0.901
Musculoskeletal system examination and evaluation (6) 0.874
Nervous system examination and evaluation (11) 0.911
Cardiopulmonary blood relation  examination and evaluation (6) 0.939
Clinical decisions (6) 0.905
Interventions (43) 0.969 Musculoskeletal interventions (8) 0.863
Neurological interventions (8) 0.890
Cardiopulmonary blood relations  interventions (5) 0.898
Skin system interventions (2) 0.929
Physical therapy in the community (2) 0.951
Physical therapy for children and adolescents(4) 0.952
Physical therapy in sports (3) 0.960
Physical therapy for the elderly (4) 0.923
Physical therapy for women (2) 0.942
Medical care regulations (5) 0.921
Other competencies (9) 0.914 Areas of communication (4) 0.804
Professional training and development (2) 0.853
Medical personnel’s ethical and interpersonal personal capabilities (3) 0.912

Parentheses indicate the number of questions.

Table 3.
Analysis of the importance of essential competencies of Korean physical therapists
Importance of essential competencies for physical treatment Mean±standard deviation Sum of squares Degree of freedom Mean squared F-value Post-hoc
Basic medicine 4.06±0.50 27.94 2.14 13.09 129.33** 1<4<2,3
Diagnosis and evaluation 4.45±0.48
Interventions 4.42±0.50
Other competencies 4.36±0.52

1: basic medicine, 2: diagnosis and evaluation, 3: interventions, 4: other competencies (communication capabilities, professional training and development capabilities, and medical personnel’s ethical and interpersonal capabilities).

** P<0.01.

Table 4.
Frequency analysis of the utilization of essential competencies of physical therapists in Korea
Frequency of the utilization of essential competencies of physical therapists Mean±standard deviation Sum of squares Degree of freedom Mean squared F-value Post-hoc
Basic medicine 3.89±0.89 13.08 2.32 5.64 42.98** 1<3<2,4
Diagnosis and evaluation 4.14±0.14
Interventions 4.08±0.08
Other competencies 4.16±0.16

1: basic medicine, 2: diagnosis and evaluation, 3: interventions, 4: other competencies (communication capabilities, professional training and development capabilities, and medical personnel’s ethical and interpersonal capabilities).

** P<0.01.

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