# Assessment of differential diagnostic skills of physiotherapists related to the cervical spine - approaches to improving effectiveness: observational, cross-sectional study

## TL;DR

This study evaluates how well physiotherapists in Hungary can diagnose serious cervical spine conditions and finds that additional training improves their ability to recognize critical symptoms.

## Contribution

The study identifies factors influencing diagnostic accuracy and highlights the role of postgraduate training in improving recognition of cervical spine red flags.

## Key findings

- Only 22.7% of physiotherapists recognized critical signs and symptoms in cervical spine cases.
- Postgraduate training significantly improved the ability to identify critical cases.
- Physiotherapists with more experience and advanced education performed better in diagnosis.

## Abstract

Cervical disorders are a significant cause of disability worldwide, often presenting with pain and symptoms affecting the musculoskeletal system and other organs. It is essential for healthcare professionals to accurately identify and comprehend the underlying causes of these potentially life-threatening conditions. This study aimed to assess the diagnostic knowledge and clinical decision-making abilities of physiotherapists in Hungary regarding serious health conditions in patients with cervical disorders and the factors influencing these decisions.

Data were collected through an electronic questionnaire containing demographic information, educational background, and professional experience. The second section includes excerpts from eight case reports on diagnosing cervical complaints from international literature. A cohort of 128 physiotherapists (114 female and 14 male; mean age: 34.65 ± 8.88 years; 101 BSc degrees and 27 MSc/PhD degrees, average of 9.73 ± 7.82 years of professional practice) who completed their higher education in Hungary were recruited for participation. Statistical analyses were performed using R software version 4.0.2. The primary outcome was correct decision-making, measuring its association with years of practice, clinical experience, educational level (BSc, MSc/PhD), and postgraduate training in cervical spine management.

61.7% of therapists identified the appropriate treatment for musculoskeletal cases, while only 22.7% recognized critical signs and symptoms. Participants with postgraduate training in neck conditions (odds ratio 1.25–7.99, p = 0.014) and those treating orthopedic (odds ratio 0.18–0.99, p = 0.047) and trauma cases (odds ratio 0.11–0.65, p = 0.004) were significantly more effective at recognizing critical cases.

Our findings emphasize the need for ongoing education and training to recognize cervical spine red flags. These results align with global literature and highlight the importance of improving diagnostic knowledge in undergraduate programs. These results underscore the significance of extensive professional experience and advanced education within the discipline.

Not applicable.

The online version contains supplementary material available at 10.1186/s12909-025-07682-x.