Development and validation of a script concordance test to assess clinical reasoning in physiotherapy students focusing on lower limb tendinopathies

Abstract

Background: Tendinopathies are prevalent, complex musculoskeletal conditions that challenge clinical decision-making. While various tools have been developed to assess clinical reasoning across health professions, the Script Concordance Test (SCT) has shown promise as a context-sensitive method, though its application in physiotherapy particularly for tendinopathy has not been explored. Objective: This study aimed to develop and assess the reliability and validity of an SCT administered to final-year physiotherapy students and experts, focusing on the diagnosis and treatment of lower limb tendinopathies.  Method: Three experts in musculoskeletal disorders developed the script concordance test (SCT) with a structured three-phase process. They created 16 clinical scenarios focused on lower limb tendinopathies, resulting in a preliminary version of the test composed of 48 items. These items were administered online to a panel of 15 expert physiotherapists and 50 final-year physiotherapy students from the Université Libre de Bruxelles. Results: After optimization, the SCT demonstrated an internal consistency, reflected by a Cronbach’s alpha coefficient of 0.69. A statistically highly significant difference (P<0.001) was noted between the two groups. The average score for students was 61.3 (±8.4), whereas experts scored 74.6 (±6.4). Conclusion: The results suggest that our SCT sequence is valid and reliable when it comes to distinguishing clinical reasoning levels between students and experts from our sample on the management of lower limb tendinopathies. This study highlights the potential of a context-specific SCT sequence to assess clinical reasoning in physiotherapy students and experts managing lower limb tendinopathies.