{"paper_id":"1acdc3e8-6528-4b95-8d3f-e54d54b93b90","body_text":"Attitudes of physiotherapists towards the use of performance-based measures and questionnaires | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Attitudes of physiotherapists towards the use of performance-based measures and questionnaires Sven Karstens, Tim Bumb, Jana Koriath, Tobias Braun, Balz Ronald Winteler, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6038523/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background The use of outcome assessments in physiotherapy is widely recommended to support clinical decision-making, document patient progress and ensure therapeutic quality. Despite these recommendations, outcome assessments are underutilised in practice. One factor that might influence their usage is physiotherapists’ attitudes towards them. However, informative value from existing research is limited due to the use of non-standardised instruments to measure these attitudes. The aim of this study was to develop a standardised instrument for measuring the attitudes of physiotherapists towards the use of outcome assessments in clinical practice and to examine the instrument’s validity and reliability. Methods A set of preliminary items was generated and tested within a two-phase validation study conducted as an online survey. Licenced physiotherapists were invited to participate. Phase one included a 10-day-retest, whereas the survey was completed only once in the second phase. Correlation analyses were performed to explore the relationships between items and identify clusters potentially measuring the same construct. Factor analysis was performed to assess structural validity. Test-retest reliability (ICC) and internal consistency reliability (Cronbach’s alpha) were determined, as well as floor and ceiling effects. Results Data were collected from 144 physiotherapists, and 30 participants completed the retest assessment. The final instrument consists of a subscale of 9 items for the attitude towards the use of performance-based measures (PBM) and one with 10 towards the use of questionnaires, with factor loadings between 0.6 and 0.9. The instrument significantly differentiates between therapists who use/do not use PBM or questionnaires in practice. Cronbach’s alpha for the subscales was 0.90/0.93 and ICC was 0.84. No floor or ceiling effects were given. Conclusion The developed instrument might provide a better understanding of the impact of attitudes on the use of clinical outcome assessments in physiotherapy practice. First evidence of the instrument’s psychometric properties indicate it as a valuable tool for research and education, supporting analysis of the gap between the recommended and actual use of outcome assessments. Trial registration: German Clinical Trials Register (DRKS00029360). Registered 01 July 2022. Measurement instrument Outcome measure Physiotherapy Psychometrics Clinical Reasoning Figures Figure 1 Figure 2 Figure 3 Figure 4 Background ‘Assessment is defined as any systematic procedure for collecting information that can be used to make inferences about the characteristics of people or objects’ (1, 2). In practice, the terms testing, measurement and assessment are often used interchangeably (1). In its core standards, the European Region of the World Physiotherapy Association recommends using standardised outcome measures in the course of examination and progress documentation and in the documentation of results (3). Correspondingly, physiotherapists measure a patient’s health status to diagnose, document progress or predict (4). This is of fundamental importance for professional action. Examination findings are integral to the clinical decision-making process (5, 6). Cott et al. (7) describe, in line with the Movement Continuum Theory, that the current movement capability should be recorded through outcome measures. A structured assessment therefore serves as a cornerstone of therapeutic quality assurance and is required by law in many countries (8-10). It also shows potential to have a positive influence on treatment outcomes (11). In contrast to the requirements described above, practice outcome measures are currently not widely used in physiotherapy (12-14). The reported barriers are insufficient knowledge of the various measurement instruments, insufficient training in their use, limited access and increased time expenditure (13-15). Additionally, in everyday practice, instruments are used that primarily focus on body structures or body functions. Activities in daily life, participation and quality of life are measured less often, despite their overarching importance (13, 15). This lack of emphasis could be related to the fact that therapists are not familiar with the instruments required or that the instruments are only familiar to those working in a specific setting (16). Some evidence indicates that physiotherapists with a positive attitude towards outcome measures tend to use them more frequently (17). However, although standardised outcome measures were the research topic in preciding work, to capture the attitudes no standardised instruments were used (13, 17-19). The resulting lack of information on the reliability and validity of the questionnaires used previously indicates that the validity of those studies might be limited. Therefore, the aim of the present study was to develop and validate a standardised instrument for measuring the attitudes of physiotherapists towards the use of outcome measures in clinical practice. In detail, structural validity, known-groups validity, internal consistency reliability and test-retest reliability were examined. Methods Study design A validation study with two phases was conducted. In the first phase, participants were invited to complete a survey at baseline, followed by a 10-day-retest assessment. The length of the test-retest period was chosen to balance a recall effect on the one hand and a change over time on the other (20). If the survey was not completed or only completed once after two weeks, a reminder was sent manually via the survey tool (see below). In the second phase, the group of participants was expanded using an extended recruitment pathway (see Participants and recruitment ). Due to the more complex contact procedures, this phase was carried out without retesting. For preparation of the manuscript, the CROSS-Checklist (Consensus-Based Checklist for Reporting of Survey Studies) was used (21). The study was conducted in accordance with the research regulations of Swissethics (Swiss Association of Research Ethics Committees). According to the decision of the Cantonal Ethics Committee for Research (Bern), this was not within the remit of the Swiss Human Research Act, as no health data were collected (Req-2022-00527). All participants voluntarily participated and gave their active informed consent to participate. The study was registered in the German Clinical Trials Register (DRKS00029360) prior to participant enrolment. Participants and recruitment Recruitment was conducted from September 2022 to March 2023. Inclusion criteria for the survey were licenced physiotherapist, main occupation in Switzerland and proficiency in German. Exclusion criteria were working in research or teaching only or having no therapeutic contact with patients in the previous three months. A call for participation in the first phase was published internally on the learning platforms of two Swiss universities. At one university, invitations were also sent by email and given in courses. In the second phase, the invitations were spread via additional university mailing lists and via the national newsletter of two musculoskeletal physiotherapy specialist groups and the newsletter of the regional professional association. Another physiotherapy musculoskeletal specialist group posted the link to the survey on its website. Considering the described procedure the exact number of people invited to participate is unknown, but an estimation is given in Figure 1. Item set An item set was developed to build the foundation for a questionnaire that would assess the attitude towards the utilisation of outcome measures in physiotherapy practice. In this sense, outcome measures were considered questionnaires or other procedures used to systematically record patient characteristics and attributes. This information could relate to the person’s current state of health and be used for diagnostic, prognostic or documentation therapy goals (22). This definition of ‘outcome assessment’ was given to the participants prior to the item set. To build on previous experience, after consultation and agreement with Braun et al., their survey questions were used as an initial orientation (13, 17). The items were assigned to the categories ‘performance-based measures’ (PBM), ‘questionnaires’ and ‘classic test and measurement procedures’ (Numeric Rating Scale, Goniometer [Range of Motion] and Measuring Tape [circumference]). The development of the items for each of the three categories covered the routine aspects associated with the utilisation of outcome measures, evaluation and interpretation, knowledge, use, workplace, training, communication, clinical decision-making, remuneration, time expenditure, quality assurance and digital use. As the items on training and digitalisation are specific constructs on their own, they were not used to compile the measurement instrument, although they were included in the survey. Each category was preceded by a list of typical instruments (see Appendix, Table A0). The participants were asked to indicate whether they were familiar with the assessments and whether they had used an assessment in the past three months. The core items were formulated as statements (‘The use of questionnaires promotes ...’ or ‘The use of performance-based measures requires ...’). Six-point Likert scales were selected as response options (‘Completely Agree’, ‘Mostly Agree’, ‘Slightly Agree’, ‘Slightly Disagree’, ‘Mostly Disagree’ and ‘Completely Disagree’). A preliminary set of items was used in a pretest with 8 participants, using cognitive interviews and subjected to a qualitative content analysis and behaviour coding (23-25). A total of 28 items on PBM, 27 on questionnaires and 10 on classic test and measurement procedures were selected for the online survey. The items were converted into an online version in Lime-Survey (LimeSurvey Version 2.56.1, LimeSurvey GmbH, Hamburg, Germany) and were set as mandatory items. The lists of typical measurement instruments in the online version included 12 for PBM, 10 for questionnaires and 3 for classical procedures (Appendix Table A0). The online version was subjected to a further four pretests with physiotherapists in Switzerland. Questionnaire completion took approximately 20 to 25 minutes. Analyses The analyses of the measurement properties were aligned with the criteria of the COSMIN Checklist (26). A reflective model was applied (27, 28). Analyses were performed using R Statistics, version 3.4.1 (29). For ease of understanding, the PAssAt total scores and subscores were standardised to a range of 0 to 100. To achieve this, the lowest possible raw values were subtracted and the resulting values were converted to percentages. Validity Face and content validity were verified throughout the development process by conducting pretests and regular discussions in the research group (30). As a first step, the largest number of items was identified from the developed set of items for PBM and for questionnaires. For this, r s ≥ 0.3 was applied, with the largest mean correlation, according to Spearman. The structural validity of all items selected in this way was analysed using exploratory factor analysis. Structural validity was assumed if the .40-.30-.20 rule suggested by Howard (31) was fulfilled, meaning that (a) items were loading onto their primary factor above 0.40, and in the case of cross-loadings, (b) they were loading onto alternative factors below 0.30, and (c) they demonstrated a difference of at least 0.20 between their primary and alternative factor loadings. An explorative factor analysis was conducted by calculating Spearman’s rho correlations. The number of factors was determined by calculating the eigenvalues. Oblimin was selected as a rotation method to allow the establishment of correlation between factors (27). This choice appeared appropriate in the case of various subscales that measured attitudes towards the use of different outcome measures. Following the definition of the factor structure, the known group validity (as an aspect of construct validity) was determined (27). In this context, groups were determined by the questions on the use of PBM or questionnaires in the past three months (yes/no). Box plots were created, and the groups were compared using Mann-Whitney U-tests. Reliability The PBM Cronbach’s alpha was calculated to assess the internal consistency of the subscales (32). A value of 0.70 to 0.95 was defined as the acceptable range (33). For the test-retest reliability of the subscales, as well as the total score, intraclass correlation coefficients (ICC) were calculated (ICC 2.1, two-way random effects; ICCAGREEMENT). A value of ≥0.70 indicated sufficient reliability for comparison of groups (32). Floor and ceiling effects Ceiling or floor effects were assumed if more than 15% of the participants achieved the lowest or highest score for the instrument or its subscales (33). Sample size The sample size for the first phase of the survey was determined based on the requirements for reliability (32) and on the requirements for structural validity for the second phase (27). During the first phase (test-retest reliability), the aim was to include 50 participants, and during the second phase, a total of 100 participants. Results Approximately 200 physiotherapists were invited to participate via universities in phase 1, whereas around 900 physiotherapists were invited by email via associations in phase 2. An invitation to take part was also posted on the website of a physiotherapy association (Fig. 1). Overall, 144 participants completed the survey at least once. The retest was completed by 30 physiotherapists. The mean age of the participants was 38.9±12.0 years, and 74% of the participants were female. Further details on the participants’ sociodemographics are presented in Table 1. Table 1 Sociodemographic characteristics of the participants Total sample (N = 144) Subsample Test-Retest-Reliability (n = 30) Years of age, mean ±SD 38.9 ±12.0 35.3 ±10.2 Sex (female / male) 107 / 37 (74% / 26%) 20 / 10 (67% / 33%) Additional courses/further training completed* None 29 (20%) 11 (37%) Manual lymphatic drainage / lymphological physiotherapy 37 (26%) 6 (20%) Manual therapy / musculoskeletal physiotherapy 73 (51%) 12 (40%) Sports physiotherapy 41 (28%) 5 (17%) Neurology (e.g. Neurophysiotherapy / basic course Bobath or Proprioceptive Neuromuscular Facilitation) 31 (22%) 4 (13%) Other 54 (38%) 6 (20%) Current workplace* Hospital inpatient 31 (22%) 11 (37%) Hospital outpatient 26 (18%) 9 (30%) Independent practice 95 (66%) 18 (60%) Rehab clinic 14 (9.7%) 3 (10%) Other 10 (6.9%) 3 (10%) Employment relationship* Employed 109 (76%) 29 (97%) Self-employed / freelance 34 (24%) 1 (3.3%) Other 4 (2.8%) 0 (0%) Available treatment time per patient in minutes per session <25 3 (2.1%) 0 (0%) 25 22 (15%) 5 (17%) 30 103 (72%) 24 (80%) >30 16 (11%) 1 (3.3%) Patients from the following areas* Orthopaedics / traumatology 119 (83%) 20 (67%) Rheumatology 94 (65%) 18 (60%) Internal medicine 26 (18%) 3 (10%) Gynaecology 10 (6.9%) 0 (0%) Neurology 46 (32%) 9 (30%) Geriatrics 60 (42%) 8 (27%) Urology 5 (3.5%) 0 (0%) Paediatrics 13 (9.0%) 1 (3.3%) Psychosomatic 20 (14%) 2 (6.7%) Other 19 (13%) 6 (20%) Working hours per week , median (IQR) 30 (22, 38) 26 (21, 34) <30 81 (56%) 21 (70%) 31-40 37 (26%) 6 (20%) >40 26 (18%) 3 (10%) Years of experience in physiotherapy , median (IQR) 10 (4, 22) 4 (2, 16) Level of education Graduate physiotherapist HF 49 (34%) 6 (20%) Bachelor 82 (57%) 20 (67%) Master 32 (22%) 6 (20%) Doctorate (PhD, Dr) 1 (0.7%) 0 (0%) Other 17 (12%) 2 (6.7%) * multiple choices possible Structural validity Descriptive analyses indicated a difference in the use of various methods. While 98% of participants had used classic measurements in the past three months, the frequency of use for PBM and questionnaires was 86% and 67%, respectively. Due to this difference, a decision was made to analyse the items for the PBM and questionnaires separately. Tables 2 and 3 illustrate the correlation matrices for PBM and questionnaire items that showed correlations of r s ≥ 0.3 across all combinations. Bar charts on the distribution of responses for the selected items and correlation matrices for all item combinations for the PBM and questionnaire are given in the Appendix (Figure A1, A2 and Table A1, A2). Table 2 Correlation matrix for items on attitude towards the use of performance-based measures B019_B019 B019_B021 B019_B022 B019_B023 B019_B024 B019_B025 B019_B026 B027_B027 B008 0.41 0.52 0.50 0.46 0.47 0.40 0.52 0.56 B019_B019 0.49 0.49 0.53 0.61 0.39 0.55 0.45 B019_B021 0.67 0.60 0.57 0.40 0.66 0.55 B019_B022 0.61 0.56 0.54 0.64 0.53 B019_B023 0.73 0.46 0.61 0.57 B019_B024 0.37 0.56 0.49 B019_B025 0.61 0.46 B019_B026 0.58 B008 usefulness for physiotherapeutic practice, B019_B019 communication patient and therapist, B019_B021 more information about patient, B019_B022 tailoring treatment, B019_B023 patients engaged in treatment planning, B019_B024 cooperation between patient and therapist, B019_B025 documenting progress, B019_B026 impact clinical reasoning, B027_B027 treatment quality Table 3 Correlation matrix for items on attitude towards the use of questionnaires B052_B052 B052_B053 B052_B054 B052_B055 B052_B056 B052_B057 B052_B058 B059_B059 B059_B060 B040 0.48 0.36 0.52 0.54 0.51 0.54 0.64 0.58 0.72 B052_B052 0.59 0.57 0.65 0.58 0.35 0.53 0.48 0.55 B052_B053 0.44 0.52 0.52 0.32 0.45 0.64 0.47 B052_B054 0.67 0.59 0.37 0.62 0.48 0.63 B052_B055 0.62 0.38 0.66 0.52 0.64 B052_B056 0.49 0.63 0.52 0.62 B052_B057 0.49 0.43 0.50 B052_B058 0.60 0.75 B059_B059 0.64 B040 usefulness for physiotherapeutic practice, B052_B052 communication patient and therapist, B052_B053 communication patient and physician, B052_B054 more information about patient, B052_B055 goal setting process, B052_B056 adapt treatment during course of therapy, B052_B057 documenting progress, B052_B058 impact clinical reasoning, B059_B059 argumentation paying bodies, B059_B060 treatment quality In line with the eigenvalues given by the Scree Plot (Appendix A3), a two-factor model was chosen. All variables shown in Tables 2 and 3 were analysed together in the exploratory factor analysis. A coefficient of 0.6 was obtained for the correlation between the factors (see Figure 2). The factor loadings for the attitude towards the use of PBM ranged between 0.6 and 0.9, while the factor loadings for the attitude towards the use of questionnaires ranged between 0.6 and 0.8. One item of the factor on the attitude towards the use of questionnaires also loaded with a value of 0.2 on the second factor, but since this did not break the .40-.30-.20 rule, the item was kept. The distribution of the scores for the total score and the subscales is illustrated in Figure 3. Table 4 and Figure 4 confirm that the two subscales significantly differentiated the participants who use/do not use PBM or questionnaires in practice. The relative frequencies of participants with the maximum value for the total score, the PBM and the questionnaire subscale were 2.8%, 9.7% and 4.9%, respectively, while the relative frequencies for the minimum value were 0%, 0% and 0.7%. Therefore, no floor or ceiling effects were present. Table 4 Differentiation of known groups … used within the previous 3 months Yes No p Performance-based measures n 124 20 Subscale PBM Median (IQR) 84 (77, 93) 68 (59, 74) < 0,001 Questionnaire n 97 47 Subscale Questionnaire Median (IQR) 80 (74, 90) 64 (56, 77) < 0,001 Reliability The test-retest reliability analysis indicated an acceptable result, with ICC = 0.84 (95% CI: 0.70 to 0.92). The values for test-retest reliability and internal consistency of the subscales, as well as the measurement errors, are given in Table 4. Table 4 Internal consistency reliability, test-retest reliability and measurement error of the PAssAT scale Total Subscale performance-based measures Subscale questionnaire Cronbach’s Alpha (95% CI) (n = 144) 0.90 (0.87; 0.92) 0.93 (0.91; 0.95) ICC 2.1 (95% CI) (n = 30) 0.84 (0.70; 0.92) 0.82 (0.67; 0.91) 0.86 (0.72; 0.93) SEM AGREEMENT (n = 30) 4.26 2.00 3.17 Discussion In this study, a questionnaire to measure the attitudes of physiotherapists towards the use of outcome measures in clinical practice was developed in a structured process. The final instrument consisted of two subscales: one on attitudes towards the use of PBM and the other on attitudes towards the use of questionnaires. The two subscales correlated substantially with each other and each subscale demonstrated acceptable internal consistency reliability. Acceptable results for the test-retest reliability of the scale indicated that the results for two groups can be measured and compared reliably. No ceiling or floor effects were detected. A comprehensive set of items was first generated for the subsequent selection of suitable items (30). This procedure proved sufficient for applying a reflective model (27). Several items were not retained in the final set. Assigning the total set of 19 items to two subscales revealed some items that were appropriate for use as interpretable factors (Moosbrugger and Kelava, 2020). This maintained the distinction between PBM and questionnaires that was envisaged during the development process. However, items based on classical measures, such as goniometer or measuring tape measurements, were removed because the data showed that their utilisation differed substantially from the previous data and therefore might reflect a different construct. This aspect of the assessment should be revisited in future work. No clear consensus on factor loadings has yet been identified in the statistical literature (34). However, all items in the present study loaded well on their specific factor and the one item with a double loading met the conservatively set requirements of the .40-.30-.20-rule (31). Previous research showed that the actual use of an outcome measure and its reported use or the attitude towards it can differ (15). The compiled instrument developed here at least enabled a significant differentiation between participants who stated that they used or did not use PBM or questionnaires in practice. The results on reliability justify the differentiation of the group mean values. Higher values would have been desirable for differentiating at the level of individuals (32). Face validity was tested in multiple pretests prior to this study. The final tool strongly relates to communication and clinical decision making. Conceivably, future studies could examine whether the content coverage can be expanded by developing further strengthens dimensions of use, such as quality assurance or reimbursement (1). The included list of known/used instruments is presumably a significant component of the questionnaire, especially with regard to attitudes towards PBM, as it makes the construct more transparent for the respondents. In the case of cross-cultural adaptations, further adaptations of this list may be necessary (35). A standardised clinical assessment is an important foundation of evidence-based practice (11, 36). Instruments addressing this field have been developed, but the attitude towards the use of clinical measurements needs more attention (37, 38). The values determined in the present study indicate that — as in evidence-based practice in general — the attitude towards the use of outcome measures is positive, but the use of questionnaires is particularly limited (39). The developed PAssAt-scale is useful in a variety of ways, such as in teaching, postgraduate education and research to explore the gaps described. In training, changes in the attitude towards the use of outcome measures from pre- to post-participation in courses can be assessed. In implementation science, the instrument can be used to determine baseline values, thereby supporting the development of tailored interventions to facilitate the use of standardised outcome measures in clinical routines. Strengths and limitations Most of the Swiss physiotherapists in this study fell into an age category around 38 years, and three-quarters were female; thus, the sociodemographic data of the surveyed sample closely reflects the characteristics of physiotherapists in terms of age and gender when compared with recent federal data. The proportion of master’s degrees was higher (40), which might be explained by access via universities and the greater willingness of therapists with higher academic qualifications to take part in surveys (13). The study was registered before implementation. The consistent realisation of the design developed a priori, except for the additional analysis of known-group validity, can therefore be verified. Starting with a comprehensive set of items was of great importance for the development process. This meant that the time required to answer all items ranged from 20 to 25 minutes and therefore was in line with the suggestion given by Sharma (41) to stay under 30 minutes. This duration likely influenced the number of surveys fully completed by the retest participants. The finally selected set of items will naturally take considerably less time. This will likely lead to more complete data in future projects since shorter questionnaires result in higher response rates (42). Furthermore, the possibility of working with incentives for participation should be considered in future projects (42). The overall lower-than-planned response rate for the retest questionnaires means a limitation for reliability (33). Nevertheless, the confidence intervals remained within a range defined as acceptable. Only the lower 95% CI value of the subscale for PBM slightly missed the set threshold. Conclusion The developed questionnaire provides an instrument for the assessment of physiotherapists’ attitudes towards the use of standardised outcome measures in clinical practice. The instrument can be used as a standardised module, thereby strengthening future surveys on the topic. It facilitates comparison of groups in research or post-graduation programmes. Nevertheless, extending the coverage of the construct of attitude towards the use of outcome measures in physiotherapy remains a possibility. Abbreviations CROSS: Consensus-Based Checklist for Reporting of Survey Studies PBM: Performance-Based Measures Declarations Ethics approval and consent to participate The study falls, according to the decision of the Cantonal Ethics Committee for Research (Bern), not under the authority of the Swiss Human Research Act (Req-2022-00527), as no health-sensitive data was requested. Consent for publication All participants participated voluntarily and gave their active informed consent to participate. Availability of data and materials The study data will be shared by the corresponding author upon reasonable request. Competing interests The authors declare no conflict of interest. Funding The study was conducted without external funding. Authors' contributions Design of the work: SK, TBu, SR, BRW, JK, TBr Acquisition of data: TBu, BRW, JK Analysis of data: TBu, SK, SR, JK Interpretation of data: SK, TBu, SR, BRW, JK, TBr Drafted the work or substantively revised: SK, TBu, SR, BRW, JK, TBr Acknowledgements The authors thank all study participants. References Reynolds CR, Altmann RA, Allen DN. Mastering Modern Psychological Testing Theory and Methods. 2 ed. Cham: Springer International Publishing; 2021. American Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for educational and psychological testing. Washington: American Educational Research Association; 2014. European Region World Physiotherapy. European Core Standards of Physiotherapy 2018. Available from: https://www.erwcpt.eu/_files/ugd/3e47dc_032110c5811a4710bfa866acb32a5587.pdf. Potter K, Fulk GD, Salem Y, Sullivan J. Outcome measures in neurological physical therapy practice: part I. Making sound decisions. J Neurol Phys Ther. 2011;35(2):57-64. Karstens S, Schulte-Frei B, Wolff H, Froböse I. Physiotherapie: Theoretischer Rahmen und Interventionen. In: Froböse I, Nellessen-Martens G, Wilke C, editors. Training in der Therapie - Grundlagen. 4 ed. München: Urban & Fischer; 2015. p. 223-35. Widerström B, Elvén M, Rasmussen-Barr E, Boström C. \"How does physical examination findings influence physiotherapists' decision-making when matching treatment to patients with low back pain?\". Musculoskelet Sci Pract. 2021;53:102374. Cott CA, Finch E, Gasner D, Yoshida K, Thomas SG, Verrier MC. The Movement Continuum Theory of Physical Therapy. Physiother Can. 1995;47:87-95. Phillips A, Stiller K, Williams M. Medical Record Documentation: The Quality of Physiotherapy Entries. Internet Journal of Allied Health Sciences and Practice. 2006. Geraedts M, Drösler SE, Döbler K, Eberlein-Gonska M, Heller G, Kuske S, et al. DNVF-Memorandum III „Methoden für die Versorgungsforschung“, Teil 3: Methoden der Qualitäts- und Patientensicherheitsforschung. Gesundheitswesen. 2017;79(10):e95-e124. Kyte DG, Calvert M, van der Wees PJ, ten Hove R, Tolan S, Hill JC. An introduction to patient-reported outcome measures (PROMs) in physiotherapy. Physiotherapy. 2015;101(2):119-25. Lambert MJ, Harmon KL. The merits of implementing routine outcome monitoring in clinical practice. Clinical Psychology: Science and Practice. 2018;25(4):e12268. Duncan EAS, Murray J. The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC Health Serv Res. 2012;12(1):96. Braun T, Rieckmann A, Weber F, Grüneberg C. Current use of measurement instruments by physiotherapists working in Germany: a cross-sectional online survey. BMC Health Serv Res. 2018;18(1):810. Leiner G, Pallauf M, Müller G, Seeberger B. Anwendung von Assessments in der Physiotherapie – eine empirische Studie in Österreich. physioscience. 2021;17(04):150-60. Swinkels RA, van Peppen RP, Wittink H, Custers JW, Beurskens AJ. Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands. BMC Musculoskelet Disord. 2011;12:106. Oesch P, Kool J, Overberg J-A, Perrot G, Rigter K, Ott B, et al. Kenntnisse und Anwendung von Assessments in der muskuloskelettalen Rehabilitation: Eine Umfrage in Spitälern und Rehabilitationskliniken der deutschsprachigen Schweiz. fisio active. 2004(5):5-11. Schomberg M, Braun T, Handgraaf M, Aftenberger H, Grüneberg C. Förderfaktoren und Barrieren in der Anwendung von Assessments in der Neurorehabilitation. Zeitschrift für Physiotherapeuten. 2016;68:25-38. Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: perceptions and applications. Phys Ther. 2009;89(2):125-35. Copeland JM, Taylor WJ, Dean SG. Factors influencing the use of outcome measures for patients with low back pain: a survey of New Zealand physical therapists. Phys Ther. 2008;88(12):1492-505. Streiner DL, Norman GR, Cairney J. Health Measurement Scales: A practical guide to their development and use: Oxford University Press; 2014. Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36(10):3179-87. Wirz M, Koehler B, Marks D, Kool J, Sattelmayer M, Oesch P, et al. Lehrbuch Assessments in der Rehabilitation - Messmethoden für Physiotherapeuten. Bern: Hogrefe AG; 2014. Lenzner T, Neuert C, Otto W, Gesis. GESIS Survey Guidelines. Kognitives Pretesting2015. Porst R. Fragebogen. Ein Arbeitsbuch. Wiesbaden: Springer VS; 2014. Mayring P. Qualitative Content Analysis. Forum: Qualitative Social Research. 2000;1(2):20. Mokkink LB, Prinsen CAC, Patrick DL, Alonso J, Bouter LM, de Vet HCW, et al. COSMIN Study Design checklist for Patient-reported outcome measurement instruments 2019. Available from: https://www.cosmin.nl/wp-content/uploads/COSMIN-study-designing-checklist_final.pdf. Fayers PM, Machin D. Quality of life the assessment, analysis, and reporting of patient-reported outcomes. Chichester: John Wiley & Sons Inc; 2016. Jung A, Challoumas D, Pagels L, Armijo-Olivo S, Braun T, Luedtke K. Guidelines for the development and validation of patient-reported outcome measures: a scoping review. BMJ evidence-based medicine. 2024;29(6):363-73. R Development Core Team. R: A language and environment for statistical computing Vienna, Austria: R Foundation for Statistical Computing; 2014. Available from: http://www.R-project.org. Moosbrugger H, Kelava A. Testtheorie und Fragebogenkonstruktion. 3. ed. Berlin, Heidelberg: Springer Berlin Heidelberg; 2020. Howard M. A Review of Exploratory Factor Analysis (EFA) Decisions and Overview of Current Practices: What We Are Doing and How Can We Improve? Int J Hum Comput Interact. 2015;32:150914142834000. de Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in Medicine: A Practical Guide. Cambridge: Cambridge University Press; 2011. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. Mirabelli J, Jensen K, Vohra SR, Johnson E, editors. Exploring the exploratory factor analysis: Comparisons and insights from applying five procedures to determining EFA item retention. ASEE Annual Conference proceedings; 2022. Beaton D, Bombardier C, Guillemin F, Ferraz MB. Recommendations for the Cross-Cultural Adaptation of the DASH & QuickDASH Outcome Measures: Institute for Work & Health; 2007 26.04.2020. Available from: http://dash.iwh.on.ca/sites/dash/files/downloads/cross_cultural_adaptation_2007.pdf. Grady M, Drisko JW. Thorough Clinical Assessment: The Hidden Foundation of Evidence-Based Practice. Families in Society. 2014;95(1):5-14. Balzer J, Jung A, Gerhard J, Reinecke S, Mijic M, Fichtmüller A, et al. Psychometric properties of questionnaires to assess evidence-based practice among occupational, physical and speech therapists: A systematic review. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2023;176:1-11. da Silva AM, Valentim DP, Martins AL, Padula RS. Instruments to Assess Evidence-Based Practice Among Health Care Professionals: A Systematic Review. Health Educ Behav. 2024;51(3):467-76. Braun T, Ehrenbrusthoff K, Bahns C, Happe L, Kopkow C. Cross-cultural adaptation, internal consistency, test-retest reliability and feasibility of the German version of the evidence-based practice inventory. BMC Health Serv Res. 2019;19(1):455. Reicherzer L, Wirz M, Nast I. Die berufliche Situation von Physiotherapeut*innen im Schweizer Gesundheitswesen. Eine Analyse der Strukturerhebungsdaten 2016–2018. 2023;19(04):180-9. Sharma H. How short or long should be a questionnaire for any research? Researchers dilemma in deciding the appropriate questionnaire length. Saudi J Anaesth. 2022;16(1):65-8. Deutskens E, de Ruyter K, Wetzels M, Oosterveld P. Response Rate and Response Quality of Internet-Based Surveys: An Experimental Study. Marketing Letters. 2004;15(1):21-36. Additional Declarations No competing interests reported. Supplementary Files AppendixMscrptUtilisationAssessmPhysios08.0.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 07 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers invited by journal 24 Mar, 2025 Editor invited by journal 25 Feb, 2025 Editor assigned by journal 21 Feb, 2025 Submission checks completed at journal 21 Feb, 2025 First submitted to journal 15 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6038523\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":550814007,\"identity\":\"5f506601-9376-4a18-89b2-c7dad9d47727\",\"order_by\":0,\"name\":\"Sven 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21:53:08\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6038523/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6038523/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":104175898,\"identity\":\"335cf80f-306f-4bf2-9077-899fda21eba0\",\"added_by\":\"auto\",\"created_at\":\"2026-03-08 16:33:43\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":119483,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eFlow diagram of the survey\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6038523/v1/826cf6963f8dcaf1c61f0a2d.png\"},{\"id\":104175901,\"identity\":\"a2a9cb0f-d7a2-40d9-9cd3-0041cedba0a5\",\"added_by\":\"auto\",\"created_at\":\"2026-03-08 16:33:43\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":120209,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eStructure of factors\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePA1: Attitude towards the usefulness of questionnaires, PA2: Attitude towards the usefulness of PBM\\u003c/p\\u003e\\n\\u003cp\\u003eB008 usefulness for physiotherapeutic practice, B019_B019 communication patient and therapist, B019_B021 more information about patient, B019_B022 tailoring treatment, B019_B023 patients engaged in treatment planning, B019_B024 cooperation between patient and therapist, B019_B025 documenting progress, B019_B026 impact clinical reasoning, B027_B027 treatment quality;\\u003c/p\\u003e\\n\\u003cp\\u003eB040 usefulness for physiotherapeutic practice, B052_B052 communication patient and therapist, B052_B053 communication patient and physician, B052_B054 more information about patient, B052_B055 goal setting process, B052_B056 adapt treatment during course of therapy, B052_B057 documenting progress, B052_B058 impact clinical reasoning, B059_B059 argumentation paying bodies, B059_B060 treatment quality\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6038523/v1/9279fbe19a0fd507634622a7.png\"},{\"id\":104175903,\"identity\":\"1f5d4f54-0e2d-490a-93f9-40014c91be4b\",\"added_by\":\"auto\",\"created_at\":\"2026-03-08 16:33:44\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":34086,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eDistributions for (A) the total score and the subscales on the attitude towards the use of (B) performance-based measures (PBM) and (C) questionnaires\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6038523/v1/d22500c92289b531670d4f9b.png\"},{\"id\":104404906,\"identity\":\"68fc970f-53ca-4748-8c13-b4c47dc819eb\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:21:20\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":38594,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eComparison of the attitudes of the known groups towards (A) the use of performance-based measures (PBM) and (B) questionnaires\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6038523/v1/f0bbb6310b36b8aa67889f1a.png\"},{\"id\":104408680,\"identity\":\"4ee25b64-a97c-4af8-8cb0-2e377717c5d0\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:43:06\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1272414,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6038523/v1/6849c0dd-9b33-4535-bd32-1ee77d4fbe42.pdf\"},{\"id\":104404907,\"identity\":\"637a1914-adee-4de9-ab3e-dde8a66fca45\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:21:20\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":49234,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"AppendixMscrptUtilisationAssessmPhysios08.0.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6038523/v1/1de9fce4580876ef2934c92d.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003e\\u003cstrong\\u003eAttitudes of physiotherapists towards the use of performance-based measures and questionnaires\\u003c/strong\\u003e\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003e‘Assessment is defined as any systematic procedure for collecting information that can be used to make inferences about the characteristics of people or objects’ (1, 2). In practice, the terms testing, measurement and assessment are often used interchangeably (1). In its core standards, the European Region of the World Physiotherapy Association recommends using standardised outcome measures in the course of examination and progress documentation and in the documentation of results (3). Correspondingly, physiotherapists measure a patient’s health status to diagnose, document progress or predict (4). This is of fundamental importance for professional action.\\u003c/p\\u003e\\n\\u003cp\\u003eExamination findings are integral to the clinical decision-making process (5, 6). Cott et al. (7) describe, in line with the Movement Continuum Theory, that the current movement capability should be recorded through outcome measures. A structured assessment therefore serves as a cornerstone of therapeutic quality assurance and is required by law in many countries (8-10). It also shows potential to have a positive influence on treatment outcomes (11).\\u003c/p\\u003e\\n\\u003cp\\u003eIn contrast to the requirements described above, practice outcome measures are currently not widely used in physiotherapy (12-14). The reported barriers are insufficient knowledge of the various measurement instruments, insufficient training in their use, limited access and increased time expenditure (13-15). Additionally, in everyday practice, instruments are used that primarily focus on body structures or body functions. Activities in daily life, participation and quality of life are measured less often, despite their overarching importance (13, 15). This lack of emphasis could be related to the fact that therapists are not familiar with the instruments required or that the instruments are only familiar to those working in a specific setting (16).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eSome evidence indicates that physiotherapists with a positive attitude towards outcome measures tend to use them more frequently (17). However, although standardised outcome measures were the research topic in preciding work, to capture the attitudes no standardised instruments were used (13, 17-19). The resulting lack of information on the reliability and validity of the questionnaires used previously indicates that the validity of those studies might be limited. Therefore, the aim of the present study was to develop and validate a standardised instrument for measuring the attitudes of physiotherapists towards the use of outcome measures in clinical practice. In detail, structural validity, known-groups validity, internal consistency reliability and test-retest reliability were examined.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStudy design\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA validation study with two phases was conducted. In the first phase, participants were invited to complete a survey at baseline, followed by a 10-day-retest assessment. The length of the test-retest period was chosen to balance a recall effect on the one hand and a change over time on the other (20). If the survey was not completed or only completed once after two weeks, a reminder was sent manually via the survey tool (see below). In the second phase, the group of participants was expanded using an extended recruitment pathway (see \\u003cem\\u003eParticipants and recruitment\\u003c/em\\u003e). Due to the more complex contact procedures, this phase was carried out without retesting. For preparation of the manuscript, the CROSS-Checklist (Consensus-Based Checklist for Reporting of Survey Studies) was used (21).\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was conducted in accordance with the research regulations of Swissethics (Swiss Association of Research Ethics Committees). According to the decision of the Cantonal Ethics Committee for Research (Bern), this was not within the remit of the Swiss Human Research Act, as no health data were collected (Req-2022-00527). All participants voluntarily participated and gave their active informed consent to participate. The study was registered in the German Clinical Trials Register (DRKS00029360) prior to participant enrolment.\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants and recruitment\\u003c/p\\u003e\\n\\u003cp\\u003eRecruitment was conducted from September 2022 to March 2023. Inclusion criteria for the survey were licenced physiotherapist, main occupation in Switzerland and proficiency in German. Exclusion criteria were working in research or teaching only or having no therapeutic contact with patients in the previous three months.\\u003c/p\\u003e\\n\\u003cp\\u003eA call for participation in the first phase was published internally on the learning platforms of two Swiss universities. At one university, invitations were also sent by email and given in courses. In the second phase, the invitations were spread via additional university mailing lists and via the national newsletter of two musculoskeletal physiotherapy specialist groups and the newsletter of the regional professional association. Another physiotherapy musculoskeletal specialist group posted the link to the survey on its website. Considering the described procedure the exact number of people invited to participate is unknown, but an estimation is given in Figure 1.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eItem set\\u003c/p\\u003e\\n\\u003cp\\u003eAn item set was developed to build the foundation for a questionnaire that would assess the attitude towards the utilisation of outcome measures in physiotherapy practice. In this sense, outcome measures were considered questionnaires or other procedures used to systematically record patient characteristics and attributes. This information could relate to the person’s current state of health and be used for diagnostic, prognostic or documentation therapy goals (22). This definition of ‘outcome assessment’ was given to the participants prior to the item set.\\u003c/p\\u003e\\n\\u003cp\\u003eTo build on previous experience, after consultation and agreement with Braun et al., their survey questions were used as an initial orientation (13, 17). The items were assigned to the categories ‘performance-based measures’ (PBM), ‘questionnaires’ and ‘classic test and measurement procedures’ (Numeric Rating Scale, Goniometer [Range of Motion] and Measuring Tape [circumference]). The development of the items for each of the three categories covered the routine aspects associated with the utilisation of outcome measures, evaluation and interpretation, knowledge, use, workplace, training, communication, clinical decision-making, remuneration, time expenditure, quality assurance and digital use. As the items on training and digitalisation are specific constructs on their own, they were not used to compile the measurement instrument, although they were included in the survey. Each category was preceded by a list of typical instruments (see Appendix, Table A0). The participants were asked to indicate whether they were familiar with the assessments and whether they had used an assessment in the past three months.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe core items were formulated as statements (‘The use of questionnaires promotes ...’ or ‘The use of performance-based measures requires ...’). Six-point Likert scales were selected as response options (‘Completely Agree’, ‘Mostly Agree’, ‘Slightly Agree’, ‘Slightly Disagree’, ‘Mostly Disagree’ and ‘Completely Disagree’). A preliminary set of items was used in a pretest with 8 participants, using cognitive interviews and subjected to a qualitative content analysis and behaviour coding (23-25).\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 28 items on PBM, 27 on questionnaires and 10 on classic test and measurement procedures were selected for the online survey. The items were converted into an online version in Lime-Survey (LimeSurvey Version 2.56.1, LimeSurvey GmbH, Hamburg, Germany) and were set as mandatory items. The lists of typical measurement instruments in the online version included 12 for PBM, 10 for questionnaires and 3 for classical procedures (Appendix Table A0). The online version was subjected to a further four pretests with physiotherapists in Switzerland. Questionnaire completion took approximately 20 to 25 minutes.\\u003c/p\\u003e\\n\\u003cp\\u003eAnalyses\\u003c/p\\u003e\\n\\u003cp\\u003eThe analyses of the measurement properties were aligned with the criteria of the COSMIN Checklist (26). A reflective model was applied (27, 28). Analyses were performed using R Statistics, version 3.4.1 (29). For ease of understanding, the PAssAt total scores and subscores were standardised to a range of 0 to 100. To achieve this, the lowest possible raw values were subtracted and the resulting values were converted to percentages.\\u003c/p\\u003e\\n\\u003cp\\u003eValidity\\u003c/p\\u003e\\n\\u003cp\\u003eFace and content validity were verified throughout the development process by conducting pretests and regular discussions in the research group (30).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAs a first step, the largest number of items was identified from the developed set of items for PBM and for questionnaires. For this, r\\u003csub\\u003es\\u003c/sub\\u003e ≥ 0.3 was applied, with the largest mean correlation, according to Spearman. The structural validity of all items selected in this way was analysed using exploratory factor analysis. Structural validity was assumed if the .40-.30-.20 rule suggested by Howard (31) was fulfilled, meaning that (a) items were loading onto their primary factor above 0.40, and in the case of cross-loadings, (b) they were loading onto alternative factors below 0.30, and (c) they demonstrated a difference of at least 0.20 between their primary and alternative factor loadings.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAn explorative factor analysis was conducted by calculating Spearman’s rho correlations. The number of factors was determined by calculating the eigenvalues. Oblimin was selected as a rotation method to allow the establishment of correlation between factors (27). This choice appeared appropriate in the case of various subscales that measured attitudes towards the use of different outcome measures.\\u003c/p\\u003e\\n\\u003cp\\u003eFollowing the definition of the factor structure, the known group validity (as an aspect of construct validity) was determined (27). In this context, groups were determined by the questions on the use of PBM or questionnaires in the past three months (yes/no). Box plots were created, and the groups were compared using Mann-Whitney U-tests.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eReliability\\u003c/p\\u003e\\n\\u003cp\\u003eThe PBM Cronbach’s alpha was calculated to assess the internal consistency of the subscales (32). A value of 0.70 to 0.95 was defined as the acceptable range (33). For the test-retest reliability of the subscales, as well as the total score, intraclass correlation coefficients (ICC) were calculated (ICC 2.1, two-way random effects; ICCAGREEMENT). A value of ≥0.70 indicated sufficient reliability for comparison of groups (32).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFloor and ceiling effects\\u003c/p\\u003e\\n\\u003cp\\u003eCeiling or floor effects were assumed if more than 15% of the participants achieved the lowest or highest score for the instrument or its subscales (33).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eSample size\\u003c/p\\u003e\\n\\u003cp\\u003eThe sample size for the first phase of the survey was determined based on the requirements for reliability (32) and on the requirements for structural validity for the second phase (27). During the first phase (test-retest reliability), the aim was to include 50 participants, and during the second phase, a total of 100 participants.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eApproximately 200 physiotherapists were invited to participate via universities in phase 1, whereas around 900 physiotherapists were invited by email via associations in phase 2. An invitation to take part was also posted on the website of a physiotherapy association (Fig. 1). Overall, 144 participants completed the survey at least once. The retest was completed by 30 physiotherapists. The mean age of the participants was 38.9\\u0026plusmn;12.0 years, and 74% of the participants were female. Further details on the participants\\u0026rsquo; sociodemographics are presented in Table 1.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTable 1 Sociodemographic characteristics of the participants\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"633\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal sample\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(N = 144)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSubsample Test-Retest-Reliability\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n = 30)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eYears of age, mean \\u0026plusmn;SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e38.9 \\u0026plusmn;12.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e35.3 \\u0026plusmn;10.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eSex (female / male)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e107 / 37\\u003c/p\\u003e\\n \\u003cp\\u003e(74% / 26%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e20 / 10\\u003c/p\\u003e\\n \\u003cp\\u003e(67% / 33%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAdditional courses/further training completed*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e29 (20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e11 (37%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eManual lymphatic drainage / lymphological physiotherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e37 (26%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e6 (20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eManual therapy / musculoskeletal physiotherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e73 (51%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e12 (40%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eSports physiotherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e41 (28%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e5 (17%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eNeurology (e.g. Neurophysiotherapy / basic course Bobath or Proprioceptive Neuromuscular Facilitation)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e31 (22%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e4 (13%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e54 (38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e6 (20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCurrent workplace*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eHospital inpatient\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e31 (22%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e11 (37%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eHospital outpatient\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e26 (18%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e9 (30%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eIndependent practice\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e95 (66%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e18 (60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eRehab clinic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e14 (9.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e3 (10%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e10 (6.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e3 (10%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEmployment relationship*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eEmployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e109 (76%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e29 (97%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eSelf-employed / freelance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e34 (24%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e1 (3.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e4 (2.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAvailable treatment time per patient in minutes per session\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e3 (2.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e22 (15%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e5 (17%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e103 (72%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e24 (80%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e16 (11%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e1 (3.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePatients from the following areas*\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eOrthopaedics / traumatology\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e119 (83%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e20 (67%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eRheumatology\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e94 (65%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e18 (60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eInternal medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e26 (18%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e3 (10%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eGynaecology\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e10 (6.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eNeurology\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e46 (32%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e9 (30%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eGeriatrics\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e60 (42%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e8 (27%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eUrology\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e5 (3.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003ePaediatrics\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e13 (9.0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e1 (3.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003ePsychosomatic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e20 (14%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e2 (6.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e19 (13%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e6 (20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eWorking hours per week\\u003c/strong\\u003e, median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e30 (22, 38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e26 (21, 34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e81 (56%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e21 (70%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e31-40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e37 (26%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e6 (20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e26 (18%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e3 (10%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYears of experience in physiotherapy\\u003c/strong\\u003e, median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e10 (4, 22)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e4 (2, 16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLevel of education\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eGraduate physiotherapist HF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e49 (34%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e6 (20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eBachelor\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e82 (57%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e20 (67%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eMaster\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e32 (22%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e6 (20%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eDoctorate (PhD, Dr)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1 (0.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 378px;\\\"\\u003e\\n \\u003cp\\u003eOther\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e17 (12%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e2 (6.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e* multiple choices possible\\u003c/p\\u003e\\n\\u003ch2\\u003eStructural validity\\u003c/h2\\u003e\\n\\u003cp\\u003eDescriptive analyses indicated a difference in the use of various methods. While 98% of participants had used classic measurements in the past three months, the frequency of use for PBM and questionnaires was 86% and 67%, respectively. Due to this difference, a decision was made to analyse the items for the PBM and questionnaires separately.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTables 2 and 3 illustrate the correlation matrices for PBM and questionnaire items that showed correlations of r\\u003csub\\u003es\\u003c/sub\\u003e \\u0026ge; 0.3 across all combinations. Bar charts on the distribution of responses for the selected items and correlation matrices for all item combinations for the PBM and questionnaire are given in the Appendix (Figure A1, A2 and Table A1, A2).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTable 2 Correlation matrix for items on attitude towards the use of performance-based measures\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"594\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB019_B019\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB019_B021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB019_B022\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB019_B023\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB019_B024\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB019_B025\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB019_B026\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB027_B027\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB008\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB019_B019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB019_B021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB019_B022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB019_B023\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB019_B024\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB019_B025\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB019_B026\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.58\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eB008 usefulness for physiotherapeutic practice, B019_B019 communication patient and therapist, B019_B021 more information about patient, B019_B022 tailoring treatment, B019_B023 patients engaged in treatment planning, B019_B024 cooperation between patient and therapist, B019_B025 documenting progress, B019_B026 impact clinical reasoning, B027_B027 treatment quality\\u003c/p\\u003e\\n\\u003cp\\u003eTable 3 Correlation matrix for items on attitude towards the use of questionnaires\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"649\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB052_B052\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB052_B053\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB052_B054\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB052_B055\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB052_B056\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB052_B057\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB052_B058\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB059_B059\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eB059_B060\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB040\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e0.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.58\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.72\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB052_B052\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.58\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e0.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB052_B053\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e0.32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB052_B054\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e0.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB052_B055\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e0.38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB052_B056\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e0.49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB052_B057\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB052_B058\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003eB059_B059\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 72px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eB040 usefulness for physiotherapeutic practice, B052_B052 communication patient and therapist, B052_B053 communication patient and physician, B052_B054 more information about patient, B052_B055 goal setting process, B052_B056 adapt treatment during course of therapy, B052_B057 documenting progress, B052_B058 impact clinical reasoning, B059_B059 argumentation paying bodies, B059_B060 treatment quality\\u003c/p\\u003e\\n\\u003cp\\u003eIn line with the eigenvalues given by the Scree Plot (Appendix A3), a two-factor model was chosen. All variables shown in Tables 2 and 3 were analysed together in the exploratory factor analysis. A coefficient of 0.6 was obtained for the correlation between the factors (see Figure 2). The factor loadings for the attitude towards the use of PBM ranged between 0.6 and 0.9, while the factor loadings for the attitude towards the use of questionnaires ranged between 0.6 and 0.8. One item of the factor on the attitude towards the use of questionnaires also loaded with a value of 0.2 on the second factor, but since this did not break the .40-.30-.20 rule, the item was kept.\\u003c/p\\u003e\\n\\u003cp\\u003eThe distribution of the scores for the total score and the subscales is illustrated in Figure 3. Table 4 and Figure 4 confirm that the two subscales significantly differentiated the participants who use/do not use PBM or questionnaires in practice. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe relative frequencies of participants with the maximum value for the total score, the PBM and the questionnaire subscale were 2.8%, 9.7% and 4.9%, respectively, while the relative frequencies for the minimum value were 0%, 0% and 0.7%. Therefore, no floor or ceiling effects were present.\\u003c/p\\u003e\\n\\u003cp\\u003eTable 4 Differentiation of known groups\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"593\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 238px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026hellip; used within the previous 3 months\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYes\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 122px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003ePerformance-based measures\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 122px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003en\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e124\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 122px;\\\"\\u003e\\n \\u003cp\\u003e20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003eSubscale PBM Median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e84 (77, 93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 122px;\\\"\\u003e\\n \\u003cp\\u003e68 (59, 74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 0,001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 122px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003eQuestionnaire\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 122px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003en\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 122px;\\\"\\u003e\\n \\u003cp\\u003e47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 278px;\\\"\\u003e\\n \\u003cp\\u003eSubscale Questionnaire Median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e80 (74, 90)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 122px;\\\"\\u003e\\n \\u003cp\\u003e64 (56, 77)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 0,001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003ch1\\u003eReliability\\u003c/h1\\u003e\\n\\u003cp\\u003eThe test-retest reliability analysis indicated an acceptable result, with ICC = 0.84 (95% CI: 0.70 to 0.92). The values for test-retest reliability and internal consistency of the subscales, as well as the measurement errors, are given in Table 4.\\u003c/p\\u003e\\n\\u003cp\\u003eTable 4\\u0026nbsp;Internal consistency reliability, test-retest reliability and measurement error of the PAssAT scale\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"597\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 167px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 178px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSubscale performance-based measures\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 143px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSubscale questionnaire\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 167px;\\\"\\u003e\\n \\u003cp\\u003eCronbach\\u0026rsquo;s Alpha (95% CI) (n = 144)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 178px;\\\"\\u003e\\n \\u003cp\\u003e0.90 (0.87; 0.92)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 143px;\\\"\\u003e\\n \\u003cp\\u003e0.93 (0.91; 0.95)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 167px;\\\"\\u003e\\n \\u003cp\\u003eICC\\u003csub\\u003e2.1\\u003c/sub\\u003e (95% CI) (n = 30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e0.84 (0.70; 0.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 178px;\\\"\\u003e\\n \\u003cp\\u003e0.82 (0.67; 0.91)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 143px;\\\"\\u003e\\n \\u003cp\\u003e0.86 (0.72; 0.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 167px;\\\"\\u003e\\n \\u003cp\\u003eSEM\\u003csub\\u003eAGREEMENT\\u0026nbsp;\\u003c/sub\\u003e(n = 30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e4.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 178px;\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 143px;\\\"\\u003e\\n \\u003cp\\u003e3.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, a questionnaire to measure the attitudes of physiotherapists towards the use of outcome measures in clinical practice was developed in a structured process. The final instrument consisted of two subscales: one on attitudes towards the use of PBM and the other on attitudes towards the use of questionnaires. The two subscales correlated substantially with each other and each subscale demonstrated acceptable internal consistency reliability. Acceptable results for the test-retest reliability of the scale indicated that the results for two groups can be measured and compared reliably. No ceiling or floor effects were detected. \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eA comprehensive set of items was first generated for the subsequent selection of suitable items (30). This procedure proved sufficient for applying a reflective model (27). Several items were not retained in the final set. Assigning the total set of 19 items to two subscales revealed some items that were appropriate for use as interpretable factors (Moosbrugger and Kelava, 2020). This maintained the distinction between PBM and questionnaires that was envisaged during the development process. However, items based on classical measures, such as goniometer or measuring tape measurements, were removed because the data showed that their utilisation differed substantially from the previous data and therefore might reflect a different construct. This aspect of the assessment should be revisited in future work. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eNo clear consensus on factor loadings has yet been identified in the statistical literature (34). However, all items in the present study loaded well on their specific factor and the one item with a double loading met the conservatively set requirements of the .40-.30-.20-rule (31).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003ePrevious research showed that the actual use of an outcome measure and its reported use or the attitude towards it can differ (15). The compiled instrument developed here at least enabled a significant differentiation between participants who stated that they used or did not use PBM or questionnaires in practice. The results on reliability justify the differentiation of the group mean values. Higher values would have been desirable for differentiating at the level of individuals (32).\\u003c/p\\u003e\\n\\u003cp\\u003eFace validity was tested in multiple pretests prior to this study. The final tool strongly relates to communication and clinical decision making. Conceivably, future studies could examine whether the content coverage can be expanded by developing further strengthens dimensions of use, such as quality assurance or reimbursement (1).\\u003c/p\\u003e\\n\\u003cp\\u003eThe included list of known/used instruments is presumably a significant component of the questionnaire, especially with regard to attitudes towards PBM, as it makes the construct more transparent for the respondents. In the case of cross-cultural adaptations, further adaptations of this list may be necessary (35).\\u003c/p\\u003e\\n\\u003cp\\u003eA standardised clinical assessment is an important foundation of evidence-based practice (11, 36). Instruments addressing this field have been developed, but the attitude towards the use of clinical measurements needs more attention (37, 38). The values determined in the present study indicate that — as in evidence-based practice in general — the attitude towards the use of outcome measures is positive, but the use of questionnaires is particularly limited (39). The developed PAssAt-scale is useful in a variety of ways, such as in teaching, postgraduate education and research to explore the gaps described. In training, changes in the attitude towards the use of outcome measures from pre- to post-participation in courses can be assessed. In implementation science, the instrument can be used to determine baseline values, thereby supporting the development of tailored interventions to facilitate the use of standardised outcome measures in clinical routines.\\u003c/p\\u003e\\n\\u003cp\\u003eStrengths and limitations\\u003c/p\\u003e\\n\\u003cp\\u003eMost of the Swiss physiotherapists in this study fell into an age category around 38 years, and three-quarters were female; thus, the sociodemographic data of the surveyed sample closely reflects the characteristics of physiotherapists in terms of age and gender when compared with recent federal data. The proportion of master’s degrees was higher (40), which might be explained by access via universities and the greater willingness of therapists with higher academic qualifications to take part in surveys (13).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was registered before implementation. The consistent realisation of the design developed a priori, except for the additional analysis of known-group validity, can therefore be verified.\\u003c/p\\u003e\\n\\u003cp\\u003eStarting with a comprehensive set of items was of great importance for the development process. This meant that the time required to answer all items ranged from 20 to 25 minutes and therefore was in line with the suggestion given by Sharma (41) to stay under 30 minutes. This duration likely influenced the number of surveys fully completed by the retest participants. The finally selected set of items will naturally take considerably less time. This will likely lead to more complete data in future projects since shorter questionnaires result in higher response rates (42). Furthermore, the possibility of working with incentives for participation should be considered in future projects (42). \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe overall lower-than-planned response rate for the retest questionnaires means a limitation for reliability (33). Nevertheless, the confidence intervals remained within a range defined as acceptable. Only the lower 95% CI value of the subscale for PBM slightly missed the set threshold. \\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe developed questionnaire provides an instrument for the assessment of physiotherapists\\u0026rsquo; attitudes towards the use of standardised outcome measures in clinical practice. The instrument can be used as a standardised module, thereby strengthening future surveys on the topic. It facilitates comparison of groups in research or post-graduation programmes. Nevertheless, extending the coverage of the construct of attitude towards the use of outcome measures in physiotherapy remains a possibility.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eCROSS: Consensus-Based Checklist for Reporting of Survey Studies\\u003c/p\\u003e\\n\\u003cp\\u003ePBM: Performance-Based Measures\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study falls, according to the decision of the Cantonal Ethics Committee for Research (Bern), not under the authority of the Swiss Human Research Act (Req-2022-00527), as no health-sensitive data was requested.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll participants participated voluntarily and gave their active informed consent to participate.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study data will be shared by the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no conflict of interest.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was conducted without external funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors' contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDesign of the work: SK, TBu, SR, BRW, JK, TBr\\u003c/p\\u003e\\n\\u003cp\\u003eAcquisition of data: TBu, BRW, JK\\u003c/p\\u003e\\n\\u003cp\\u003eAnalysis of data: TBu, SK, SR, JK\\u003c/p\\u003e\\n\\u003cp\\u003eInterpretation of data: SK, TBu, SR, BRW, JK, TBr\\u003c/p\\u003e\\n\\u003cp\\u003eDrafted the work or substantively revised: SK, TBu, SR, BRW, JK, TBr\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors thank all study participants.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eReynolds CR, Altmann RA, Allen DN. Mastering Modern Psychological Testing Theory and Methods. 2 ed. Cham: Springer International Publishing; 2021.\\u003c/li\\u003e\\n\\u003cli\\u003eAmerican Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for educational and psychological testing. Washington: American Educational Research Association; 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eEuropean Region World Physiotherapy. European Core Standards of Physiotherapy 2018. Available from: https://www.erwcpt.eu/_files/ugd/3e47dc_032110c5811a4710bfa866acb32a5587.pdf.\\u003c/li\\u003e\\n\\u003cli\\u003ePotter K, Fulk GD, Salem Y, Sullivan J. Outcome measures in neurological physical therapy practice: part I. Making sound decisions. J Neurol Phys Ther. 2011;35(2):57-64.\\u003c/li\\u003e\\n\\u003cli\\u003eKarstens S, Schulte-Frei B, Wolff H, Frob\\u0026ouml;se I. Physiotherapie: Theoretischer Rahmen und Interventionen. In: Frob\\u0026ouml;se I, Nellessen-Martens G, Wilke C, editors. Training in der Therapie - Grundlagen. 4 ed. M\\u0026uuml;nchen: Urban \\u0026amp; Fischer; 2015. p. 223-35.\\u003c/li\\u003e\\n\\u003cli\\u003eWiderstr\\u0026ouml;m B, Elv\\u0026eacute;n M, Rasmussen-Barr E, Bostr\\u0026ouml;m C. \\u0026quot;How does physical examination findings influence physiotherapists\\u0026apos; decision-making when matching treatment to patients with low back pain?\\u0026quot;. Musculoskelet Sci Pract. 2021;53:102374.\\u003c/li\\u003e\\n\\u003cli\\u003eCott CA, Finch E, Gasner D, Yoshida K, Thomas SG, Verrier MC. The Movement Continuum Theory of Physical Therapy. Physiother Can. 1995;47:87-95.\\u003c/li\\u003e\\n\\u003cli\\u003ePhillips A, Stiller K, Williams M. Medical Record Documentation: The Quality of Physiotherapy Entries. Internet Journal of Allied Health Sciences and Practice. 2006.\\u003c/li\\u003e\\n\\u003cli\\u003eGeraedts M, Dr\\u0026ouml;sler SE, D\\u0026ouml;bler K, Eberlein-Gonska M, Heller G, Kuske S, et al. DNVF-Memorandum III \\u0026bdquo;Methoden f\\u0026uuml;r die Versorgungsforschung\\u0026ldquo;, Teil 3: Methoden der Qualit\\u0026auml;ts- und Patientensicherheitsforschung. Gesundheitswesen. 2017;79(10):e95-e124.\\u003c/li\\u003e\\n\\u003cli\\u003eKyte DG, Calvert M, van der Wees PJ, ten Hove R, Tolan S, Hill JC. An introduction to patient-reported outcome measures (PROMs) in physiotherapy. Physiotherapy. 2015;101(2):119-25.\\u003c/li\\u003e\\n\\u003cli\\u003eLambert MJ, Harmon KL. The merits of implementing routine outcome monitoring in clinical practice. Clinical Psychology: Science and Practice. 2018;25(4):e12268.\\u003c/li\\u003e\\n\\u003cli\\u003eDuncan EAS, Murray J. The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC Health Serv Res. 2012;12(1):96.\\u003c/li\\u003e\\n\\u003cli\\u003eBraun T, Rieckmann A, Weber F, Gr\\u0026uuml;neberg C. Current use of measurement instruments by physiotherapists working in Germany: a cross-sectional online survey. BMC Health Serv Res. 2018;18(1):810.\\u003c/li\\u003e\\n\\u003cli\\u003eLeiner G, Pallauf M, M\\u0026uuml;ller G, Seeberger B. Anwendung von Assessments in der Physiotherapie \\u0026ndash; eine empirische Studie in \\u0026Ouml;sterreich. physioscience. 2021;17(04):150-60.\\u003c/li\\u003e\\n\\u003cli\\u003eSwinkels RA, van Peppen RP, Wittink H, Custers JW, Beurskens AJ. Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands. BMC Musculoskelet Disord. 2011;12:106.\\u003c/li\\u003e\\n\\u003cli\\u003eOesch P, Kool J, Overberg J-A, Perrot G, Rigter K, Ott B, et al. Kenntnisse und Anwendung von Assessments in der muskuloskelettalen Rehabilitation: Eine Umfrage in Spit\\u0026auml;lern und Rehabilitationskliniken der deutschsprachigen Schweiz. fisio active. 2004(5):5-11.\\u003c/li\\u003e\\n\\u003cli\\u003eSchomberg M, Braun T, Handgraaf M, Aftenberger H, Gr\\u0026uuml;neberg C. F\\u0026ouml;rderfaktoren und Barrieren in der Anwendung von Assessments in der Neurorehabilitation. Zeitschrift f\\u0026uuml;r Physiotherapeuten. 2016;68:25-38.\\u003c/li\\u003e\\n\\u003cli\\u003eJette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: perceptions and applications. Phys Ther. 2009;89(2):125-35.\\u003c/li\\u003e\\n\\u003cli\\u003eCopeland JM, Taylor WJ, Dean SG. Factors influencing the use of outcome measures for patients with low back pain: a survey of New Zealand physical therapists. Phys Ther. 2008;88(12):1492-505.\\u003c/li\\u003e\\n\\u003cli\\u003eStreiner DL, Norman GR, Cairney J. Health Measurement Scales: A practical guide to their development and use: Oxford University Press; 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eSharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36(10):3179-87.\\u003c/li\\u003e\\n\\u003cli\\u003eWirz M, Koehler B, Marks D, Kool J, Sattelmayer M, Oesch P, et al. Lehrbuch Assessments in der Rehabilitation - Messmethoden f\\u0026uuml;r Physiotherapeuten. Bern: Hogrefe AG; 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eLenzner T, Neuert C, Otto W, Gesis. GESIS Survey Guidelines. Kognitives Pretesting2015.\\u003c/li\\u003e\\n\\u003cli\\u003ePorst R. Fragebogen. Ein Arbeitsbuch. Wiesbaden: Springer VS; 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eMayring P. Qualitative Content Analysis. Forum: Qualitative Social Research. 2000;1(2):20.\\u003c/li\\u003e\\n\\u003cli\\u003eMokkink LB, Prinsen CAC, Patrick DL, Alonso J, Bouter LM, de Vet HCW, et al. COSMIN Study Design checklist for Patient-reported outcome measurement instruments 2019. Available from: https://www.cosmin.nl/wp-content/uploads/COSMIN-study-designing-checklist_final.pdf.\\u003c/li\\u003e\\n\\u003cli\\u003eFayers PM, Machin D. Quality of life the assessment, analysis, and reporting of patient-reported outcomes. Chichester: John Wiley \\u0026amp; Sons Inc; 2016.\\u003c/li\\u003e\\n\\u003cli\\u003eJung A, Challoumas D, Pagels L, Armijo-Olivo S, Braun T, Luedtke K. Guidelines for the development and validation of patient-reported outcome measures: a scoping review. BMJ evidence-based medicine. 2024;29(6):363-73.\\u003c/li\\u003e\\n\\u003cli\\u003eR Development Core Team. R: A language and environment for statistical computing Vienna, Austria: R Foundation for Statistical Computing; 2014. Available from: http://www.R-project.org.\\u003c/li\\u003e\\n\\u003cli\\u003eMoosbrugger H, Kelava A. Testtheorie und Fragebogenkonstruktion. 3. ed. Berlin, Heidelberg: Springer Berlin Heidelberg; 2020.\\u003c/li\\u003e\\n\\u003cli\\u003eHoward M. A Review of Exploratory Factor Analysis (EFA) Decisions and Overview of Current Practices: What We Are Doing and How Can We Improve? Int J Hum Comput Interact. 2015;32:150914142834000.\\u003c/li\\u003e\\n\\u003cli\\u003ede Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in Medicine: A Practical Guide. Cambridge: Cambridge University Press; 2011.\\u003c/li\\u003e\\n\\u003cli\\u003eTerwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42.\\u003c/li\\u003e\\n\\u003cli\\u003eMirabelli J, Jensen K, Vohra SR, Johnson E, editors. Exploring the exploratory factor analysis: Comparisons and insights from applying five procedures to determining EFA item retention. ASEE Annual Conference proceedings; 2022.\\u003c/li\\u003e\\n\\u003cli\\u003eBeaton D, Bombardier C, Guillemin F, Ferraz MB. Recommendations for the Cross-Cultural Adaptation of the DASH \\u0026amp; QuickDASH Outcome Measures: Institute for Work \\u0026amp; Health; 2007 26.04.2020. Available from: http://dash.iwh.on.ca/sites/dash/files/downloads/cross_cultural_adaptation_2007.pdf.\\u003c/li\\u003e\\n\\u003cli\\u003eGrady M, Drisko JW. Thorough Clinical Assessment: The Hidden Foundation of Evidence-Based Practice. Families in Society. 2014;95(1):5-14.\\u003c/li\\u003e\\n\\u003cli\\u003eBalzer J, Jung A, Gerhard J, Reinecke S, Mijic M, Fichtm\\u0026uuml;ller A, et al. Psychometric properties of questionnaires to assess evidence-based practice among occupational, physical and speech therapists: A systematic review. Zeitschrift f\\u0026uuml;r Evidenz, Fortbildung und Qualit\\u0026auml;t im Gesundheitswesen. 2023;176:1-11.\\u003c/li\\u003e\\n\\u003cli\\u003eda Silva AM, Valentim DP, Martins AL, Padula RS. Instruments to Assess Evidence-Based Practice Among Health Care Professionals: A Systematic Review. Health Educ Behav. 2024;51(3):467-76.\\u003c/li\\u003e\\n\\u003cli\\u003eBraun T, Ehrenbrusthoff K, Bahns C, Happe L, Kopkow C. Cross-cultural adaptation, internal consistency, test-retest reliability and feasibility of the German version of the evidence-based practice inventory. BMC Health Serv Res. 2019;19(1):455.\\u003c/li\\u003e\\n\\u003cli\\u003eReicherzer L, Wirz M, Nast I. Die berufliche Situation von Physiotherapeut*innen im Schweizer Gesundheitswesen. Eine Analyse der Strukturerhebungsdaten 2016\\u0026ndash;2018. 2023;19(04):180-9.\\u003c/li\\u003e\\n\\u003cli\\u003eSharma H. How short or long should be a questionnaire for any research? Researchers dilemma in deciding the appropriate questionnaire length. Saudi J Anaesth. 2022;16(1):65-8.\\u003c/li\\u003e\\n\\u003cli\\u003eDeutskens E, de Ruyter K, Wetzels M, Oosterveld P. Response Rate and Response Quality of Internet-Based Surveys: An Experimental Study. Marketing Letters. 2004;15(1):21-36.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-medical-education\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"meed\",\"sideBox\":\"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/meed/default.aspx\",\"title\":\"BMC Medical Education\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Measurement instrument, Outcome measure, Physiotherapy, Psychometrics, Clinical Reasoning\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6038523/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6038523/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe use of outcome assessments in physiotherapy is widely recommended to support clinical decision-making, document patient progress and ensure therapeutic quality. Despite these recommendations, outcome assessments are underutilised in practice. One factor that might influence their usage is physiotherapists’ attitudes towards them. However, informative value from existing research is limited due to the use of non-standardised instruments to measure these attitudes.\\u003c/p\\u003e\\n\\u003cp\\u003eThe aim of this study was to develop a standardised instrument for measuring the attitudes of physiotherapists towards the use of outcome assessments in clinical practice and to examine the instrument’s validity and reliability.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA set of preliminary items was generated and tested within a two-phase validation study conducted as an online survey. Licenced physiotherapists were invited to participate. Phase one included a 10-day-retest, whereas the survey was completed only once in the second phase.\\u003c/p\\u003e\\n\\u003cp\\u003eCorrelation analyses were performed to explore the relationships between items and identify clusters potentially measuring the same construct. Factor analysis was performed to assess structural validity. Test-retest reliability (ICC) and internal consistency reliability (Cronbach’s alpha) were determined, as well as floor and ceiling effects.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eData were collected from 144 physiotherapists, and 30 participants completed the retest assessment. The final instrument consists of a subscale of 9 items for the attitude towards the use of performance-based measures (PBM) and one with 10 towards the use of questionnaires, with factor loadings between 0.6 and 0.9. The instrument significantly differentiates between therapists who use/do not use PBM or questionnaires in practice. Cronbach’s alpha for the subscales was 0.90/0.93 and ICC was 0.84. No floor or ceiling effects were given.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe developed instrument might provide a better understanding of the impact of attitudes on the use of clinical outcome assessments in physiotherapy practice. First evidence of the instrument’s psychometric properties indicate it as a valuable tool for research and education, supporting analysis of the gap between the recommended and actual use of outcome assessments.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTrial registration: \\u003c/strong\\u003eGerman Clinical Trials Register (DRKS00029360). 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