There is a concern that traditional instruction based methods of learning do not adequately prepare students for the challenges of physical therapy practice. Self-directed learning is considered to be the most appropriate educational approach to enhance life-long learning as it enhances self-efficacy. This study compares outcomes in two educational approaches: self-directed learning (SDL), and traditional instruction based learning (IBL). In this non-randomized experimental study two groups of second year physiotherapy students were compared using pre-post-test assessments. Study results (both knowledge and physiotherapy performance), and self-reported self-efficacy were used as outcome variables. Study results from the end of year 1 and the end of year two were retrieved form the student information system. Self-reported variables including general and physical therapy self-efficacy were assessed using an online questionnaire which was completed at the start and the end of year two. Changes in self-efficacy were analysed using a repeated measures multivariate ANOVA. A total of 174 students were enrolled in the second year, of which 108 (62%) agreed to participate in the online questionnaire. The online questionnaire at baseline (September 2015) was completed by 27 students in the SDL condition compared to 81 students in the IBL condition. There were no statistical differences at baseline between both educational approaches on any of the variables in the study. At the end of year two, there was no difference between both conditions in indicators of study results: knowledge and performance. Perceived self-efficacy in functioning as a physical therapist increased between both assessments. However, this increase was observed in both condition, and the difference between both conditions was not statistically significant. Self-directed learning and traditional instruction based learning result in equal study outcome and self-efficacy at the end of year two. More research is needed to determine the long term outcome that is most relevant for lifelong learning, and which students will benefit most from this approach. Nonetheless, self-directed learning might be an important alternative for instruction-based l education.

Apart from skills, and knowledge, self-efficacy is an important factor in the students’ preparation for clinical work. The Physiotherapist Self-Efficacy (PSE) questionnaire was developed to measure physical therapy (TP) students’ self-efficacy in the cardiorespiratory, musculoskeletal, and neurological clinical areas. The aim of this study was to establish the measurement properties of the Dutch PSE questionnaire, and to explore whether self-efficacy beliefs in students are clinical area specific. Methodological quality of the PSE was studied using COSMIN guidelines. Item analysis, structural validity, and internal consistency of the PSE were determined in 207 students. Test-retest reliability was established in another sample of 60 students completing the PSE twice. Responsiveness of the scales was determined in 80 students completing the PSE at the start and the end of the second year. Hypothesis testing was used to determine construct validity of the PSE. Exploratory factor analysis resulted in three meaningful components explaining similar proportions of variance (25%, 21%, and 20%), reflecting the three clinical areas. Internal consistency of each of the three subscales was excellent (Cronbach’s alpha > .90). Intra Class Correlation Coefficient was good (.80). Hypothesis testing confirmed construct validity of the PSE. The PSE shows excellent measurement properties. The component structure of the PSE suggests that self-efficacy about physiotherapy in PT students is not generic, but specific for a clinical area. As self-efficacy is considered a predictor of performance in clinical settings, enhancing self-efficacy is an explicit goal of educational interventions. Further research is needed to determine if the scale is specific enough to assess the effect of educational interventions on student self-efficacy.

Rationale: Adherence rates to guidelines show room for improvement, and increase in adherence to guidelines may potentially lead to better outcomes and reduced costs of treatment. To improve adherence, it is essential to understand the considerations of physiotherapists regarding the assessment and management of low back pain (LBP). The purpose of this study is to gain insight in the considerations of Dutch physiotherapists on adherence to the national physiotherapy guideline in the treatment of patients with LBP.Methods: This is a qualitative study, using an interpretive approach of semi‐structured interviews with 14 physiotherapists who regularly treat patients with LBP. Thematic analysis was conducted with open coding using an existing framework. This framework distinguishes five components to adherence based on patient factors, provider factors, guideline characteristics, institutional factors and the implementation process.Results: Participating physiotherapists mentioned that the guideline should provide more information about psychosocial prognostic factors and psychosocial treatment options. The participants experienced difficulties in addressing patient expectations that conflict with guideline recommendations. The implementation process of the guideline was considered insufficient. Physiotherapists might rely too much on their experience, and knowledge of evidence‐based treatment might be improved. In general, the interviewed physiotherapists thought they were mainly non‐adherent to the guidelines. However, when comparing their considerations with the actual guideline recommendations they were mainly adherent.Conclusion: To improve adherence, the guideline should provide more information about addressing psychosocial prognostic factors, and Dutch physiotherapists might be trained in communication skills to better address patient expectations. A more extensive implementation process is warranted for the next guideline to increase the physiotherapists' knowledge of evidence‐based treatment.

Understanding motivation for exercise can be helpful in improving levels of physical activity. The Physical Activity and Leisure Motivation Scale (PALMS) measures distinct goal-oriented motivations. In this study selected measurement properties of the Dutch version (PALMS-D) are determined. Forward-backward translation was used for cross-cultural adaptation. Construct validity of the PALMS-D was assessed in five subsamples completing the PALMS-D and the Behavioral Regulation in Exercise Questionnaire (BREQ-3). The study population consisted of five samples recruited from different populations; samples consisted of runners, hockey players, soccer players, participants in medical fitness, and a sedentary group of young adults with low activity. A total of 733 participants completed the questionnaire: 562 athletes and 171 non-athletes. Exploratory for Analysis confirmed the original eight factors. Internal consistency of the subscales was high, except for Others’ expectations. The a priori determined hypotheses related to differences between athletes participating in different sports were confirmed, as well as the hypothesis related to differences between amateur athletes, patients in medical fitness, and non-active participants. It was concluded that the Dutch version of the PALMS is an acceptable questionnaire with which to evaluate the individual motivation of athletes in the Netherlands, and discriminates between different leisure athletes, patients in medical fitness, and non-active youths.

Background: Improving pain education for undergraduate health professionals is hampered by lacking shared education outcomes. This study describes how educators and pain experts operationalize content and competency levels deemed necessary for a undergraduate pain education core curriculum for health professionals (physical and occupational therapists, nurses, psychologists). Methods: Educators and experts on pain and pain education gave their opinion on content and competency level for each individual item of the International Association for the Study of Pain (IASP) inter professional curriculum. Participants decided whether or not to include each item in the undergraduate curriculum. Items were included when > 70% of the respondents agreed. The required competency for each item was rated using ordinal Dublin Descriptors. Results: Overall, 22 experts rated the curriculum, with > 70% agreement on inclusion on 62% of the IASP items. Within the IASP domain ‘Multidimensional nature of pain’ there was full agreement on the inclusion of 12 items. ‘Ethics’ was considered less important with only 1 item deemed necessary. There is a high number of items selected within the domains ‘Pain Assessment and measurement’ (78%) and ‘Management of Pain’ (74%). Considerably less items were chosen in the domain ‘Clinical Conditions’ (41%). For most items the median required skills and competency level was either Knowledge and Understanding, or Applying Knowledge and Understanding. Conclusion: Overall, educators and experts in pain agreed on content and competency levels for an undergraduate pain curriculum based on the IASP. Defining a shared competency level will help improve definition of education outcome.