Content Validation of PT Solutions Physical Therapy Clinical Pathways© for Management of Musculoskeletal (MSK) Conditions Using the CARE-CCF Tool

Background Musculoskeletal (MSK) care shows significant variability in clinical decision-making, influenced by differences in clinician judgment. To assist with streamlined care, clinicians have consistently used support from tools such as clinical practice guidelines and algorithms. In this study, we have developed six clinical pathways to provide clinicians with patient care guidelines to manage MSK conditions with consistent care. This study evaluated the contents of the six novel PT Solutions Physical Therapy Clinical Pathways© used to manage MSK conditions. Content validation is necessary to confirm that they accurately represent clinical knowledge and are evidence-based to ensure their efficacy. Methods Thirty-five subject matter experts (SMEs) were invited to complete an anonymous 34-question online survey on clarity, applicability, relevance, effectiveness, comprehensiveness, completeness, and feasibility described as the CARE-CCF tool for usability of the pathways in different clinical settings. The study design included the Delphi Method to validate the contents across three rounds, which involved initial responses (round 1), refinement and consensus (round 2), and final consensus (round 3). Results Mutual consensus was achieved in a total of two rounds. The Content Validation Index (CVI) was used as a statistical analysis to quantify the responses to the survey. The CVI acceptance threshold was > 0.78. The Item-CVI evaluated the individual item content validity with a response. Five questions had an I-CVI of < 0.78. This included 2 Likert-type and 3 Yes/No questions. The overall CVI or SCVI/Average was ≥ 0.80. The results of round 1 and revisions were shared with the SMEs. Twenty-nine responses were received in round 2, and > 79% agreed on the revisions. The survey was closed and completed with round 2 as a mutual consensus agreement with the set threshold on all items was achieved. Conclusion The results of this survey provide excellent validation for the pathways' contents and their use to standardize clinical decision-making for MSK care. The SMEs agreed that the structure and content of the clinical pathways provide them with guidance to handle varied types of MSK disorders while also maintaining their clinical autonomy for standardized care and reduced clinician variability.