Knowledge of Italian Physiotherapists on Cognitive Testing of Musculoskeletal Disorders

Neurocognitive tests and treatments are increasingly recognised as relevant in Musculoskeletal Physiotherapy. However, their integration into clinical physiotherapy remains limited. Therefore, the aim of this study was to assess the knowledge, beliefs, and clinical use of neurocognitive tests and treatments for musculoskeletal disorders among Italian physiotherapists.

A cross-sectional online survey was conducted between July 2024 and February 2025 according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The 23-item questionnaire explored demographic data, knowledge, clinical use, and treatment practices.

A total of 383 responses were analysed. Physiotherapists with a first-level Master's degree or Orthopaedic Manipulative Physical Therapist (OMPT) qualification demonstrated significantly greater knowledge and use of neurocognitive tools (p < 0.01). Younger physiotherapists (aged 21-30) and those working in direct access settings reported higher use and perceived usefulness of cognitive testing, particularly in Anterior Cruciate Ligament (ACL) injuries, Lateral Ankle Sprain (LAS) and Chronic Ankle Instability (CAI) cases. Female physiotherapists were more likely to recognise the value of neurocognitive assessments and interventions. Despite this, 75% of respondents found it difficult to select appropriate tools or cognitive domains to assess. More than 50% reported not using neurocognitive tests in Anterior Cruciate Ligament (ACL) injuries and Chronic Ankle Instability (CAI) management; among those who use them modified Stars Excursion Balance Test (mSEBT) and neurocognitive hop test are the most cited tools.

Despite the growing interest, neurocognitive assessment remains underutilised in musculoskeletal physiotherapy in Italy. Specialised education (e.g., OMPT training), younger age, and direct access work settings are associated with greater adoption. Further integration into bachelor's degree education and clearer clinical guidelines are needed to improve both assessment and treatment.