Exploration of Physiotherapists' Understanding and Application of Safety Netting Procedures in France-A Qualitative Study.

backgroundPhysiotherapists in primary care frequently manage patients with musculoskeletal disorders that may conceal serious underlying pathologies, leading to diagnostic uncertainty. Although safety netting is recommended to enhance diagnostic reasoning and ensure patient safety, its conceptualisation and implementation in physiotherapy remain poorly understood. PURPOSE: This study aimed to explore how physiotherapists understand and apply safety netting in clinical practice, with particular attention to diagnostic uncertainty, patient safety and interprofessional collaboration.

methodsA generic qualitative study was undertaken in France. Twenty-eight (28) physiotherapists were purposively recruited to achieve maximum variation in clinical experience, practice setting and postgraduate training. Semi-structured interviews were analysed using an inductive reflexive thematic analysis.

resultsAn interpretive typology comprising three diagnostic uncertainty scenarios (controlled, manageable and challenging uncertainty), was developed. The typology shows that safety netting implementation is shaped by the interaction between clinical expertise, organisational support, interprofessional collaboration and access to healthcare resources. Controlled uncertainty was characterised by integrated support systems that facilitated confident clinical decision-making, whereas challenging uncertainty reflected fragmented care pathways, limited resources and reduced confidence in managing serious underlying pathologies. Across all scenarios, participants framed safety netting as a dynamic patient-centred framework, integrating clinical assessment, clinical reasoning, patient education, follow-up planning and referral decision-making.

conclusionsIn physiotherapy, safety netting appears to be a context-dependent approach to managing diagnostic uncertainty rather than a standardised procedure. The proposed typology provides a conceptual framework for understanding how individual, professional and organisational factors interact to shape safety netting implementation, with implications for physiotherapy education, interprofessional collaboration and patient safety.