The main focus of this study was to assess the level of agreement of interpretation of plain radiographs (PFR) between the radiologists and physiotherapists in Ghana. The mean score of interpretation of the physiotherapists compared to that of the radiologists in this study was 12.7 (approximately 50.0% of the total point) which was statistically lower than the required scores. This finding falls short of expectation giving the high agreement of other health care professionals with the radiologists in the previous studies [5, 6]. For instance, Brealey et al. reported high accuracy levels for radiographers at 92.6% and 97.7% sensitivity and specificity respectively  while Benger submitted that nurses working in remote units had 96% sensitivity and 87% specificity in the interpretation agreement . These variations might not be unconnected with the different settings in which the studies were conducted.
In addition, approximately 85.4% of the physiotherapists’ scores were within the moderate range (9–16 points) which implies that majority of the participants’ performances were within the average in PFR interpretation. Although PFR viewing is a common routine procedure in physiotherapy, it seems little priority has been placed on its techniques in the series of their continuing education programmes. Presumably, they might have acquired their rudimentary skills through personal efforts and interest. These speculations may be justifiable given the crops of young generation of the practicing physiotherapists in Ghana.
In the same vein, the levels of agreement in the interpretation of PFR by the physiotherapists’ were significantly associated with their academic qualification and sex. Most of the physiotherapists were first degree holders implying that they were still at the minimum entry level of the profession as stipulated by the World Confederation for Physical Therapy . Post-graduate training programme in the field of physiotherapy is yet to take off in Ghana, thus the few physiotherapists with masters degree had to divert to other fields that may not directly impact on their clinical proficiency. The link between gender and level of agreement may be ascribed to the relative proportion of the sampled male and female physiotherapists in this study. Contrarily, the age, work settings, years of clinical practice and the preferred PFR views have no significant impact on the level of agreements. These findings suggest that the physiotherapists’ disposition towards PFR viewing rather than the selected clinical variables are the influencing factors. Further, specialty physiotherapy training and practice in Ghana are yet to be established, hence daily practice cuts across the branches of the profession without specific emphasis on orthopaedics-related cases where x-ray viewing and interpretation are mostly needed.
A shift in the focus of health care delivery from the hospital to the community, are placing increased demands on physiotherapists to embrace primary-care systems. Available evidence suggests that physiotherapists’ involvements in the primary health care setting are beneficial to patients suffering from musculoskeletal problems such as arthritis and low back pain . Indeed, the convergence of rising health care costs and physician shortages have made health care transformation a priority in many developing countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for most allied health professionals. Physiotherapists in extended scope roles must emerge as key providers in such new models, especially in settings providing services to patients with musculoskeletal disorders .
Limitation of the study
The findings from this study are limited by the use of very few plain film radiographs of patients suffering from lumbar spondylosis with which the participants were assessed. Sampling over sufficient numbers of patients’ x-rays would have ensured external validity of the results. These observations should be the focus of the future study.