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Abstract

Purpose. Musculoskeletal disorders are a major cause of disability, underscoring the need for clearly defined and assessable competencies in physical therapy education. Although OSCEs are increasingly used in physical therapy programs, evidence regarding their design and psychometric properties is not yet fully characterized within musculoskeletal physical therapy education. This systematic review aimed to describe how OSCEs have been applied to assess musculoskeletal competencies in physical therapy education, summarize their structural characteristics and reported psychometric properties, and identify methodological gaps.

Method. A systematic review was performed according to PRISMA guidelines. Electronic searches were conducted in PubMed, Scopus, Web of Science, EBSCOhost, ScienceDirect, SciELO, Cochrane Library, and Google Scholar (updated on June 3, 2026). Studies reporting experimental and observational use of OSCEs to assess musculoskeletal competencies in physical therapy students were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools and risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool in randomized controlled trials. Psychometric properties were evaluated according to the COSMIN framework. Because of heterogeneity in study design and outcomes, the results were synthesized narratively. The review was registered in PROSPERO (registration number: CRD42023475453).

Results. Eleven studies met the inclusion criteria, including cross-sectional, cohort, and randomized controlled designs, involving 610 physical therapy students. Methodological quality was generally moderate across the included studies (mean JBI score = 72%). Frequent methodological weaknesses included lack of assessor blinding and limited control of confounding variables. Evidence was available for inter-rater reliability (ICC = 0.71–0.90) and internal consistency (α =0.83–0.91; KR-20 = 0.78), with limited evidence for construct validity (KMO = 0.71). Moderate to substantial agreement in clinical reasoning assessments was observed following educational interventions (κ = 0.56–0.72), and student satisfaction with OSCE-based assessments was high (90.7%; 95% CI: 84.1–97.2). Among the two included RCTs, both were judged as having a overall high risk of bias according to the RoB 2 tool.

Conclusion. OSCEs may represent a useful approach for assessing musculoskeletal competencies in physical therapy education; however, current psychometric evidence remains limited and heterogeneous, and variability in structure, scoring, and validation limits comparability across studies. Future research should adopt standardized, COSMIN-informed frameworks to strengthen methodological rigor and educational consistency.

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