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Gross AR, Olson KA, Pool J, Basson A, Clewley D, Dice JL, Milne N. Spinal manipulation and mobilisation in paediatrics - an international evidence-based position statement for physiotherapists. J Man Manip Ther 2024; 32:211-233. [PMID: 38855972 DOI: 10.1080/10669817.2024.2332026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/14/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION An international taskforce of clinician-scientists was formed by specialty groups of World Physiotherapy - International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) & International Organisation of Physiotherapists in Paediatrics (IOPTP) - to develop evidence-based practice position statements directing physiotherapists clinical reasoning for the safe and effective use of spinal manipulation and mobilisation for paediatric populations (<18 years) with varied musculoskeletal or non-musculoskeletal conditions. METHOD A three-stage guideline process using validated methodology was completed: 1. Literature review stage (one scoping review, two reviews exploring psychometric properties); 2. Delphi stage (one 3-Round expert Delphi survey); and 3. Refinement stage (evidence-to-decision summative analysis, position statement development, evidence gap map analyses, and multilayer review processes). RESULTS Evidence-based practice position statements were developed to guide the appropriate use of spinal manipulation and mobilisation for paediatric populations. All were predicated on clinicians using biopsychosocial clinical reasoning to determine when the intervention is appropriate.1. It is not recommended to perform:• Spinal manipulation and mobilisation on infants.• Cervical and lumbar spine manipulation on children.•Spinal manipulation and mobilisation on infants, children, and adolescents for non-musculoskeletal paediatric conditions including asthma, attention deficit hyperactivity disorder, autism spectrum disorder, breastfeeding difficulties, cerebral palsy, infantile colic, nocturnal enuresis, and otitis media.2. It may be appropriate to treat musculoskeletal conditions including spinal mobility impairments associated with neck-back pain and neck pain with headache utilising:• Spinal mobilisation and manipulation on adolescents;• Spinal mobilisation on children; or• Thoracic manipulation on children for neck-back pain only.3. No high certainty evidence to recommend these interventions was available.Reports of mild to severe harms exist; however, risk rates could not be determined. CONCLUSION Specific directives to guide physiotherapists' clinical reasoning on the appropriate use of spinal manipulation or mobilisation were identified. Future research should focus on trials for priority conditions (neck-back pain) in children and adolescents, psychometric properties of key outcome measures, knowledge translation, and harms.
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Affiliation(s)
- Anita R Gross
- Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Kenneth A Olson
- Northern Rehab Physical Therapy Specialists, DeKalb, Illinois, USA
| | - Jan Pool
- HU University of Applied Sciences, Epidemiologist, Emeritus Senior Researcher, Utrecht, The Netherlands
| | - Annalie Basson
- Rehabilitation Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Derek Clewley
- Doctor of Physical Therapy Division, Duke University, Durham, USA
| | - Jenifer L Dice
- School of Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Nikki Milne
- THINK Paediatrics Research Group, Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- International Organisation of Physiotherapists in Paediatrics (IOPTP)
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Kowalski KL, Gillis H, Henning K, Parikh P, Sadi J, Rushton A. Use of the International IFOMPT Cervical Framework to inform clinical reasoning in postgraduate level physiotherapy students: a qualitative study using think aloud methodology. BMC MEDICAL EDUCATION 2024; 24:486. [PMID: 38698376 PMCID: PMC11064242 DOI: 10.1186/s12909-024-05399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Vascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs. OBJECTIVE To explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students. METHODS Qualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes). RESULTS For all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant's clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection). CONCLUSIONS Findings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels.
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Affiliation(s)
- Katie L Kowalski
- School of Physical Therapy, Western University, London, Ontario, Canada.
| | - Heather Gillis
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Katherine Henning
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Paul Parikh
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Jackie Sadi
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
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Galgon AK, Bliss RA. Experienced Clinical Decision-Making in Physical Therapist Management of Concussion: A Qualitative Study. Phys Ther 2024; 104:pzae027. [PMID: 38386996 DOI: 10.1093/ptj/pzae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/02/2023] [Accepted: 02/21/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE The recent publication of the Physical Therapy Evaluation and Treatment After Concussion Clinical Practice Guideline is intended to assist clinicians in their decision-making specific to evaluation and intervention. Clinical practice guidelines are supported by best available evidence, though it is unknown what other factors drive clinical decision-making in the realm of concussion management. The purpose of this study was to explore factors related to the process of clinical decision-making of experienced physical therapists who treat individuals with concussion. METHODS This grounded theory approach used semi-structured interviews of physical therapists who have practiced concussion management ≥3 years and have treated ≥15 individuals for postconcussion symptoms in the last year. Following the inductive approach, deductive qualitative methodology was used to explore alignment with recent guidelines. Member checking was used to ensure trustworthiness. RESULTS Ten therapists' experience in treating concussion ranged from 5 to 20 years. Four overarching themes were identified that contribute to clinical decision-making: expert practice behaviors through use of reflection in action, clinical reasoning, collaboration, and evidenced informed practice; therapeutic alliance building using individualized education, reassurance, and relationship building; adaptability in prioritizing, assessing, and responding to patients' needs; and listening and observing. Clinician decision-making statements showed alignment with clinical practice guideline recommendations. CONCLUSION Experienced therapists demonstrate a consistent approach that parallels the current clinical practice guideline while building off clinical experience to tailor individualized care focusing on patient centeredness. These factors may assist more novice clinicians to develop and improve their management strategies for optimal outcomes. IMPACT Identified themes may broaden frameworks and guidelines for the management of individuals postconcussion specific to the field of physical therapy.
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Affiliation(s)
- Anne K Galgon
- Physical Therapy Department, Saint Joseph's University, Philadelphia, Pennsylvania, USA
| | - Rebecca A Bliss
- Department of Physical Therapy, University of Missouri, Columbia, Missouri, USA
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Scheper MC, van Velzen M, L U van Meeteren N. Towards responsible use of artificial intelligence in daily practice: what do physiotherapists need to know, consider and do? J Physiother 2024; 70:81-84. [PMID: 38036398 DOI: 10.1016/j.jphys.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/14/2023] [Accepted: 07/09/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Mark C Scheper
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands; Institute for Communication, Media and Information Technology, Rotterdam University of Applied Sciences Rotterdam, Rotterdam, the Netherlands; Responsible AI, Creating010, Rotterdam University of Applied Sciences Rotterdam, Rotterdam, the Netherlands; Allied Health Professions, Faculty of Medicine and Science, Macquarie University, Sydney, Australia.
| | - Mark van Velzen
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands; Erasmus University Medical Center, Department of Anesthesiology, Rotterdam, the Netherlands
| | - Nico L U van Meeteren
- Erasmus University Medical Center, Department of Anesthesiology, Rotterdam, the Netherlands; Top Sector Life Sciences & Health (Health∼Holland), The Hague, the Netherlands
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Veenstra M, Klemm R, Szikszay TM, Luedtke K, Jung A. Clinical reasoning skills of German and Dutch manual therapists: a cross-sectional study. J Man Manip Ther 2024:1-9. [PMID: 38497346 DOI: 10.1080/10669817.2024.2330775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/09/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Reflective clinical reasoning (CR) is believed to play a crucial role in achieving an efficient therapy process, supported by evidence-based approaches that improve patient outcomes. The aim of this study was to evaluate the CR process of German manual therapists (MTs) using the CR skills of Dutch MTs as a reference. METHODS This cross-sectional study evaluated the CR process and diagnostic ability of German MTs. Dutch MTs served as the reference standard due to their experience with direct access. The CR skills were assessed using the Diagnostic Thinking Inventory (DTI), a questionnaire measuring diagnostic competence. Descriptive and inferential statistics were conducted to compare the groups. Subgroup analyses were performed to analyze the influence of work experience (in years) and the level of education on CR. RESULTS 396 manual therapists (229 German and 167 Dutch) completed the DTI. Dutch MTs revealed higher DTI sum-scores compared to German MTs (p < .001; Cohen´s d = .41). Subgroup analyses regarding professional education revealed no significant differences in DTI sum-scores within German MTs and between both groups. In the subgroup analyses regarding professional experience, differences of moderate effect size were reached between German and Dutch novice MTs (in favor of Dutch novice MTs; p = .001; Cohen´s d = .62), and between German novice MTs and experienced German MTs (in favor of experienced German MTs; p < .001; Cohen´s d = .6). CONCLUSION The results suggest that academically educated German and Dutch MTs as well as experienced German and Dutch MTs are similar in terms of their hypothetical-deductive CR skills. In turn, German novice MTs seem to use hypothetical-deductive processing to a lesser extent compared to Dutch novice MTs and experienced German MTs, which in turn may support the hypothesis that the level of professional experience and education has a significant impact on the development of hypothetical-deductive CR skills.
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Affiliation(s)
- Myrthe Veenstra
- Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Idstein, Germany
| | - Riccarda Klemm
- Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Idstein, Germany
| | - Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
| | - Andres Jung
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Proffit M, Magni M, Huck O, Karsandi K, Abdellaoui A, Pichon R. [Respiratory physiotherapy in private practice: Interest and prescription modalities]. Rev Mal Respir 2024; 41:248-256. [PMID: 38320877 DOI: 10.1016/j.rmr.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 10/07/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Respiratory diseases represent a major public health issue and impact both quality of life and life expectancy of the patients. STATE OF ART Several interventions used in respiratory physiotherapy have been shown to reduce dyspnoea, improve quality of life and reduce hospitalisation in many respiratory diseases. However, respiratory physiotherapy remains poorly known to the medical community and may be under-prescribed. PERSPECTIVES In order to improve the interdisciplinarity around the patient with respiratory impairment, we describe the interests and prescription modalities of liberal respiratory physiotherapy. In the context of respiratory physiotherapy acts, the precision of drafting prescription directly conditions the means implemented by the physiotherapist regarding care provided to the patient. CONCLUSION The increased knowledge of prescribers, both concerning the prescription methods and the precise content of the rehabilitation sessions is one of the keys to their success.
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Affiliation(s)
- M Proffit
- Cabinet libéral de kinésithérapie respiratoire La Bulle, Nice, France.
| | - M Magni
- Cabinet libéral de kinésithérapie respiratoire La Bulle, Nice, France
| | - O Huck
- Cabinet libéral de kinésithérapie respiratoire La Bulle, Nice, France
| | - K Karsandi
- Cabinet libéral de kinésithérapie respiratoire La Bulle, Nice, France
| | - A Abdellaoui
- Institut de formation en masso-kinésithérapie, Montpellier, France; Cabinet de rééducation, 244, rue Claude-François, Montpellier, France
| | - R Pichon
- Institut de formation en pédicurie-podologie, ergothérapie et masso-kinésithérapie (IFPEK), Rennes, France; Laboratoire M2S - EA 7470, université Rennes 2, Bruz, France
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Elvén M, Prenkert M, Holmström IK, Edelbring S. Reasoning about reasoning - using recall to unveil clinical reasoning in stroke rehabilitation teams. Disabil Rehabil 2024:1-10. [PMID: 38392962 DOI: 10.1080/09638288.2024.2320263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin. MATERIALS AND METHODS An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed. RESULTS A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions. CONCLUSIONS Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.
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Affiliation(s)
- Maria Elvén
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Malin Prenkert
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Inger K Holmström
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Samuel Edelbring
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Kishita R, Miyaguchi H, Ohura T, Arihisa K, Matsushita W, Ishizuki C. Fall risk prediction ability in rehabilitation professionals: structural equation modeling using time pressure test data for Kiken-Yochi Training. PeerJ 2024; 12:e16724. [PMID: 38188148 PMCID: PMC10771090 DOI: 10.7717/peerj.16724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background Falls occur frequently during rehabilitation for people with disabilities. Fall risk prediction ability (FRPA) is necessary to prevent falls and provide safe, high-quality programs. In Japan, Kiken Yochi Training (KYT) has been introduced to provide training to improve this ability. Time Pressure-KYT (TP-KYT) is an FRPA measurement specific to fall risks faced by rehabilitation professionals. However, it is unclear which FRPA factors are measured by the TP-KYT; as this score reflects clinical experience, a model can be hypothesized where differences between rehabilitation professionals (licensed) and students (not licensed) can be measured by this tool. Aims To identify the FRPA factors included in the TP-KYT and verify the FRPA factor model based the participants' license status. Methods A total of 402 participants, with 184 rehabilitation professionals (physical and occupational therapists) working in 12 medical facilities and three nursing homes, and 218 rehabilitation students (physical and occupational therapy students) from two schools participated in this study. Participant characteristics (age, gender, job role, and years of experience and education) and TP-KYT scores were collected. The 24 TP-KYT items were qualitatively analyzed using an inductive approach based on content, and FRPA factors were extracted. Next, the correction score (acquisition score/full score: 0-1) was calculated for each extracted factor, and an observation variable for the job role (rehabilitation professional = 1, rehabilitation student = 0) was set. To verify the FRPA factors associated with having or not having a rehabilitation professional license, FRPA as a latent variable and the correction score of factors as an observed variable were set, and structural equation modeling was performed by drawing a path from the job role to FRPA. Results The results of the qualitative analysis aggregated patient ability (PA), physical environment (PE), and human environment (HE) as factors. The standardized coefficients of the model for participants with or without a rehabilitation professional license and FRPA were 0.85 (p < 0.001) for FRPA from job role, 0.58 for PA, 0.64 for PE, and 0.46 for HE from FRPA to each factor (p < 0.001). The model showed a good fit, with root mean square error of approximation < 0.001, goodness of fit index (GFI) = 0.998, and adjusted GFI = 0.990. Conclusion Of the three factors, PA and PE were common components of clinical practice guidelines for fall risk assessment, while HE was a distinctive component. The model's goodness of fit, which comprised three FRPA factors based on whether participants did or did not have rehabilitation professional licenses, was good. The system suggested that rehabilitation professionals had a higher FRPA than students, comprising three factors. To provide safe and high-quality rehabilitation for patients, professional training to increase FRPA should incorporate the three factors into program content.
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Affiliation(s)
- Ryohei Kishita
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
- Department of Occupational Therapy, Faculty of Health Sciences, Osaka University of Human Sciences, Settsu, Osaka, Japan
| | - Hideki Miyaguchi
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Tomoko Ohura
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Katsuhiko Arihisa
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Wataru Matsushita
- Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Okawa, Fukuoka, Japan
| | - Chinami Ishizuki
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
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Zanconato L, Rossettini G, Mourad F, Cotrozzi M, Carità E, Di Filippo L, Turolla A, Smania N, Picelli A, Valè N, Maselli F. Ewing's sarcoma in a young man mimicking lateral elbow pain: A case report with 2 years follow-up. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2063. [PMID: 37937470 DOI: 10.1002/pri.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/10/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND PURPOSE Lateral elbow pain represents a common musculoskeletal disorder, mostly non-specific and benign. In rare cases, it can be the first symptom of a severe disease such as Ewing's sarcoma (ES). ES is the second most common primary malignant bone tumor in the young population, with a high probability of an unfavourable prognosis. CASE PRESENTATION This case report presents the history of a young man presenting to the physical therapist with a diagnosis of "epicondylitis" in the right elbow, which was later revealed to be an aggressive ES of the ulna. Findings raising clinical doubts were (a) constant pain even at night and not dependent on load, (b) significant loss of function, (c) patient's young age, and (d) a palpable mass in the elbow. RESULTS After diagnosis, the patient received medical (chemotherapy, radiotherapy and surgery) and a rehabilitation program. After treatment, the patient improved elbow function, decreased disability and returned to social participation, maintaining positive outcomes at the 2-year follow-up. DISCUSSION In summary, this case report emphasizes the importance of differential diagnosis and screening for referral of red flags in physical therapy. Moreover, it describes the rehabilitation of a patient with ES, enriching the scientific literature in the field.
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Affiliation(s)
| | | | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., Differdange, Luxembourg
| | | | | | - Luigi Di Filippo
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Turolla
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
- Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada
| | - Nicola Valè
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Christensen N, Black L, Gilliland S, Huhn K, Wainwright S. The Role of Movement in Physical Therapist Clinical Reasoning. Phys Ther 2023; 103:pzad085. [PMID: 37418230 DOI: 10.1093/ptj/pzad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/27/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The purpose of this study was to explore how physical therapists use movement as a component of their clinical reasoning. Additionally, this research explored whether movement as a component of clinical reasoning aligns with the proposed signature pedagogy for physical therapist education, human body as teacher. METHODS The study utilized qualitative, descriptive methods in a multiple case studies design (each practice setting represented a different case for analysis purposes) with cross-case comparisons. Researchers conducted 8 focus groups across practice settings including acute care, inpatient neurological, outpatient orthopedics, and pediatrics. Each focus group had 4 to 6 participants. Through an iterative, interactive process of coding and discussion among all researchers, a final coding scheme was developed. RESULTS Through exploration of the research aims, 3 themes emerged from the data. These primary themes are: (1) movement drives clinical reasoning to optimize function; (2) reasoning about movement is multisensory and embodied; and (3) reasoning about movement relies on communication. CONCLUSIONS This research supports a description of movement as the lens used by physical therapists in clinical reasoning and the integral role of movement in clinical reasoning and in learning from and through movement of the human body while learning from clinical reasoning experiences in practice. IMPACT As the understanding of the ways physical therapists use and learn from movement in clinical reasoning and practice continues to emerge, it is important to continue exploring ways to best make this expanded, embodied conception of clinical reasoning explicit in the education of future generations of physical therapists.
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Affiliation(s)
- Nicole Christensen
- Department of Physical Therapy, Samuel Merritt University, Oakland, California, USA
| | - Lisa Black
- Department of Physical Therapy, Creighton University, Omaha, Nebraska, USA
| | - Sarah Gilliland
- Department of Physical Therapy, Tufts University, Seattle, Washington, USA
| | - Karen Huhn
- School of Physical Therapy, Husson University, Bangor, Maine, USA
| | - Susan Wainwright
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Silva Ríos AP, del Campo Rivas MN, Kuncar Uarac PK, Calvo Sprovera VA. Reliability of a script agreement test for undergraduate speech-language therapy students. Codas 2023; 35:e20220098. [PMID: 37970957 PMCID: PMC10688298 DOI: 10.1590/2317-1782/20232022098es] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/09/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE To estimate the reliability of scripts designed for undergraduate Speech-Language Therapy students. METHODS A descriptive cross-sectional study was carried out. Qualitative variables were summarized by frequency or proportion and quantitative through means (CI 95%). Reliability was estimated through Cronbach's α coefficient, and inter-rater agreement was determined using Fleiss's Kappa index. The analytical tests considered a significance level of p<0.05. RESULTS 80 scripts organized in four areas of speech-language therapy were validated by 41 speech-language pathologists. The average experience of the professionals was 17.1 years. The reliability of the corpus was α: 0.67 (min= 0.34; max: 0.84), and the inter-rater agreement κ: 0.29 (min: 0.07; max: 0.45). CONCLUSION The corpus's reliability scores were similar to those reported by previous studies in different health professions. Having validated strategies aimed at developing proficiency and supporting classic training actions in undergraduate courses will contribute to increasing the quality of future health professionals.
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Affiliation(s)
- Angélica Pilar Silva Ríos
- Escuela de Fonoaudiología, Facultad de Salud, Universidad Santo Tomás - Chile.
- Centro Interdisciplinario de Innovación Educativa, Universidad Santo Tomás - Chile.
| | - Manuel Nibaldo del Campo Rivas
- Escuela de Fonoaudiología, Facultad de Ciencias de la Salud, Universidad Católica Silva Henríquez - Santiago, Región Metropolitana, Chile.
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Lyon MF, Mitchell K, Roddey T, Medley A, Gleeson P. Keeping it all in balance: a qualitative analysis of the role of balance outcome measurement in physical therapist decision-making and patient outcomes. Disabil Rehabil 2023; 45:3099-3107. [PMID: 36083016 DOI: 10.1080/09638288.2022.2118872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 07/20/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury. MATERIALS AND METHODS This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories. RESULTS Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists' decision-making. CONCLUSIONS In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes.Implications For RehabilitationBalance outcome measures are considered an important tool to the optimal management of the profound impact of balance impairments after brain injury.Most physical therapists in this study believe that using balance outcome measures results in better outcomes for patients with brain injury.In this study, physical therapists reported using outcome measures in wide-ranging ways to guide clinical decisions about balance in those with brain injury.
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Affiliation(s)
- Marissa F Lyon
- Physical Therapy, University of New England, Portland, ME, USA
| | - Katy Mitchell
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Toni Roddey
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Ann Medley
- Physical Therapy, Texas Woman's University, Houston, TX, USA
| | - Peggy Gleeson
- Physical Therapy, Texas Woman's University, Houston, TX, USA
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Shaffer SM, Naze GS. Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning. J Man Manip Ther 2023; 31:143-152. [PMID: 36171740 PMCID: PMC10288906 DOI: 10.1080/10669817.2022.2124617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.
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Affiliation(s)
- Stephen M. Shaffer
- Department of Rehabilitation Sciences, College of Education, Nursing, and Health Professions, University of Hartford, West Hartford, CT, USA
| | - Garrett S. Naze
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
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de Zwart L, Koenders N, Steenbruggen R, Nijhuis-van der Sanden R, Hoogeboom TJ. What is complexity of hospital-based physiotherapy from the perspective of physiotherapists themselves? A grounded theory study. BMJ Open 2023; 13:e069368. [PMID: 37076163 PMCID: PMC10124244 DOI: 10.1136/bmjopen-2022-069368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The concept of 'complexity' is widely used by healthcare professionals in patient care. However, it is not completely understood. The inappropriate use and incorrect understanding of complexity lead to ambiguity for hospital-based physiotherapists in dealing with complex patients and work situations. OBJECTIVES To develop an understanding of complexity for hospital-based physiotherapy from the perspective of physiotherapists themselves. DESIGN A grounded theory study was conducted using data from face-to-face, semi-structured interviews with purposive sampled hospital-based physiotherapists. The sampling was used to incorporate variety in hospital work experience, field of expertise and gender. The interviews were conducted in three different types of Dutch hospitals. A conceptual model and grounded theory were constructed after open, axial and selective coding. RESULTS Twenty-four hospital-based physiotherapists were interviewed. Two core themes emerged from the data: 'puzzle-solving' and 'reflecting on decisions'. The third theme-'relationship between learning, adapting and complexity'-describes how hospital-based physiotherapists' perceptions of complexity change over time. Complexity as a construct was interpreted as the balance between context and patient-related factors on the one hand and therapist-related factors on the other. CONCLUSIONS Hospital-based physiotherapists encounter complexity during performing job-related activities and decision-making. Complexity depends on balancing context and patient-related factors and therapist-related factors. In hospital-based physiotherapy, it was perceived as challenging yet meaningful. Complexity contributes to becoming more competent and, as such, a balance between complex and non-complex activities should be sought for hospital-based physiotherapists.
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Affiliation(s)
- Lieven de Zwart
- Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niek Koenders
- Department of Rehabilitation-Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rudi Steenbruggen
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Physiotherapy, Saxion University of Applied Sciences, Enschede, The Netherlands
| | | | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Schwab SM, Andrade V, Santos Moreira T, Cavanaugh JT, Vaz DV, Silva PL. Narrowing the physiotherapy knowledge-practice gap: faculty training beyond the health sciences. Physiother Theory Pract 2023; 39:675-689. [PMID: 35068343 DOI: 10.1080/09593985.2022.2027585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Physiotherapists seek to improve client movement and promote function within an individual's unique environmental and social realities. Despite this intention, there is a well-noted knowledge-practice gap, that is, therapists generally lack sufficient foundational preparation to effectively navigate societal challenges impacting contemporary healthcare. As one step toward addressing the issue, we propose an educational solution targeting current and future physiotherapy faculty, whose responsibilities for entry-level course development and curriculum design substantially impact student readiness for clinical practice. We propose that physiotherapy faculty trained via postprofessional education in a non-biomedical field (e.g. psychology, education, and philosophy) will be uniquely prepared to provide students with tools for dealing with complex social issues facing their clients; critical analysis skills; statistical and technological training; and a deeper theoretical and philosophical understanding of practice. Taken together, such interdisciplinary tools could help address the knowledge-practice gap for physiotherapists and promote the ongoing evolution of the profession in concert with contemporary healthcare. Physiotherapists who pursue interdisciplinary studies may more deeply understand the challenges faced by clinicians and may be well-positioned to leverage knowledge and methods in another scientific discipline to expand and transform the scope of solutions to these challenges.
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Affiliation(s)
- Sarah M Schwab
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, OH, USA
| | - Valéria Andrade
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, OH, USA
| | - Tarcísio Santos Moreira
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, OH, USA
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Daniela V Vaz
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paula L Silva
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, OH, USA
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Anarte-Lazo E, Rodriguez-Blanco C, Falla D, Bernal-Utrera C. Physical testing in patients with acute whiplash-associated disorders: A within session test-retest reliability study. Musculoskelet Sci Pract 2023; 64:102738. [PMID: 36870148 DOI: 10.1016/j.msksp.2023.102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND People with whiplash-associated disorders (WAD) commonly present with a variety of physical impairments. However, the reliability of physical tests has not been established for patients with acute WAD. OBJECTIVE To assess test-retest reliability of different physical tests in acute WAD. DESIGN Intra-rater test-retest reliability. METHODS Patients with acute WAD were recruited. Physical tests were used to evaluate articular, muscular and neural systems in two blocks of measurements separated by 10 min. Bland-Altman plots were performed to assess intrarater agreement, which included calculation of the mean difference (d) between rates, the 95% CI for d, the standard deviation of the differences and the 95% limits of agreement. Reliability was calculated via the standard error of measurement, the minimal detectable change, percent of agreement, the intraclass-correlation coefficient, and kappa coefficient. RESULTS 47 patients participated. Test-retest reliability was excellent or good for almost all measures, except for extension ROM, ULTT for the radial nerve, and active cervical extension and upper cervical rotation performed in 4-point kneeling, which presented moderate reliability. Systematic bias was found in cervical ROM in flexion, left and right lateral-flexion, left and right rotation; left ULTT for radial nerve; right trapezius, suboccipitalis and temporalis muscles, left temporalis; C3, both sides of C1-C2, left C3-C4. CONCLUSION The majority of physical tests achieved good or excellent test-retest intra-rater reliability when tested in patients with acute WAD. Findings must be considered with caution for those tests which demonstrated systematic bias. Additional research is warranted to evaluate inter-rater reliability.
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Affiliation(s)
- E Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, Seville, Spain; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - C Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - C Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
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Del Campo Rivas MN, Silva-Ríos AP. Prueba de concordancia de guiones para entrenar el razonamiento clínico en estudiantes de fonoaudiología. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2023. [DOI: 10.5209/rlog.80748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
La prueba de concordancia de guiones (PCG) ha sido utilizada en el entrenamiento y evaluación del razonamiento clínico (RC) como una estrategia innovadora en la formación de profesionales. Sin embargo, no se dispone de evidencia de su aplicación en el pregrado de fonoaudiología. El objetivo de esta investigación fue analizar el desempeño y la percepción de estudiantes de fonoaudiología con respecto al uso de scripts. Se diseñó un piloto pre-experimental y multicéntrico, complementado con tres grupos focales. Las variables cuantitativas continuas fueron resumidas a través de medias y desviación estándar. La comparación entre grupos se ejecutó con Anova one way y la prueba post hoc de Bonferroni, considerando un nivel de significancia p<.05. La fase cualitativa incorporó un análisis de contenido mediante la codificación abierta de textos y la identificación e interpretación de familias de significado emergentes. El rendimiento promedio de los estudiantes fue de 4.03 (DS= 0.35), observándose un incremento en el rendimiento de RC durante el semestre (p= 0.03). La percepción de los estudiantes resulto positiva y se identificó cuatro familias de significado relacionadas con: razonamiento clínico, oportunidades de mejora implementación de la estrategia y retroalimentación docente. A modo de conclusión, la incorporación de scripts en estudiantes de pregrado de fonoaudiología es factible, incrementa el rendimiento y apoya el desarrollo del RC.
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O'Brien SR, Barry M, Davidson E, Porzi L, Spink M, Weatherbee D. Physical therapist clinical reasoning in home care for walking assistive device prescription: A description of practice. Physiother Theory Pract 2023; 39:80-88. [PMID: 34706615 DOI: 10.1080/09593985.2021.1996495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Home care in the United States (US) provides rehabilitative care to people who are homebound after acute hospitalization. Patients with stroke and brain injury (BI) are commonly seen by physical therapists (PTs/PTAs), who often address the loss of walking independence. Clinical reasoning (CR) is required for walking assistive device (WAD) prescription within the home. There has never been a description of the home care PT CR process, which could inform entry-level training and health policy. PURPOSE To describe the homecare CR process by identifying factors used for prescription of WADs in patients with stroke and BI. Secondly, to describe any practice issues associated with WADs. METHODS Directors of 7 agencies affiliated with Nazareth College DPT program were recruited to identify PTs/PTAs to complete an online survey between March - July 2017. Quantitative and qualitative data were collected, and analyzed for frequencies or for common themes. RESULTS A total of 334 PTs/PTAs were enrolled from all agencies and 72 responses were analyzed. The CR process did not differ between stroke and BI. Safety was the primary factor, which was assessed by patient query, observation skills, and objective measures. PTs/PTAs also measured balance, strength, function, cognition, and patient preferences within the context of the home. WADs obtained prior to initiation of home care often weren't used. CONCLUSION A complex CR process has been described for WAD prescription in home care for patients with stroke and BI. Entry-level training and health policy implications are described.
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Affiliation(s)
- Suzanne R O'Brien
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Meghan Barry
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Emily Davidson
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Lauren Porzi
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Makenzi Spink
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Danae Weatherbee
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
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19
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Socially Assistive Robots for Parkinson's Disease: Needs, Attitudes and Specific Applications as Identified by Healthcare Professionals. ACM TRANSACTIONS ON HUMAN-ROBOT INTERACTION 2022. [DOI: 10.1145/3570168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To explore how socially assistive robots (SARs) may assist the specific needs of individuals with Parkinson's disease (IwPD), we conducted three focus groups with 12 clinicians who treat IwPD. We present a thematic analysis of their perceptions of the needs of the patients, and their own expectations, perceived advantages, disadvantages and concerns regarding the use of SARs for IwPD. Clinicians were positive towards using SARs for IwPD, if used in the patient's home, for motor, communication, emotional, and cognitive needs, especially for practice and for help with activities of daily living. They were concerned that a SAR might be used to replace clinicians’ work, and stressed it should only
augment
the clinicians’ work. They thought a SAR may relieve some of the burden experienced by informal caregivers, and identified specific applications for SARs for PD. We asked 18 stakeholders (nine IwPD, nine family members) to rate their level of agreement with the clinicians’ statements. The greatest divergence between their views and those of the clinicians was on the topic of using a SAR as a companion, or as a feeding assistant, to which they objected. This work may be used as a basis for future studies designing SARs for IwPD.
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20
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Mertens JF, Koster ES, Deneer VHM, Bouvy ML, van Gelder T. Clinical reasoning by pharmacists: A scoping review. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1326-1336. [PMID: 36123233 DOI: 10.1016/j.cptl.2022.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/27/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Clinical reasoning is considered a core competency for pharmacists, but there is a lack of conceptual clarity that complicates teaching and assessment. This scoping review was conducted to identify, map, and examine evidence on used cognitive processes and their conceptualization of clinical reasoning by pharmacists. METHODS In March 2021, seven databases were searched for relevant primary research studies. Included were studies that examined cognitive processes in pharmacists while addressing a clinical scenario in a pharmacy-related setting. Using descriptive analysis, study characteristics, conceptualizations, operationalizations, and key findings were mapped, summarized, and examined. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. RESULTS From 2252 abstracts, 17 studies were included that examined clinical reasoning in the context of forming a diagnosis (n = 9) or determining medication appropriateness (n = 4). Most studies conceptualized clinical reasoning as a context-dependent cognitive process whereby pharmacists apply and integrate knowledge and clinical experience to interpret available clinical data. Different terms labelled pharmacists' reasoning that showed analytical and intuitive approaches to clinical scenarios, either separately or combined. Medication review studies reported a predominance of analytical reasoning. The majority of diagnosis-forming studies in primary care identified no distinct cognitive reasoning pattern when addressing self-care scenarios. IMPLICATIONS This overview reflects a small but growing body of research on clinical reasoning by pharmacists. It is recommended that this competence be taught by explicating and reflecting on clinical reasoning as separate stage of the clinical decision-making process with transparent cognitive processes.
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Affiliation(s)
- Josephine F Mertens
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Postbus 9600, 2300 RC Leiden, the Netherlands.
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Vera H M Deneer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Teun van Gelder
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
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21
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Furze JA, Black L, McDevitt AW, Kobal KL, Durning SJ, Jensen GM. Clinical Reasoning: The Missing Core Competency in Physical Therapist Education and Practice. Phys Ther 2022; 102:6628208. [PMID: 35781736 DOI: 10.1093/ptj/pzac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/22/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Jennifer A Furze
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
| | - Lisa Black
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
| | - Amy W McDevitt
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kara L Kobal
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven J Durning
- Department of Medicine, Center for Health Professions Education, School of Medicine Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Gail M Jensen
- Department of Medicine, Center for Health Professions Education, School of Medicine Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
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22
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Cunningham S, Cunningham C, Foote L. Use of a Clinical Reasoning Activity to Assist with Interprofessional Communication. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2115184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Shala Cunningham
- Department of Physical Therapy, Radford University, Roanoke, Virginia, USA
| | | | - Lisa Foote
- School of Nursing, Liberty University, Lynchburg, Virginia, USA
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Assessing clinical reasoning in physical therapy: Discriminative validity of the Reasoning 4 Change instrument. Physiotherapy 2022; 117:8-15. [DOI: 10.1016/j.physio.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/17/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022]
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Harrington KL, Teramoto M, Black L, Carey H, Hartley G, Yung E, Osborne J, Goldberg P, Tran RT, Hillegass E. Physical Therapist Residency Competency-Based Education: Development of an Assessment Instrument. Phys Ther 2022; 102:6535133. [PMID: 35225348 DOI: 10.1093/ptj/pzac019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/20/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to develop generic domains of competence (DoC) with associated competencies and milestones for physical therapist residency education. This work was intended to culminate in establishing validity evidence to support a competency-based assessment instrument that could be used by residency programs to evaluate resident achievement of the competencies, regardless of specialty area. METHODS Employing the modified Delphi method, a residency education work group developed an evaluation instrument that included 7 DoC and 31 associated competencies with 6 milestones as rating scales for each competency. The instrument was distributed to mentors and residents in accredited physical therapist residency programs to establish validity evidence. Evaluations (measured by milestones) and demographics were collected at 3 time points (program entry, midterm, and final). Scores across these time points were compared using Kruskal-Wallis tests. Reliability was assessed with kappa statistics (interrater reliability) and alpha reliability coefficients (internal consistency). Construct validity was examined using confirmatory factor analysis via structural equation modeling. RESULTS Overall, 237 mentors and 228 residents completed 824 evaluations (460 by mentors and 364 resident self-evaluations) across the time points. Scores significantly increased from entry through final time points. The interrater reliability of the associated behaviors ranged from moderate to substantial agreement (κ = 0.417-0.774). The internal consistency was high for all DoC at every time point (α reliability coefficients = .881-.955 for entry, .857-.925 for midterm, and .824-.902 for final). After confirmatory factor analysis with structural equation modeling was performed, a model that included 7 DoC and 20 associated competencies was proposed. CONCLUSIONS The residency assessment instrument developed demonstrates interrater reliability and validity evidence and therefore supports competency-based assessment of resident clinical performance across specialty areas. Additionally, the instrument aligns the physical therapy profession with other professions, such as medicine, dentistry, and pharmacy, that have transitioned to competency-based education. IMPACT This study outlines the benefits of moving to competency-based education for physical therapist residents, using a sound evaluation tool that evaluates residents across specialty areas. The instrument will allow for transition to competency-based education in physical therapist residency education programs.
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Affiliation(s)
- Kendra L Harrington
- Residency and Fellowship Education, American Physical Therapy Association, Alexandria, Virginia, USA
| | - Masaru Teramoto
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Lisa Black
- Department of Physical Therapy, Creighton University, Omaha, Nebraska, USA
| | - Helen Carey
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Greg Hartley
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Emmanuel Yung
- Department of Physical Therapy, Sacred Heart University College of Health Professions, Fairfield, Connecticut, USA
| | - Jacqueline Osborne
- Brooks Rehabilitation Institute of Higher Learning, Jacksonville, Florida, USA
| | | | - Rachel Tabak Tran
- Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - Ellen Hillegass
- Department of Physical Therapy, Mercer University College of Health Professions, Atlanta, Georgia, USA
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da Silva Araujo A, Anne Kinsella E, Thomas A, Demonari Gomes L, Quevedo Marcolino T. Clinical Reasoning in Occupational Therapy Practice: A Scoping Review of Qualitative and Conceptual Peer-Reviewed Literature. Am J Occup Ther 2022; 76:23279. [PMID: 35648118 DOI: 10.5014/ajot.2022.048074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The occupational therapy clinical reasoning literature includes a large proportion of peer-reviewed qualitative and conceptual articles. Although these articles can contribute to the understanding of how clinical reasoning has been conceptualized in occupational therapy, they have not yet received in-depth analytic attention. To address this gap, we conducted a scoping review. OBJECTIVE To examine how qualitative and conceptual literature has addressed clinical reasoning in occupational therapy. DATA SOURCES Database searches were conducted in Scopus, Web of Science, PsycINFO, Embase, and MEDLINE. STUDY SELECTION AND DATA COLLECTION Included articles were published between 2010 and 2019, were peer reviewed, addressed clinical reasoning in occupational therapy, were qualitative or conceptual articles, focused on practitioners, and were in English. Twenty-six articles met the inclusion criteria. Data were extracted according to relevant categories and were analyzed numerically and thematically. FINDINGS Four themes were identified: clinical reasoning processes, factors influencing clinical reasoning, new models or frameworks to guide clinical reasoning, and emergent perspectives on clinical reasoning. CONCLUSIONS AND RELEVANCE This review advances knowledge about how clinical reasoning has been conceptualized in occupational therapy and has been applied in a range of practice contexts. The review highlights discussions about types of reasoning, the dynamic and iterative nature of reasoning, contextual dimensions of reasoning, client-centered and occupation-based approaches, new frameworks and models, and emergent and innovative perspectives on clinical reasoning in occupational therapy. What This Article Adds: This scoping review represents an important contribution to knowledge about how clinical reasoning has been conceptualized in occupational therapy by mapping key themes and illuminating scholarly conversations in the qualitative and conceptual clinical reasoning literature.
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Affiliation(s)
- Angelica da Silva Araujo
- Angelica da Silva Araujo, MSc, BSc, is PhD Student, Postgraduate Program in Occupational Therapy, Federal University of São Carlos, São Paulo, Brazil;
| | - Elizabeth Anne Kinsella
- Elizabeth Anne Kinsella, PhD, MAEd, BSc(OT), is Professor and Director, Institute of Health Sciences Education, and Associate Member, School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Aliki Thomas
- Aliki Thomas, PhD, is Associate Professor, School of Physical and Occupational Therapy and Institute of Health Sciences Education, Centre for Interdisciplinary Research in Rehabilitation, McGill University, Montreal, Quebec, Canada
| | - Laysla Demonari Gomes
- Laysla Demonari Gomes, BSc, MSc, is PhD Student, Department of Occupational Therapy, Federal University of São Carlos, São Paulo, Brazil
| | - Tais Quevedo Marcolino
- Tais Quevedo Marcolino, PhD, MSc, BSc, is Associate Professor, Department of Occupational Therapy, Federal University of São Carlos, São Paulo, Brazil
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Deutsch JE, Gill-Body KM, Schenkman M. Updated Integrated Framework for Making Clinical Decisions Across the Lifespan and Health Conditions. Phys Ther 2022; 102:6497836. [PMID: 35079823 DOI: 10.1093/ptj/pzab281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/16/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022]
Abstract
The updated Integrated Framework for Clinical Decision Making responds to changes in evidence, policy, and practice since the publication of the first version in 2008. The original framework was proposed for persons with neurological health conditions, whereas the revised framework applies to persons with any health condition across the lifespan. In addition, the revised framework (1) updates patient-centered concepts with shared clinical decision-making; (2) frames the episode of care around the patient's goals for participation; (3) explicitly describes the role of movement science; (4) reconciles movement science and International Classification of Function language, illustrating the importance of each perspective to patient care; (5) provides a process for movement analysis of tasks; and (6) integrates the movement system into patient management. Two cases are used to illustrate the application of the framework: (1) a 45-year-old male bus driver with low back pain whose goals for the episode of care are to return to work and recreational basketball; and (2) a 65-year-old female librarian with a fall history whose goals for the episode of care are to return to work and reduce future falls. The framework is proposed as a tool for physical therapist education and to guide clinical practice for all health conditions across the lifespan.
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Affiliation(s)
- Judith E Deutsch
- Rivers Lab, Department of Rehabilitation and Movement Science, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | | | - Margaret Schenkman
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Brentnall J, Thackray D, Judd B. Evaluating the Clinical Reasoning of Student Health Professionals in Placement and Simulation Settings: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020936. [PMID: 35055758 PMCID: PMC8775520 DOI: 10.3390/ijerph19020936] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Clinical reasoning is essential to the effective practice of autonomous health professionals and is, therefore, an essential capability to develop as students. This review aimed to systematically identify the tools available to health professional educators to evaluate students' attainment of clinical reasoning capabilities in clinical placement and simulation settings. (2) Methods: A systemic review of seven databases was undertaken. Peer-reviewed, English-language publications reporting studies that developed or tested relevant tools were included. Searches included multiple terms related to clinical reasoning and health disciplines. Data regarding each tool's conceptual basis and evaluated constructs were systematically extracted and analysed. (3) Results: Most of the 61 included papers evaluated students in medical and nursing disciplines, and over half reported on the Script Concordance Test or Lasater Clinical Judgement Rubric. A number of conceptual frameworks were referenced, though many papers did not reference any framework. (4) Conclusions: Overall, key outcomes highlighted an emphasis on diagnostic reasoning, as opposed to management reasoning. Tools were predominantly aligned with individual health disciplines and with limited cross-referencing within the field. Future research into clinical reasoning evaluation tools should build on and refer to existing approaches and consider contributions across professional disciplinary divides.
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Affiliation(s)
- Jennie Brentnall
- Work Integrated Learning, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Correspondence:
| | - Debbie Thackray
- Physiotherapy, School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK;
| | - Belinda Judd
- Work Integrated Learning, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
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Green-Wilson J, Clark D, Tschoepe B, Zeigler SL, Sebelski CA. Exploring the Concept of Leadership from the Perspective of Physical Therapists in the United States. Physiother Can 2022; 74:54-63. [PMID: 35185248 PMCID: PMC8816367 DOI: 10.3138/ptc-2020-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/03/2023]
Abstract
Purpose: The purpose of this study was to examine the perceptions of physical therapists practising in the United States of the importance of leadership characteristics and of demographic traits and other factors that might be associated with perceptions of leadership in three contexts: workplace, health care system, and society. Method: An online questionnaire was distributed through snowball sampling to physical therapists practising in the United States over an 8-week period between October and November 2019. A total of 15 leadership characteristics were rated on a 5-point scale of importance. Results: A total of 278 physical therapists responded to the questionnaire. They rated communication and professionalism as the top two leadership characteristics across all settings. Self-awareness and business acumen were not perceived as important for leadership. No relationship was found between gender and self-declaration as a leader or between a participant's practice setting and their rating of the importance of leadership characteristics. Conclusions: Our results further the discussion of leadership in the physical therapy profession. They highlight a comprehensive acceptance of leadership characteristics as important regardless of context. Further work will be necessary to transition this declaration of the importance of leadership skills to identifying the essential leadership skills for physical therapist education and clinical practice.
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Affiliation(s)
- Jennifer Green-Wilson
- Department of Healthcare Studies, SUNY Brockport (State University of New York), Brockport, New York, United States
| | - Diane Clark
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | | | - Stacey L. Zeigler
- Department of Physical Therapy, Clarkson University, Potsdam, New York, United States
| | - Chris A. Sebelski
- Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, United States
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29
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Snook AG, Schram AB. Perceived faculty development needs of physical therapy adjuncts: a comparison study. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2000810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Asta B. Schram
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
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30
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Budtz CR, Rønn-Smidt H, Thomsen JNL, Hansen RP, Christiansen DH. Primary care physiotherapists ability to make correct management decisions - is there room for improvement? A mixed method study. BMC FAMILY PRACTICE 2021; 22:196. [PMID: 34615482 PMCID: PMC8496017 DOI: 10.1186/s12875-021-01546-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
Background With increasing interest in direct access to physiotherapy, it is important to consider the physiotherapists (PTs) ability to make correct management decisions, because identification of differential diagnostic pathologies and timely referral for specialist care is vital for patient safety. The aims of the study were to investigate PTs ability to make correct management decisions in patients presenting with musculoskeletal conditions and to identify explanatory factors associated with this ability. Furthermore, we wanted to explore the PTs views on the identified factors. Methods The study was a mixed methods study with an explanatory sequential design consisting of a questionnaire survey and semi-structured interviews. The questionnaire comprised 12 clinical vignettes describing patient scenarios for musculoskeletal conditions, non-critical medical conditions and critical medical conditions. Based on this, the PTs indicated whether the patient should be managed by the PT or were in need of medical referral. Associations between correct decisions and explanatory variables was analyzed by mixed- effects logistic regression. Interviews were performed with nine PTs to explore their reactions to the results. A directed content analysis was performed. Results A total of 195 PTs participated in the questionnaire survey and 9 PTs were interviewed. Overall, PTs were more likely to make correct management decisions in the musculoskeletal conditions category, whereas wrong decisions were more often chosen for underlying medical conditions categories. Positive associations between correct management decision in the critical medical category were found for experience: odds ratio (OR) 2.73 (1.33;5.57) and passed quality audit OR 2.90 (1.50;5.58). In the interviews, PTs expressed concerns about the differential diagnostic abilities. They all noted, that experience is immensely important in the clinical reasoning process because the ability to recognise diagnostic patterns evolves over time. Furthermore, the quality audit seems to address and systematize the clinical reasoning process and workflow within the clinics. Conclusion The lack of ability to make correct management decision in critical medical categories and the uncertainties expressed by PT’s should raise concern, as direct access to physiotherapy is already well-established and the results indicate that patient safety could be at risk. The findings that experience and passed quality audit was associated with correct management decisions highlights the need for ongoing awareness and education into differential diagnostics. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01546-1.
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Affiliation(s)
- Cecilie Rud Budtz
- Department of Occupational Medicine, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.
| | | | | | | | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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31
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Mohammadi-Shahboulaghi F, Khankeh H, HosseinZadeh T. Clinical reasoning in nursing students: A concept analysis. Nurs Forum 2021; 56:1008-1014. [PMID: 34228356 DOI: 10.1111/nuf.12628] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/23/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of this analysis is to clarify the concept of clinical reasoning in nursing students. BACKGROUND Sound clinical reasoning is the most important skill required in professional nursing and understanding of this concept is emphasized as a basis for clinical reasoning development in nursing education curricula. DESIGN Rodgers' concept analysis method was used to achieve a clear and understandable definition. DATA SOURCE Resources published from 2000 to 2020 were identified via electronic databases. REVIEW METHODS A review of the literature was completed, and the data were analyzed to identify the Surrogate and related terms, attributes, antecedents and consequences of the concept. RESULTS This concept is a holistic and recursive cognitive process that has a dynamic and flexible nature to perceive the patient's condition, select the best practice to respond to the situation, and learn from the situation. Clinical reasoning in nursing students emerges despite professional standards; discipline-specific knowledge, cognitive perception, critical thinking, learning experiences, and intuitive ability, and the requirements of the professional system affect its establishment in the nursing discipline. Clinical reasoning is the cognitive process underlying clinical judgment, appropriate decision making, improvement of nursing quality, metacognitive awareness, and professional competence in nursing, whose achievement, generally, paves the way for nursing professionalization and development that are important steps toward independence in the nursing profession. CONCLUSIONS The present concept analysis clarifies the concept of clinical reasoning as a complex thinking process that should be considered as a fundamental thinking skill in nursing program.
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Affiliation(s)
- Farahnaz Mohammadi-Shahboulaghi
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Touba HosseinZadeh
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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32
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Clark NC. Noncontact Knee Ligament Injury Prevention Screening in Netball: A Clinical Commentary with Clinical Practice Suggestions for Community-Level Players. Int J Sports Phys Ther 2021; 16:911-929. [PMID: 34123542 PMCID: PMC8169033 DOI: 10.26603/001c.23553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/22/2021] [Indexed: 12/20/2022] Open
Abstract
Netball is a predominantly female team court-sport which is played worldwide. Netball is becoming more popular in the United States following its countrywide introduction to schools and community centers. A unique characteristic of netball is the footwork rule which restricts players to a one-step landing after catching the ball. Most netball landings are single-leg landings resulting in high vertical ground reaction forces and high skeletal tissue forces. Thus, high-risk landing events that have the biomechanical potential for injury occur frequently. Noncontact knee ligament injuries are common following a knee abduction collapse when landing. Because the consequences of noncontact knee ligament injury are profound, strategies are needed to mitigate the burden of such injury for players, teams, and society. The purpose of this clinical commentary is to demonstrate how theoretical principles, different types of research, and different levels of evidence underpin a rational clinical reasoning process for developing noncontact knee ligament injury prevention screening procedures in netball. The theoretical principles that are discussed in this commentary include injury control, the sequence of prevention, principles of screening in injury prevention, the multifactorial model of injury etiology, complex systems theory, and systems science. The different types of research that are reviewed include descriptive and analytic-observational studies. The different levels of evidence that are discussed include prospective studies, cross-sectional studies, and clinicians' own kinesiological modelling. Subsequently, an integrated approach to the evidence-informed development of noncontact knee ligament injury prevention screening procedures is presented. Clinical practice suggestions include a selection of evidence-informed screening tests that are quickly and easily implemented with netball players in local communities. The need for repeated screening at strategic timepoints across a season/year is explained. Sports physical therapists will find this commentary useful as an example for how to undertake clinical reasoning processes that justify the content of screening procedures contributing to noncontact knee ligament injury prevention in community-level netball. LEVEL OF EVIDENCE 5.
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33
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Petersen EJ, Thurmond SM, Jensen GM. Severity, Irritability, Nature, Stage, and Stability (SINSS): A clinical perspective. J Man Manip Ther 2021; 29:297-309. [PMID: 33999785 DOI: 10.1080/10669817.2021.1919284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Clinical reasoning errors in health-care can be mitigated with the use of systematic strategies and tools. One of these strategies is the SINSS construct, an acronym for Severity, Irritability, Nature, Stage, and Stability. The construct of SINSS appears in several textbooks and peer-reviewed articles. However, it has been inconsistently defined and applied in clinical practice. In this clinical perspective, the terms of the SINSS construct are defined in detail and their application to clinical practice is discussed. Current research showing the application of SINSS as a whole in clinical practice and educational settings is also presented. Recommendations for future application of SINSS are provided to advance the study of clinical reasoning and help minimize diagnostic, prognostic, and interventional clinical errors. The systematic use of SINSS allows the clinician to gain a thorough understanding of the patient's condition and symptoms, which can lead to a well-tolerated and appropriately tailored physical examination and intervention. Additionally, the proper use of this construct can result in more optimal patient outcomes, as well as provide a structure for the mentor and learner in helping uncover errors in the learner's clinical reasoning process.
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Affiliation(s)
- Evan J Petersen
- University of the Incarnate Word, School of Physical Therapy, San Antonio, TX, USA
| | - Stephanie M Thurmond
- Bowling Green State University, School of Physical Therapy, Bowling Green, OH, USA
| | - Gail M Jensen
- Creighton University, Graduate School and College of Professional Studies, Omaha, NE, USA
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34
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Ebihara S, Otsubo Y, Miyagi M. Role of physical therapists and aromatherapy for fall prevention in older people: A narrative review. Geriatr Gerontol Int 2021; 21:445-450. [PMID: 33873257 DOI: 10.1111/ggi.14165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022]
Abstract
Falls among older people are usually the result of several causes combined. Identifying all the fall-related factors that apply to a particular individual and providing comprehensive multifactorial intervention is recommended for the prevention of falls among older people. However, the overall net benefit of multifactorial intervention in preventing falls is small, and it does not appear to improve fall-related outcomes, such as the number of fall-related injuries. Therefore, we might require new perspectives to overcome this situation. Here, we raise two novel strategies for fall prevention among older people. One is using physical therapists more actively. The other is using aromatherapy for stabilization of older people. Physical therapists should carry out detailed gait assessment and caregiver education. Aromatherapy is effective in improving balance and mental stability in older people. To overcome refractory geriatric syndrome, there is no choice but to eliminate all preconceived ideas before choosing the best fall prevention strategies. Geriatr Gerontol Int 2021; 21: 445-450.
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Affiliation(s)
- Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Yuta Otsubo
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Midori Miyagi
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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35
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Adhikari SP, Shrestha N, Shakya R, Phuyal R, Gyawali M, Dev R. A structured workshop enhanced Physiotherapists' skills in clinical decision-making: A pre-post study. J Family Med Prim Care 2021; 9:5658-5664. [PMID: 33532410 PMCID: PMC7842476 DOI: 10.4103/jfmpc.jfmpc_1048_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 11/04/2022] Open
Abstract
Context Effective clinical decision-making skills enhance the quality of patient care. Clinical reasoning and decision-making are fundamental aspects of best physiotherapy clinical practice. Aims To evaluate the effectiveness of an evidence-based structured educational workshop in enhancing physiotherapists' clinical decision-making skills. Settings and Designs A pre-post design conducted in a medical college. Methods and Materials A workshop protocol was developed based on the existing evidence and clinical practice guidelines. The workshop was advertised on the social media page of Nepal Physiotherapy association. On the first come first serve method; physiotherapists were selected. Those who met eligibility criteria were recruited for one of two workshops. Discussion was made on clinical scenarios aimed at enhancing clinical decision-making skills. Data were collected before and after the workshop using a self-administered clinical decision-making skills assessment tool to evaluate effectiveness of the workshop. Paired and unpaired t-tests were used to analyze within and between groups respectively. Results Significant improvement in clinical decision-making skills was found for all individual items (P < 0.001 in all items, effect size: 0.6 - 0.9), total EP score (P < 0.001, effect size: 0.8) and total clinical decision-making score (P < 0.001, effect size: 0.9). A significant difference was found between Bachelor and Master level education (P < 0.05). Conclusions An evidence-based structured educational workshop enhanced physiotherapists' clinical decision-making skills. The findings of this study could be relevant to all health care professionals working in clinical practice. Larger studies with a control group are recommended to strengthen the findings of this study.
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Affiliation(s)
- Shambhu P Adhikari
- Department of Physiotherapy, School of Medical Sciences, Kathmandu University, Nepal
| | - Nistha Shrestha
- Department of Physiotherapy, School of Medical Sciences, Kathmandu University, Nepal
| | - Rishita Shakya
- Department of Physiotherapy, School of Medical Sciences, Kathmandu University, Nepal
| | - Rajani Phuyal
- Department of Physiotherapy, School of Medical Sciences, Kathmandu University, Nepal
| | - Manju Gyawali
- Department of Physiotherapy and Rehabilitation, Nepal Mediciti Hospital, Nepal
| | - Rubee Dev
- Sun Yat-sen University Global Health Institute, Sun Yat-sen University, Guangzhou, China
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36
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LaRosa N, Dinsmore D. Student Physical Therapists’ Perceptions of Clinical Reasoning: A Systematic Review of the Literature. HEALTH PROFESSIONS EDUCATION 2020. [DOI: 10.1016/j.hpe.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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37
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Torres G, Villagrán I, Fuentes J, Araya JP, Jouannet C, Fuentes-López E. Interactive virtual scenarios as a technological resource to improve musculoskeletal clinical reasoning skills of undergraduate physiotherapy students. Physiother Theory Pract 2020; 38:1016-1026. [PMID: 32814476 DOI: 10.1080/09593985.2020.1809043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinical reasoning is a fundamental competency in the learning process of health professionals. Since learning with traditional methods presents difficulties, teaching with interactive virtual scenarios is a good alternative. OBJECTIVE To describe the impact of a blended training with interactive virtual scenarios for the development of clinical reasoning skills in undergraduate physiotherapy students. METHODS A sample of 92 students solved eight storylines. Assessment error percentage, clinical pattern recognition, satisfaction, and the perception of difficulty were obtained. A proportions test was used to compare baseline and final assessments. To analyze the relationship between the variables, multilevel univariate logistic regression models were built. RESULTS A significant difference was observed in the error percentage between baseline and final assessment (p < .001). Comparing the last storyline to the first one, there were 2.63 times more possibilities to correctly recognize the pattern. The error percentage was associated with the opportunity to recognize the pattern precisely (p < .001). Thus, for each increasing unit in the error percentage, the possibility to correctly recognize the pattern decreased by 11% (OR = 0.89). CONCLUSIONS The use of this innovative blended training with virtual scenarios allowed students to systematically improve their recognition abilities of clinical patterns and decrease mistakes in the decision-making process.
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Affiliation(s)
- Gustavo Torres
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Villagrán
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Fuentes
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Araya
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Chantal Jouannet
- Centro de Desarrollo Docente, Vicerrectoría Académica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Carrera de Fonoaudiología, Departamento de Ciencias de La Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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38
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Oostendorp RAB, Elvers JWH, Trijffel EV. We are missing more. An international measurable model of clinical reasoning using quality indicators and routinely collected data. J Man Manip Ther 2020; 27:253-257. [PMID: 31671045 DOI: 10.1080/10669817.2019.1648714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Rob A B Oostendorp
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Brussels, Belgium.,Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, The Netherlands
| | - J W Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Amersfoort, The Netherlands
| | - Emiel Van Trijffel
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,SOMT University of Physiotherapy, Amersfoort, The Netherlands
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39
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Hartholt E, Vuoskoski P, Hebron C. Physiotherapists' lived experiences of decision making in therapeutic encounters with persons suffering from whiplash-associated disorder: A hermeneutic phenomenological study. Musculoskeletal Care 2020; 18:519-526. [PMID: 32677355 DOI: 10.1002/msc.1496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022]
Abstract
Conceptual discussions related to clinical reasoning and decision making have evolved over the years from biomedical to incorporating more holistic approach to reasoning. Empirical studies exploring clinical reasoning and decision making in physiotherapy practice have mostly focused on aspects of managing persons with low back pain, such as exercise prescription, education and communicating diagnosis. There is a paucity of studies exploring decision making in whiplash-associated disorder (WAD); thus, the aim of this study was to explore the physiotherapists' lived experiences of decision making related to treating persons with WAD. A qualitative research design based on hermeneutic phenomenological methodology was used in this study. Five participants (physiotherapists) were purposefully recruited, and data are collected via semistructured interviews, which were recorded and transcribed verbatim. Interpretative phenomenological analysis (IPA) was used as a method for analysing the data. Emergent, superordinate and master themes emerged from the data to illuminate the lived experiences under exploration. Three master themes were identified: (1) sense of collaboration; (2) sense of being out of control; and (3) sense of emotional engagement (subthemes: feeling of satisfaction and feelings of distress and uncertainty). A sense of collaboration revealed varied meaning related to the role of persons receiving care, suggesting a lack of conceptual clarity related to shared-decision making. A perceived loss of a sense of being in control was related to experienced emotions, such as feelings of distress and uncertainty. The findings of this study highlight the importance of providing space for reflection and mentoring in the workplace.
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Affiliation(s)
- Elles Hartholt
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, UK
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40
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Oostendorp RAB, Elvers JWH, Trijffel van E. Concept Analysis of Clinical Reasoning in Physical Therapist Practice. Phys Ther 2020; 100:1353-1356. [PMID: 32302388 PMCID: PMC7439222 DOI: 10.1093/ptj/pzaa065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 04/06/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Rob A B Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Brussels, Belgium; and Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, The Netherlands,Address all correspondence to Dr Oostendorp at
| | - J W Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Emiel Trijffel van
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; SOMT University of Physiotherapy, Amersfoort, The Netherlands; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. [Oostendorp RAB, Elvers JWH, van Trijffel E. Concept analysis of clinical reasoning in physical therapist practice Phys Ther. 2020;100:1–4.]
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41
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Sebelski CA, Hoogenboom BJ, Hayes AM, Held Bradford E, Wainwright SF, Huhn K. The Intersection of Movement and Clinical Reasoning: Embodying "Body as a Teacher" to Advance the Profession and Practice. Phys Ther 2020; 100:201-204. [PMID: 31595947 DOI: 10.1093/ptj/pzz137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/05/2019] [Accepted: 06/09/2019] [Indexed: 02/09/2023]
Affiliation(s)
- Chris A Sebelski
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, 3437 Caroline Mall Ste 1026, St Louis, MO 63104 (USA)
| | - Barbara J Hoogenboom
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan
| | - Ann M Hayes
- Department of Physical Therapy and Athletic Training, Saint Louis University, St Louis, Missouri
| | | | - Susan F Wainwright
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Huhn
- School of Physical Therapy, Husson University, Bangor, Maine
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O'Brien SR, Durr K, Laubisch E, Losi L, Parrillo V, Pericozzi S, Poirier B, Poirier L, Ray K, Sackett A, Simoneau D. Every person is an individual: physical therapist clinical reasoning used in inpatient rehabilitation for walking assistive device prescription in patients with stroke and brain injury. Disabil Rehabil Assist Technol 2019; 16:1-8. [PMID: 31429328 DOI: 10.1080/17483107.2019.1647568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE A complete description of the process of physical therapy clinical reasoning for walking assistive devices in patients with stroke and brain injury has never been undertaken. Describing the clinical reasoning process used in post-acute inpatient rehabilitation is important to shed light on the clinical activities and factors used in practice, prevent device abandonment, and, inform entry-level clinical training. The two purposes were first, to describe the clinical reasoning process used during inpatient rehabilitation for walking assistive devices in patients with stroke and brain injury, and second, to determine whether clinical reasoning differed by two facility types and by diagnosis. METHODS A mixed methods study of 67 participants in either an online survey or focus groups. RESULTS A consistent and comprehensive method to determine the need and justification for a walking assistive device regardless of diagnosis or facility type was found. The clinical reasoning process included five primary factors, considered throughout the rehabilitation stay (safety, balance, cognition, strength, and function). The three therapist-related factors (experience/preference, training parameters, and use of objective tools), and seven patient-related factors (experience/preference, fluctuations, fear, age, diagnosis/comorbidities, discharge environment, and payer) individualized care. Definitions of the five primary factors were derived from participants' responses. CONCLUSIONS Results from this study revealed complexity in the clinical reasoning process used in physical therapy practice to determine the best walking assistive device for patients with stroke and brain injury during inpatient rehabilitation. Information from this study can inform post-acute physical therapy practice and education, and may reduce device abandonment. Implications for rehabilitation Clinical reasoning (CR) is a complex process in which a clinician must consider multiple factors, which requires non-linear and iterative thinking, and involves many people, making it shared among the patient, caregivers, and the healthcare team. Describing the actual CR process used by physiotherapists when prescribing a walking assistive device (WAD) will identify the factors considered, thus more accurately explain the process of care. Such a description could lead to better justification of rehabilitation for patients with stroke and brain injury, and furthermore, determine whether treatments are rendered consistently and when, if ever, divergent approaches occur. Better understanding of the CR process of WAD prescription may also reduce the possibility of device abandonment.
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Affiliation(s)
- Suzanne R O'Brien
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Katherine Durr
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | | | - Lauren Losi
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Vincent Parrillo
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Sarah Pericozzi
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Brett Poirier
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Lauren Poirier
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Katlynne Ray
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Alyssa Sackett
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Drew Simoneau
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
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Tuttle N, Hazle C. An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments. Physiother Theory Pract 2019; 37:775-786. [PMID: 31385748 DOI: 10.1080/09593985.2019.1650405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Most literature on decision processes within physiotherapy relates to "reasoning that results in action" - decisions based on information including assessments that are gathered prior to treatment decisions. A process of "reasoning in interaction" that is often used, particularly by expert clinicians, has received less attention. Objective: To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting. Methods: The theory is: If an impairment that can be directly targeted by treatment (i.e. pain or limitation of passive movement) is related to patient's active impairments and functional limitations, then moment-to-moment changes in the targeted impairment can be used as feedback to guide real-time treatment modification before formal reassessment of functional limitations and other impairments. Results: Applying the theory to manual therapy results in parameters of techniques such as force, speed, direction and duration no longer being pre-determined, but rather being continually adjusted in real-time according to feedback from the patient through both therapist perception (changes in movement quantity or quality) and patient verbal responses. Conclusion: A process of continuous decision-making is described that the authors believe is used by many experienced clinicians but has not previously been adequately described in the literature. .
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Affiliation(s)
- Neil Tuttle
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Charles Hazle
- Division of Physical Therapy, Center for Rural Health, University of Kentucky, Hazard, Kentucky, USA
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