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Rey-Mota J, Escribano-Colmena G, Fernández-Lucas J, Parraca JA, Clemente-Suárez VJ. Impact of professional experience on clinical judgment and muscular response in various neuromuscular tests. Physiol Behav 2024; 283:114602. [PMID: 38851442 DOI: 10.1016/j.physbeh.2024.114602] [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: 05/23/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
Muscle testing is an integral component in assessing musculoskeletal function and tailoring rehabilitation efforts. This study aimed i. to identify an objective evaluation system sensitive to analyze changes in different muscular conditions in different neuromuscular tests across a spectrum of professional experience levels; and ii. to analyze differences in objective parameters and clinical judgment between participants of different levels of expertise in different muscular conditions in different neuromuscular tests. Participants included 60 subjects with Level I to III expertise who performed blinded neuromuscular tests on the middle deltoid and rectus femoris muscles of 40 volunteer subjects. The methodology centered on standardizing test protocols to minimize variability, employing EMG to quantify muscle activity, thermography to capture thermographic muscular response, and digital dynamometry to measure muscular resistance. The findings revealed that while traditional methods like thermography and electromyography provide valuable insights, digital dynamometry stands out for its sensitivity in detecting muscle condition changes in neuromuscular test. Moreover, the data underscored the pivotal role of advanced training and expertise in enhancing the precision and accuracy of neuromuscular diagnostics, since there were significant differences in objective parameters and clinical judgment between participants of different levels of expertise in the different muscular conditions in Middle deltoid and Rectus femoris neuromuscular tests analyzed, presenting higher expertise participant clinical judgment like objective validated instrument.
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Affiliation(s)
| | | | - Jesús Fernández-Lucas
- Applied Biotechnology Group, Universidad Europea de Madrid, Urbanización El Bosque, 28670, Villaviciosa de Odón, Spain; Grupo de Investigación en Ciencias Naturales y Exactas, GICNEX, Universidad de la Costa, CUC, Calle 58 # 55-66, 080002, Barranquilla, Colombia; Department of Biochemistry and Molecular Biology, Faculty of Biology, Universidad Complutense de Madrid, Calle José Antonio Novais, 12, 28040 Madrid, Spain.
| | - Jose A Parraca
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004 516 Évora, Portugal; Comprehensive Health Research Centre (CHRC), University of Évora, 7004-516 Évora, Portugal
| | - Vicente Javier Clemente-Suárez
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, 080002 Barranquilla, Colombia; Universidad Europea de Madrid. Faculty of Sports Sciences. Tajo Street, s/n, 28670 Madrid, Spain
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2
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Wilson AT, Hanney WJ, Richardson RM, Klausner SH, Bialosky JE. Biopsychosocial contributors to irritability in individuals with shoulder or low back pain. J Man Manip Ther 2024; 32:400-411. [PMID: 38108631 PMCID: PMC11257012 DOI: 10.1080/10669817.2023.2294679] [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: 09/10/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Irritability is a foundational clinical reasoning concept in rehabilitation to evaluate reactivity of the examination and treatment. While originally theorized to reflect tissue damage, a large body of evidence supports pain is a biopsychosocial experience impacted by pain sensitivity and psychological factors. Therefore, the purpose of this study was to examine biopsychosocial contributors to irritability. METHODS 40 patients with shoulder (n = 20) and low back (n = 20) pain underwent Quantitative Sensory Testing (QST) (Pressure Pain Threshold, Heat Pain Threshold, Conditioned Pain Modulation, Temporal Summation), completed pain-related psychological questionnaires, an Exercise-Induced Hypoalgesia protocol, and standardized irritability assessment based on Clinical Practice Guidelines. Participants were then categorized as irritable or not irritable based on Maitland's criteria and by irritability level based on Clinical Practice Guidelines. An independent samples t-test examined for differences in QST and psychological factors by irritability category. A MANOVA examined for differences in QST and psychological factors by irritability level (high, moderate, low). RESULTS Significantly lower heat and pressure pain thresholds at multiple locations (p < 0.05), as well as less efficient conditioned pain modulation (p = 0.02), were demonstrated in individuals categorized as irritable. Heat and pressure pain thresholds were also significantly lower in patients with high irritability compared to other levels. Significantly higher depression and anger, as well as lower self-efficacy, were reported in individuals with an irritable presentation. DISCUSSION/CONCLUSION Biopsychosocial factors, including widespread hyperalgesia and elevated psychological factors, may contribute to an irritable presentation.
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Affiliation(s)
- Abigail T. Wilson
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - William J. Hanney
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Randi M. Richardson
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
| | - Sheila H. Klausner
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
| | - Joel E. Bialosky
- University of Florida Department of Physical Therapy, Gainesville, FL, USA
- Brooks-PHHP Research Collaboration, Gainesville, FL, USA
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3
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Silvernail JL, Deyle GD, Jensen GM, Chaconas E, Cleland J, Cook C, Courtney CA, Fritz J, Mintken P, Lonnemann E. Orthopaedic Manual Physical Therapy: A Modern Definition and Description. Phys Ther 2024; 104:pzae036. [PMID: 38457654 DOI: 10.1093/ptj/pzae036] [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: 06/11/2023] [Revised: 11/04/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Currently, orthopaedic manual physical therapy (OMPT) lacks a description of practice that reflects contemporary thinking and embraces advances across the scientific, clinical, and educational arms of the profession. The absence of a clear definition of OMPT reduces understanding of the approach across health care professions and potentially limits OMPT from inclusion in scientific reviews and clinical practice guidelines. For example, it is often incorrectly classified as passive care or incorrectly contrasted with exercise-therapy approaches. This perspective aims to provide clinicians, researchers, and stakeholders a modern definition of OMPT that improves the understanding of this approach both inside and outside the physical therapist profession. The authors also aim to outline the unique and essential aspects of advanced OMPT training with the corresponding examination and treatment competencies. This definition of practice and illustration of its defining characteristics is necessary to improve the understanding of this approach and to help classify it correctly for study in the scientific literature. This perspective provides a current definition and conceptual model of OMPT, defining the distinguishing characteristics and key elements of this systematic and active patient-centered approach to improve understanding and help classify it correctly for study in the scientific literature.
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Affiliation(s)
| | - Gail D Deyle
- Graduate School, Baylor University, San Antonio, Texas, USA
| | - Gail M Jensen
- Graduate School and College of Professional Studies, Creighton University, Omaha, Nebraska, USA
| | - Eric Chaconas
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Josh Cleland
- Department of Rehabilitation Science, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Chad Cook
- Division of Physical Therapy, Department of Orthopaedics, Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Carol A Courtney
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Julie Fritz
- Orthopaedic Surgery, Orthopaedic Surgery Operations, Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Paul Mintken
- Department of Physical Therapy, Hawai'i Pacific University, Honolulu, Hawaii, USA
| | - Elaine Lonnemann
- Physical Therapy, University of St. Augustine for Health Sciences, St. Augustine, Florida, USA
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Pađen L, Pajnič M, Vettorazzi R, Pérez-Perdomo A, Stefaniak M, Claes N, Franco H, Vandervoort A, Ravljen M. "Learning a Way of Thinking"-World Café on Clinical Reasoning in Nursing and Midwifery Education and Practice across Five European Union Countries. Healthcare (Basel) 2023; 11:2969. [PMID: 37998462 PMCID: PMC10671496 DOI: 10.3390/healthcare11222969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Clinical reasoning is a key attribute of nursing and midwifery professionals. As a part of the Erasmus plus project, we designed a study with the aim of exploring the understanding of clinical reasoning as a concept, experiences of teaching clinical reasoning and practices related to using clinical reasoning in nursing and midwifery. A qualitative study was carried out using the World Café method, involving 44 participants from five European countries. The participants represented diverse professional backgrounds, including nurses, midwives and lecturers. Our analytical approach was based on a thematic analysis. We categorized the data into three main categories, namely, "Spiral of thinking", "The learning and teaching of a way of thinking" and "Clinical reasoning in real life", all under an overarching theme, "Learning a way of thinking". This study highlighted areas of learning and teaching which can be improved in current nursing and midwifery education. Furthermore, it identified barriers, facilitators and practices from five European countries which can be used in the further development of nursing and midwifery curricula and courses with the aim of enhancing clinical reasoning competence and ultimately improving patient care.
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Affiliation(s)
- Ljubiša Pađen
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | - Manca Pajnič
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | - Renata Vettorazzi
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
| | | | - Małgorzata Stefaniak
- Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Nele Claes
- HBO Verpleegkunde Genk, 3600 Genk, Belgium;
| | - Hugo Franco
- School of Health Setúbal, Setúbal Polytechnic University, 2910-761 Setúbal, Portugal;
| | | | - Mirjam Ravljen
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia; (L.P.); (M.P.); (R.V.)
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Duong QH, Pham TN, Reynolds L, Yeap Y, Walker S, Lyons K. A scoping review of therapeutic reasoning process research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1289-1310. [PMID: 37043070 PMCID: PMC10624714 DOI: 10.1007/s10459-022-10187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/09/2022] [Indexed: 06/19/2023]
Abstract
Therapeutic reasoning is when the purpose, task, or goal for engaging in reasoning is to determine the patient's management plan. As the field's understanding of the process of therapeutic reasoning is less well understood, we focused on studies that collected data on the process of therapeutic reasoning. To synthesize previous studies of therapeutic reasoning characteristics, methodological approaches, theoretical underpinnings, and results. We conducted a scoping review with systematic searching for English language articles with no date limits. Databases included MEDLINE, CINAHL Plus, Scopus, Embase, Proquest Dissertations and Theses Global, and ERIC. Search terms captured therapeutic reasoning in health professions education research. Initial search yielded 5450 articles. The title and abstract screening yielded 180 articles. After full-text review, 87 studies were included in this review. Articles were excluded if they were outside health professions education, did not collect data on the process of therapeutic reasoning, were not empirical studies, or not focused on therapeutic reasoning. We analyzed the included articles according to scoping questions using qualitative content analysis. 87 articles dated from 1987 to 2019 were included. Several study designs were employed including think-aloud protocol, interview and written documentation. More than half of the articles analyzed the data using qualitative coding. Authors often utilized several middle-range theories to explain therapeutic reasoning processes. The hypothetico-deductive model was most frequently mentioned. The included articles rarely built off the results from previous studies. Six key result categories were found: identifying themes, characterizing and testing previous local theory, exploring factors, developing new local theory, testing tools, and testing hypothesis. Despite the cast body of therapeutic reasoning research, individual study results remain isolated from previous studies. Our future recommendations include synthesizing pre-existing models, developing novel methodologies, and investigating other aspects of therapeutic reasoning.
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Affiliation(s)
- Quang Hung Duong
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Pde, Parkville, 3052, Australia
| | - To Nhu Pham
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Pde, Parkville, 3052, Australia
| | - Lorenna Reynolds
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Pde, Parkville, 3052, Australia
| | - Yan Yeap
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Pde, Parkville, 3052, Australia
| | - Steven Walker
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Pde, Parkville, 3052, Australia
| | - Kayley Lyons
- Centre for Digital Transformation of Health, University of Melbourne, 700 Swanston St, Carlton, 3053, Australia.
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Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Murtagh G. Physiotherapists' perceptions on using a multidimensional clinical reasoning form during psychologically informed training for low back pain. Musculoskelet Sci Pract 2023; 66:102797. [PMID: 37343402 DOI: 10.1016/j.msksp.2023.102797] [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: 01/19/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Building clinical reasoning skills is important to effectively implement psychologically informed practice. We developed a multidimensional clinical reasoning form (CRF) to be used by physiotherapists in a psychologically informed practice training programme for low back pain. In this paper we describe the development of the CRF, how the CRF was used in the training, and present an evaluation of physiotherapists' perceptions of the CRF. METHODS Qualitative semi-structured interviews were conducted with ten physiotherapists purposively sampled in primary care. Data were gathered through pre, and post training focus group interviews and a secondary analysis of individual physiotherapist interviews conducted after the training. Thematic analysis was used to analyse the data and capture the emergent themes. RESULTS Two main themes emerged before the training: (1) the CRF 'needs formal training' and (2) 'lacked instruction'. Three main themes emerged after the training (1) it provided 'a helpful framework for multidimensional clinical reasoning' (2) the CRF, and accompanying operational definitions, helped physiotherapists 'elicit information, with 'question prompts' helpful in facilitating patient disclosure (3) 'Utility' - although the CRF was not formally used by the physiotherapists it provided a conceptual reasoning framework to work from with more challenging patients. CONCLUSION The CRF was not designed to be used in isolation by clinicians without training. However, when used as a training adjunct it appears to be valued by physiotherapists to help develop their critical thinking and better characterise patients' presentations in order to personalise care from a bio-psychosocial perspective.
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Affiliation(s)
- Ian Cowell
- Department of Surgery and Cancer, Imperial College, London, UK; Brook Physiotherapy Ltd, Woodford Green, Essex, UK.
| | - Alison McGregor
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, WA,Australia; Bodylogic Physiotherapy, Perth, WA,Australia
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Ireland; Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ross Poyton
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Ged Murtagh
- Department of Surgery and Cancer, Imperial College, London, UK
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Lusardi MM. 2023 Carol B. Lewis Distinguished Lecture Address to the APTA Geriatrics Membership Combined Sections Meeting, February 23, 2023 Key Words & Challenges: Defining Our Role in Caring for Older Adults. J Geriatr Phys Ther 2023; 46:93-102. [PMID: 36935462 DOI: 10.1519/jpt.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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The why, where, and how clinical reasoning model for the evaluation and treatment of patients with low back pain. Braz J Phys Ther 2020; 25:407-414. [PMID: 33371952 DOI: 10.1016/j.bjpt.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/19/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like symptoms may originate from the lumbar spine or secondary to extra-spinal sources such as deep gluteal syndrome (GPS). Given that there are several overlapping potential anatomic sources of symptoms that may be synchronous in patients who have low back pain (LBP), it may not be realistic that a linear deductive approach can be used to establish a diagnosis and direct treatment in this group of patients. OBJECTIVE The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases. METHODS This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm. CONCLUSIONS This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's primary complaint). The integration of these components individually, in serial, or simultaneously may help to develop clinical reasoning through reflection on and in action. A better understanding of what these concepts are and how they are related through the proposed model may help to improve the clinical conversation, academic application of clinical reasoning, and clinical outcomes.
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Pepin ME, Chan D. Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy. Physiother Theory Pract 2020; 38:1078-1089. [PMID: 32892675 DOI: 10.1080/09593985.2020.1815260] [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: 10/23/2022]
Abstract
OBJECTIVE AND PURPOSE Shoulder symptoms are often encountered in physical therapy and a myriad of etiologies can cause these symptoms, either locally or remotely. The purpose of this case report is to describe the physical therapist's differential diagnostic process for a patient with acute and severe onset of shoulder pain. Case Description: The patient was a 37-year-old female with sudden onset of right shoulder pain that awakened her at night. Pain was associated with decreased range of motion and shoulder weakness. Faced with an uncertain diagnosis, the physical therapist followed a systematic approach to clinical decision-making. Outcomes: Neuralgic amyotrophy was the primary diagnostic hypothesis but other causes of shoulder pain could not be ruled out. Conclusion: The clinical decision-making process helped the physical therapist narrow down the differential diagnosis list and make a decision to send the patient for further testing. Magnetic resonance imaging and electromyogram confirmed the diagnosis of neuralgic amyotrophy.
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Affiliation(s)
- Marie-Eve Pepin
- Physical Therapy Program, Wayne State University, Detroit, MI, USA
| | - Derek Chan
- Center for Athletic Medicine, Henry Ford Health Care System, Detroit, MI, USA
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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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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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