Background Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research. Objective The objective was to conceptualize a broad description of physical therapists’ clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research. Design/Methods The design included a systematic concept analysis using Rodgers’ evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified. Results Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management. Limitations Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded. Conclusions A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.

Nonlinear time series analysis was used to estimate maximal Lyapunov exponents of select ankle and knee kinematics during three different conditions of treadmill walking: independent, side by side, and side by side with forced synchronization of stepping. Stride to stride variability was significantly increased for the condition in which individuals walked side by side and synchronized unintentionally when compared to the conditions of forced synchronization and independent walking. In addition, standard deviations of three kinematic variables of lower extremity movement were significantly increased during the condition in which unintentional synchronization occurred. No relationship was found between standard deviation and estimates of maximal Lyapunov exponents. An increase in kinematic variability during side by side walking for nonimpaired individuals who are not at risk of falling suggests that variability in certain aspects of performance might be indicative of a healthy system. Modeling this variability for an impaired individual to imitate may have beneficial effects on locomotor function. These results may therefore have implications for the rehabilitation of gait in humans by suggesting that a different functional outcome might be achieved by practicing side by side walking as opposed to more commonly used strategies involving independent walking.

Participants demonstrated development toward physical therapist--specific clinical reasoning, yet demonstrated qualitatively different approaches to the patient encounter. Multiple factors, including the use of reflection-in-action, may enable students to develop greater flexibility in their reasoning processes.

The nutrition assistant role resulted in improved patient satisfaction and maintenance of nutritional outcomes demonstrating the effectiveness of this role in supporting the management of head and neck cancer patients within a multidisciplinary treatment clinic.

Reasoning as Part of Clinical Reasoning Clinical reasoning in expert practitioners entails a complex interweaving of empiricodeductive and narrative reasoning. 7 Diagnostic reasoning, a critical skill within clinical reasoning, is a clinical classification process that involves relating the patient's level of disability with his or her physical function and pathology. 8,9 Through the diagnostic process, the clinician develops an understanding of the patient and his or her problems. 10 In all health care practices, the diagnostic process directs the clinician toward the selection of appropriate interventions.