Development and initial evaluation of an instrument to assess physiotherapists’ clinical reasoning focused on clients’ behavior change

Abstract

This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students' and physiotherapists' clinical reasoning, however continued development and testing are needed.

Physical activity promotion in daily exercise therapy: The perspectives of exercise therapists in German rehabilitation settings

“…Third, curricula for therapeutic training and the practical work of therapists are still heavily influenced by the functional biomedical model, which primarily aims at improving bodily functions and thereby neglects psychological and social factors of the rehabilitants [42,43]. The development and research of behavioural clinical reasoning models [44][45][46] and the systematic integration of PAP into the training of exercise professions [47] is only recently taking place. Accordingly, bio-psycho-social approaches and the topic of behavioural change comprise new territory for many therapists [48].…”

Physical activity promotion in daily exercise therapy: The perspectives of exercise therapists in German rehabilitation settings

“…Third, curricula for therapeutic training and the practical work of therapists are still heavily influenced by the functional biomedical model, which primarily aims at improving bodily functions and thereby neglects psychological and social factors of the rehabilitants [41,42]. The development and research of behavioural clinical reasoning models [43][44][45] and the systematic integration of PAP into the training of exercise professions [46] is only recently taking place. Accordingly, bio-psycho-social approaches and the topic of behavioural change comprise new territory for many therapists [47].…”

Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists’ clinical reasoning focused on behaviour change: ‘Reasoning 4 Change’

“…Furthermore, these tools may target particular areas of practice [8] or measure features of clinical competence or performance [9] – [12] , but may not specifically address clinical reasoning ability across physiotherapy contexts. The newly developed clinical reasoning instrument, ‘Reasoning 4 Change’ (R4C) [13] was developed to meet these needs and shortcomings. The R4C instrument includes four domains and targets the features of a biopsychosocial clinical reasoning process with a focus on clients' activity-related behaviour and behaviour change.…”

“…The nature of the clinical reasoning is characterised by a cognitive, reflective, contextual and collaborative reflexive process with multiple interrelated levels incorporating the client's behaviours and goals, behaviour analysis and behaviour change strategies. The original development of the R4C instrument followed a detailed stepwise process [13] including consideration of current guidelines for clinical reasoning assessment design. For example, features of the design included multiple cases based on the role of case specificity [15] , the addition of new client information throughout the reasoning process [16] and multiple acceptable reasoning paths [17] .…”

“…Feasibility and comprehensibility of the R4C instrument have been supported by physiotherapy students, and its content validity has been accepted by experts in physiotherapy and behavioural medicine [13] . However, information regarding R4C instrument criterion scores, i.e., expert scores that correspond to qualified practitioners' clinical reasoning abilities, reliability and construct validity is lacking.…”