Expert Practice in Physical Therapy

Abstract

Background and Purpose. The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics. Subjects. Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics. Methods. Guided by a grounded theory approach, a multiple case study research design was used, with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area. Results. A theoretical model of expert practice in physical therapy was developed that included 4 dimensions: (1) a dynamic, multidimensional knowledge base that is patient-centered and evolves through therapist reflection, (2) a clinical reasoning process that is embedded in a collaborative, problem-solving venture with the patient, (3) a central focus on movement assessment linked to patient function, and (4) consistent virtues seen in caring and commitment to patients. Conclusion and Discussion. These findings build on previous research in physical therapy on expertise. The dimensions of expert practice in physical therapy have implications for physical therapy practice, education, and continued research.

Clinical Reasoning in Physical Therapy: A Concept Analysis

“…9,[146][147][148]150,[156][157][158][159][160][161] Four articles in the physical therapy literature alluded to human movement as related to clinical reasoning. 11,159,161,164 While not identified in the initial search, additional articles in the physical therapy literature highlighting expert/novice differences and the developmental nature of therapists' reasoning were deemed informative and thus included. 11,[165][166][167][168]…”

“…11,159,161,164 While not identified in the initial search, additional articles in the physical therapy literature highlighting expert/novice differences and the developmental nature of therapists' reasoning were deemed informative and thus included. 11,[165][166][167][168]…”

“…The current literature on expertise in physical therapy points to the influence of the physical therapist's professional lens or focus of their practice. A focus on movement has been highlighted in expert practice within physical therapy 11 yet is not well explored as related to how movement is used in reasoning.…”

Physiotherapists’ accounts of their clients in geriatric inpatient rehabilitation

“…1. Each informant has been assigned a random number (1–11) which is used in Fig. 1 to illustrate the occurrences of the accounts in each informant’s talk.…”

“…Lately, however, there has been increasing emphasis on the importance of taking a patient‐centred approach in physiotherapy. In the literature on professional standards and expert practice, patient‐centred and collaborative physiotherapy practices are nowadays considered axiomatic (4–7).…”