Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy

Baker, Sarah E.; Painter, Elizabeth E.; Morgan, Brandon C; Kaus, Anna L.; Petersen, Evan J.; Allen, Christopher S.; Deyle, Gail D.; Jensen, Gail M.

doi:10.2522/ptj.20150482

Cited by 30 publications

(15 citation statements)

References 38 publications

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“…Physical therapy residencies often use a number of methods geared at developing and assessing advanced clinical reasoning, with mentorship, regular reflective exercises, and objective assessment tools constituting these tactics. 6,7,12 As residency programs increase in popularity throughout the athletic training profession, a better understanding of how programs currently perceive, instruct, and assess advanced clinical reasoning is a pivotal first step to ensuring effective outcomes in residency education. This study sought to capture these answers through semistructured interviews with residency RPDs, and as a result, the 3 emergent themes were identified.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has shown clinical mentorship to be effective in improving patient outcomes and clinician performance along with the development of practitioners' clinical reasoning capabilities. 12,22 It is no surprise that mentorship is a foundation of resident development. However, the application of clinical mentoring did differ between programs.…”

Section: Instructional Tacticsmentioning

confidence: 99%

“…10,11 Further, medical education as a whole has identified and implemented a number of objective measures of clinical reasoning that can demonstrate detectable change, such as the Diagnostic Thinking Inventory or Script Concordance Test. [12][13][14] However, to our knowledge, there is no literature suggesting how or if these techniques or others are being applied to the development of advanced clinical reasoning among clinical specialists in athletic training. Exploring how residency program directors (RPDs) or preceptors develop and assess clinical reasoning could help educators understand the purpose of a residency and aid educators at all levels of education.…”

Section: Introductionmentioning

confidence: 99%

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Athletic Training Residency Program Development and Assessment of Advanced Clinical Reasoning

Hofmann

Bacon

Rivera

et al. 2022

Athletic Training Education Journal

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Context Clinical reasoning is an inferential process of collecting and evaluating data in patient cases, necessary in all care. Athletic training residency programs are emerging rapidly as the industry standard for developing clinical specialists who possess advanced clinical reasoning needed for complex cases. Objective The purpose of this study was to explore current practices of advanced clinical reasoning development and assessment in athletic training residency programs. Design Inductive qualitative research. Setting Web-based teleconferencing platform (Zoom Video Communications). Patients or Other Participants Seven of 10 Commission on Accreditation of Athletic Training Education–accredited residency program directors (RPDs) (age = 46 ± 9 years, years as RPD = 5 ± 6). Data Collection and Analysis We used qualitative, semistructured interviews. Audio files were transcribed verbatim, checked for accuracy, deidentified, and member checked before analysis. We used a 2-person data analysis team and an inductive coding approach. The researchers reviewed the transcripts independently, met to develop a codebook, applied the codes, and conducted internal auditing. Trustworthiness was established through member checking, multiple-analyst coding, and auditing. Results Three themes emerged from the RPDs about developing advanced clinical reasoning: (1) defining clinical reasoning, (2) instructional tactics, and (3) assessment tactics. RPDs defined clinical reasoning as the process of the resident justifying their decision-making and the accuracy of their decisions. RPDs described both clinical and didactic instructional tactics, including mentoring, lectures and discussions, case presentations, and journal club. RPDs described assessing advanced clinical reasoning through patient and preceptor feedback in structured and unstructured formats, self-reflection, and knowledge testing to measure clinical reasoning. RPDs highly relied on preceptors and clinical mentoring, but also described a singular reliance on residents to appraise the clinical reasoning capacity of their own preceptors. Conclusions RPDs define clinical reasoning as rationalization and accuracy of decisions. Although the programs are engaged in effective clinical and didactic approaches to teach advanced clinical reasoning, they rely heavily on the subjectivity of preceptors and residents to assess these outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Instructional Tacticsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Athletic Training Residency Program Development and Assessment of Advanced Clinical Reasoning

Hofmann

Bacon

Rivera

et al. 2022

Athletic Training Education Journal

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“…However, the existing studies on CIMT do not especially emphasize on clinical reasoning, rather they give a straightjacket prescription of what should be done throughout the period of care whether the patients improve better or not. Clinical reasoning is important to physiotherapy practice [78]. The process of problem solving, clinical decision making, and clinical reasoning in constraint-induced movement therapy is represented in Figure 5.…”

Section: A Hypothetical Case To Help Enhance Problem Solving Clinicamentioning

confidence: 99%

Movement Rehabilitation in Physiotherapy after Stroke: The Role of Constraint-Induced Movement Therapy

Abdullahi¹

2019

Different Areas of Physiotherapy

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Stroke is increasingly becoming a global health problem. This is because it may lead to death, Long-term disability such as in motor function, and significant burden to the patients and their families. The disability can be prevented or rehabilitated using a physiotherapy technique known as constraint-induced movement therapy (CIMT). The CIMT comprises of task practice with the affected limb, constraint of the unaffected limb, and transfer package to foster compliance and increase the amount of task repetition. It helps to reestablish normal motor control through facilitating changes in physiological functions of the brain, improvement in realworld arm use, and movement precision and quality. However, its protocols vary. Some protocols use number of hours and others use number of repetitions to determine the intensity or the amount of task practice. This chapter argued that CIMT is effective, but the protocols that use a number of hours of task practice are not clear and are resource intensive; and as such they could interfere with the process of clinical decision making. Consequently, it proposed the use of a number of repetitions of task practice to determine the intensity or the amount of task practice and extending the application of CIMT to those with severe impairments after stroke. Different Areas of Physiotherapy 2 movement therapy: the future perspective. Information from all the sections to be discussed is needed by the physiotherapist in order to be able to make an effective clinical decision during application of CIMT in people with stroke.

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“…It can be used to teach clinical reasoning skills and may facilitate a critical appraisal of why and how decisions are made [11]. Since mentoring and reflection are regarded as important instruments to facilitate the progression of clinical reasoning skills in HPs, several tools for guided mentorship and reflection have been developed to date [11,19,20]. As far as we know, our strategy is the first that specifically addresses clinical reasoning related to exercise therapy in patients with a complex health status.…”

Section: Case Knee Osteoarthritis 64 Years Old Womanmentioning

confidence: 99%

Structured clinical reasoning for exercise prescription in patients with comorbidity

Leeden

Stuiver

Huijsmans

et al. 2018

Disability and Rehabilitation

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Purpose: Exercise therapy is an effective intervention in a variety of chronic diseases. The prescription of exercise therapy is usually directed toward an index disease. The presence of comorbidity may require adaptations to the exercise program as intended for the index disease. This paper aims to structure the clinical reasoning process of health professionals when prescribing exercise therapy for the individual patient with an index disease and comorbidity. Methods: We adapted the previously published strategy for developing guidelines and protocols on comorbidity-adapted exercise to a version that can be used for individual exercise prescription. Results: Essential steps and considerations involved in prescribing an exercise program to an individual patient with comorbidity are described. A case description is used as an example of how the proposed strategy leads to clinical decisions. Conclusions: The proposed strategy may have a role in educational and professional development. The advanced clinical expertise needed for safe and effective exercise therapy in patients with a complex health status is emphasized.The presence of comorbidity may require adaptations to exercise therapy. We describe the essential steps and considerations involved in prescribing an exercise program to an individual patient with an index disease and comorbidity. The proposed strategy can be used to structure the clinical reasoning process of health professionals. ARTICLE HISTORY

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Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy

Cited by 30 publications

References 38 publications

Athletic Training Residency Program Development and Assessment of Advanced Clinical Reasoning

Athletic Training Residency Program Development and Assessment of Advanced Clinical Reasoning

Movement Rehabilitation in Physiotherapy after Stroke: The Role of Constraint-Induced Movement Therapy

Structured clinical reasoning for exercise prescription in patients with comorbidity

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