| Clinical reasoning in three different fields of physiotherapy a qualitative case study | |
Abstract/OtherAbstract
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Summary Clinical reasoning refers to the thinking and decision making processes which occur during clinical practice. It has its origins in the study and teaching of problem solving in medicine. A review of the literature of the allied health fields, suggests clinical reasoning is not only a cognitive and diagnostically orientated process but also an interactional one. The aim of this qualitative study, using the grounded theory, case study methodology of Jensen et al (1990 and 1992), was to examine the clinical reasoning strategies of expert physiotherapists working in different physiotherapy settings, namely, manipulative therapy, neurological and domiciliary care areas. The objective was to generate further theory in clinical reasoning in physiotherapy. Two physiotherapists from each of the disciplines above, and who met certain criteria of expertise, were observed over at least two days in the course of their normal work. Data was collected in the form of observed treatment sessions, interviews with therapists (both of which were audiotaped), field notes and written reflections. Six other physiotherapists, most with academic backgrounds, were interviewed on the same issues of clinical practice. Data was analysed and reported by means of a case study approach. Coding was used to identify clinical reasoning strategies and knowledge frameworks. Case studies, representing the clinical practice of each therapist, were constructed using a descriptive framework. From these individual case studies, composite case studies (incorporating the views of the six interviewed physiotherapists) were constructed. From these a final thematic cross case comparison was performed. Data collection and analysis was performed in an iterative manner and was concurrent with an ongoing review of literature. The study finds that a number of clinical reasoning strategies, representing tasks within clinical practice, are common to each area even though their manifestation is particular to each setting. Such tasks include the formation of diagnosis; understanding the client and their context; the determination and carrying out of treatment procedures; establishing therapist - patient rapport; nurturing a collaborative approach towards deciding and implementing goals of treatment; engaging in individualised and context sensitive teaching; envisioning future scenarios with clients and exploring their choices and their implications; and the apprehension and resolution of ethical and pragmatic dilemmas. Activity and reasoning within these areas occupy a significant place, both philosophically and practically, in the clinical practice of these participating expert therapists. The study represents the development of a series of conceptual frameworks, from Jensen et al?s (1992) early grounded theory concerning the attributes of expert orthopaedic physiotherapists through to the proposal of a theory of dialectical reasoning in physiotherapy. I describe the clinical reasoning of the participating physiotherapists in the study as dialectical in so much as it moves between, and expresses, different conceptions of knowledge. It is not confined to an empirico-analytical knowledge paradigm as described in previous physiotherapy literature on clinical reasoning. I also describe another dialectic between the individual formation of knowledge for clinical practice and its social development. This theory of clinical reasoning has implications for both the teaching of clinical reasoning in physiotherapy and for what is considered credible evidence in research in physiotherapy generally., thesis (PhD)--University of South Australia, 2000 |
Authors
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Edwards, Ian |
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Date Detail
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2000 |
Subject
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Physical therapy, Decision making |
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Copyright Information
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Copyright 2000 Ian Edwards |
Other Details
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Languages : eng |
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