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Dean, Elizabeth
Publications (3 of 3) Show all publications
Elvén, M., Hochwälder, J., Dean, E. & Söderlund, A. (2019). Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students. Physical Therapy, 99(8), 964-976
Open this publication in new window or tab >>Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students
2019 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 99, no 8, p. 964-976Article in journal (Refereed) Published
Abstract [en]

Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-a-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. This study used an exploratory cross-sectional design. The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R-2=0.04; SBC change in R-2=0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. The limitations of this study are that it was cross-sectional. Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.

National Category
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-42932 (URN)10.1093/ptj/pzz044 (DOI)30869789 (PubMedID)2-s2.0-85070756500 (Scopus ID)
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-09-12Bibliographically approved
Elvén, M., Hochwälder, J., Dean, E., Hällman, O. & Söderlund, A. (2018). Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'. AIMS PUBLIC HEALTH, 5(3), 235-259
Open this publication in new window or tab >>Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'
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2018 (English)In: AIMS PUBLIC HEALTH, ISSN 2327-8994, Vol. 5, no 3, p. 235-259Article in journal (Refereed) Published
Abstract [en]

Background and aim: 'Reasoning 4 Change' (R4C) is a newly developed instrument, including four domains (D1-D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1-D4); inter-rater reliability (D2-D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (alpha range: 0.67-0.91), satisfactory test-retest reliability (ICC range: 0.46-0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94-1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06-0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.

Place, publisher, year, edition, pages
AMER INST MATHEMATICAL SCIENCES-AIMS, 2018
Keywords
assessment, behaviour change, clinical reasoning, education, physiotherapy, psychometrics, reliability, validity, web application
National Category
Health Sciences
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-40738 (URN)10.3934/publichealth.2018.3.235 (DOI)000442478900004 ()30280115 (PubMedID)
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2019-03-21Bibliographically approved
Sandborgh, M., Dean, E., Denison, E., Elvén, M., Fritz, J., von Heideken Wågert, P., . . . Söderlund, A. Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program: Rationale, Process and Ten-year Review. Physiotherapy Theory and Practice
Open this publication in new window or tab >>Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program: Rationale, Process and Ten-year Review
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(English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed) Epub ahead of print
Abstract [en]

In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicinecontent and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-41326 (URN)10.1080/09593985.2018.1488192 (DOI)29927660 (PubMedID)
Available from: 2018-11-13 Created: 2018-11-13 Last updated: 2018-12-05Bibliographically approved
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