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Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (BeME-Health)ORCID iD: 0000-0001-5356-916X
(BeME-Health)ORCID iD: 0000-0002-8865-6818
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Dept Phys Therapy, Vancouver, BC, Canada..
Uppsala Univ, Dept Informat Technol, Uppsala, Sweden..
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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. Vol. 5, no 3, p. 235-259
Keywords [en]
assessment, behaviour change, clinical reasoning, education, physiotherapy, psychometrics, reliability, validity, web application
National Category
Health Sciences
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:mdh:diva-40738DOI: 10.3934/publichealth.2018.3.235ISI: 000442478900004PubMedID: 30280115OAI: oai:DiVA.org:mdh-40738DiVA, id: diva2:1246056
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2019-03-21Bibliographically approved
In thesis
1. Clinical reasoning focused on clients’ behaviour change in physiotherapy: Development and evaluation of the Reasoning 4 Change instrument
Open this publication in new window or tab >>Clinical reasoning focused on clients’ behaviour change in physiotherapy: Development and evaluation of the Reasoning 4 Change instrument
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

With the recognition of the impact of lifestyle behaviours on health and the evidence of incorporating behavioural considerations in physiotherapy, there is a need to advance the clinical reasoning of physiotherapists. Clinical reasoning encompasses the thinking and decision-making processes guiding client management and is a core competency of physiotherapists. Enabling clinical reasoning advancements requires investigations in practice and education, which in turn require robust assessments. The overall aim of this thesis was to develop and evaluate an instrument to study physiotherapy students’ clinical reasoning focused on clients’ activity-related behaviour and behaviour change.

In study I, a conceptual model was developed based on exploration of existing research, theory and views of physiotherapists and students. The data resulted in the clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists (CRBC-PT). Studies II and III included instrument development and evaluation in four phases. Phase 1 included determination of the instrument structure and item generation based on the CRBC-PT model, evidence in clinical reasoning assessment and existing measures. Phase 2 included cognitive interviews with students to assess item understanding and resulted in revisions of item problems and approval of feasibility. Phase 3 included a Delphi study with physiotherapists with expertise in behavioural medicine to evaluate item relevance. The findings demonstrated a high level of consensus regarding content relevance. The final version of the Reasoning 4 Change (R4C) instrument included four domains, namely, Physiotherapist, Input from client, Functional behavioural analysis, and Strategies for behaviour change. In phase 4, the reliability and validity of the instrument were evaluated. Physiotherapists with expertise in behavioural medicine and students responded to the web-based R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists. The analyses showed excellent inter-rater reliability, satisfactory construct validity, internal consistency and test-retest reliability. In study IV, final-semester students (n=151) from all physiotherapy programmes in Sweden completed the R4C instrument. Hierarchical multiple regression analyses were conducted with three dependent variables, namely, input from client, functional behavioural analysis, and strategies for behaviour change. All included independent variables explained 37% of the variance in input from client. Cognitive and metacognitive skills explained 22%, attitudes 15% and curriculum with behavioural medicine competencies 3%. Only the variable curriculum with behavioural medicine competencies explained the variance in functional behavioural analysis (4%) and strategies for behaviour change (5%).

In conclusion, the in-depth description of clinical reasoning focused on clients’ behaviour change may contribute to expanded understanding of the complexity and multidimensionality in reasoning processes that incorporate factors related to human behaviours, analyses of what factors motivate or hinder behaviours, and interventions to support behaviour change. Such knowledge is valuable for the teaching of and learning clinical reasoning. The R4C instrument helps fill the need for well-tested instruments and can support investigations and evaluations in physiotherapy education and research. To develop students’ clinical reasoning competence, cognitive and metacognitive skills, positive attitudes and the incorporation of behavioural medicine competencies into physiotherapy curricula should be targeted. Further attention to complex reasoning, including analysis and intervention, is warranted.

Place, publisher, year, edition, pages
Västerås: Mälardalen University, 2019. p. 101
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 289
Keywords
Assessment, Behaviour change, Clinical reasoning, Education, Functional behavioural analysis, Physiotherapy, Reliability, Scale development, Validity
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-42931 (URN)978-91-7485-426-8 (ISBN)
Public defence
2019-05-24, Beta, Mälardalens högskola, Västerås, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2019-03-19 Created: 2019-03-18 Last updated: 2019-04-11Bibliographically approved

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Publisher's full textPubMedhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141557/

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Elvén, MariaHochwälder, JacekDean, ElizabethSöderlund, Anne

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