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Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change
Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.ORCID-id: 0000-0001-5356-916X
Mälardalens högskola, Akademin för ekonomi, samhälle och teknik. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.ORCID-id: 0000-0002-8865-6818
Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.ORCID-id: 0000-0002-4537-030X
2018 (Engelska)Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 34, nr 5, s. 367-383Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and Aim: A systematically developed and evaluated instrument is needed to support investigations of physiotherapists' clinical reasoning integrated with the process of clients' behavior change. This study's aim was to develop an instrument to assess physiotherapy students' and physiotherapists' clinical reasoning focused on clients' activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. Methods: The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. Results: Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument's content relevance. Conclusions: This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students' and physiotherapists' clinical reasoning, however continued development and testing are needed.

Ort, förlag, år, upplaga, sidor
2018. Vol. 34, nr 5, s. 367-383
Nyckelord [en]
Behavior change, clinical reasoning, instrument development, physiotherapy, validity
Nationell ämneskategori
Hälsovetenskaper
Identifikatorer
URN: urn:nbn:se:mdh:diva-42887DOI: 10.1080/09593985.2017.1419521ISI: 000425789400004PubMedID: 29405848Scopus ID: 2-s2.0-85041579507OAI: oai:DiVA.org:mdh-42887DiVA, id: diva2:1295285
Tillgänglig från: 2019-03-11 Skapad: 2019-03-11 Senast uppdaterad: 2019-04-11Bibliografiskt granskad
Ingår i avhandling
1. Clinical reasoning focused on clients’ behaviour change in physiotherapy: Development and evaluation of the Reasoning 4 Change instrument
Öppna denna publikation i ny flik eller fönster >>Clinical reasoning focused on clients’ behaviour change in physiotherapy: Development and evaluation of the Reasoning 4 Change instrument
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Västerås: Mälardalen University, 2019. s. 101
Serie
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 289
Nyckelord
Assessment, Behaviour change, Clinical reasoning, Education, Functional behavioural analysis, Physiotherapy, Reliability, Scale development, Validity
Nationell ämneskategori
Sjukgymnastik
Forskningsämne
fysioterapi
Identifikatorer
urn:nbn:se:mdh:diva-42931 (URN)978-91-7485-426-8 (ISBN)
Disputation
2019-05-24, Beta, Mälardalens högskola, Västerås, 09:30 (Svenska)
Opponent
Handledare
Tillgänglig från: 2019-03-19 Skapad: 2019-03-18 Senast uppdaterad: 2019-04-11Bibliografiskt granskad

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