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Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students
Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. (BeMe-Health)ORCID-id: 0000-0001-5356-916X
Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. (BeMe-Health)ORCID-id: 0000-0002-8865-6818
University of British Columbia, Canada .
Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. (BeMe-Health)ORCID-id: 0000-0002-4537-030X
2019 (engelsk)Inngår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 99, nr 8, s. 964-976Artikkel i tidsskrift (Fagfellevurdert) 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.

sted, utgiver, år, opplag, sider
2019. Vol. 99, nr 8, s. 964-976
HSV kategori
Identifikatorer
URN: urn:nbn:se:mdh:diva-42932DOI: 10.1093/ptj/pzz044ISI: 000482424200003PubMedID: 30869789Scopus ID: 2-s2.0-85070756500OAI: oai:DiVA.org:mdh-42932DiVA, id: diva2:1297023
Tilgjengelig fra: 2019-03-18 Laget: 2019-03-18 Sist oppdatert: 2019-10-14bibliografisk kontrollert
Inngår i avhandling
1. Clinical reasoning focused on clients’ behaviour change in physiotherapy: Development and evaluation of the Reasoning 4 Change instrument
Åpne denne publikasjonen i ny fane eller vindu >>Clinical reasoning focused on clients’ behaviour change in physiotherapy: Development and evaluation of the Reasoning 4 Change instrument
2019 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
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.

sted, utgiver, år, opplag, sider
Västerås: Mälardalen University, 2019. s. 101
Serie
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 289
Emneord
Assessment, Behaviour change, Clinical reasoning, Education, Functional behavioural analysis, Physiotherapy, Reliability, Scale development, Validity
HSV kategori
Forskningsprogram
fysioterapi
Identifikatorer
urn:nbn:se:mdh:diva-42931 (URN)978-91-7485-426-8 (ISBN)
Disputas
2019-05-24, Beta, Mälardalens högskola, Västerås, 09:30 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2019-03-19 Laget: 2019-03-18 Sist oppdatert: 2019-04-11bibliografisk kontrollert

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