mdh.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (BEME)ORCID iD: 0000-0001-5356-916X
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (BeMe-Health)ORCID iD: 0000-0002-8865-6818
University of British Columbia, Canada .
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (BeMe-Health)ORCID iD: 0000-0002-4537-030X
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.

Place, publisher, year, edition, pages
2019. Vol. 99, no 8, p. 964-976
National Category
Physiotherapy
Identifiers
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
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-11-12Bibliographically 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: 2019-11-12Bibliographically approved

Open Access in DiVA

fulltext(711 kB)83 downloads
File information
File name FULLTEXT04.pdfFile size 711 kBChecksum SHA-512
3fddc62829df33c9d4c50f195bed0dfbb1b9395c173718d41e91933faab9e0c2ee3976aaac891ac56b40f445f18da91bc86b18e0dbb3e3fd376b0a4c9bfd70c5
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Authority records BETA

Elvén, MariaHochwälder, JacekDean, ElizabethSöderlund, Anne

Search in DiVA

By author/editor
Elvén, MariaHochwälder, JacekDean, ElizabethSöderlund, Anne
By organisation
Health and Welfare
In the same journal
Physical Therapy
Physiotherapy

Search outside of DiVA

GoogleGoogle Scholar
Total: 89 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 247 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf