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  • 1.
    Cegrell Ulff, Lotta
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wreeby, Helena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Student-centered learning in anatomy. (Studentcentrerat lärande i anatomi i Norden)2022In: NU2022. Stockholm, Sweden. June 15-17, 2022. Oral presentation., 2022Conference paper (Refereed)
  • 2.
    Dahlen, Micael
    et al.
    Stockholm School of Economics, Sweden.
    Thorbjørnsen, Helge
    Norwegian School of Economics, Bergen, Norway.
    Sjåstad, Hallgeir
    Norwegian School of Economics, Bergen, Norway.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hellström, Charlotta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kerstis, Birgitta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Lindberg, Daniel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Stier, Jonas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Changes in Physical Activity Are Associated with Corresponding Changes in Psychological Well-Being: A Pandemic Case Study2021In: International Journal of Environmental Research and Public Health, E-ISSN 1660-4601, Vol. 20, p. 1-9, article id 10680Article in journal (Refereed)
    Abstract [en]

    Societal crises and personal challenges are often followed by substantial changes in physicalactivity. Is there a link between such changes and psychological well-being? Seeking to answerthis question, we conducted a correlational study on a representative sample in Sweden during thefirst year of the COVID-19 pandemic (N = 1035). About 49% of the sample had decreased theirphysical activity compared to their self-reported activity level prior to the pandemic, whereas 32%had increased it. The results showed a positive and robust association between changes in dailyactivity level and corresponding changes in psychological well-being. Specifically, individuals whohad reduced their physical activity over the last year reported lower life satisfaction than before, andindividuals who had increased their physical activity reported higher life satisfaction than before.The amount of complete physical inactivity (sitting) showed a similar pattern as the exercise data,meaning that individuals who reported increasing inactivity per day also reported a greater declinein life satisfaction. Additional analyses showed that the association between daily activity level andlife satisfaction was somewhat stronger for men than for women, but there was no difference whencomparing individual versus organized activities. The current study was based on a cross-sectionaldesign, measuring self-reported change over time. Recent work from other research teams have usedlongitudinal data and experience-sampling in different settings, finding similar results. We concludethat there is good reason to recommend physical exercise as a coping strategy in difficult times.

  • 3.
    Dahlen, Micael
    et al.
    Stockholm School of Economics, Sweden.
    Thorbjørnsen, Helge
    Norwegian School of Economics, Norway.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hellström, Charlotta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kerstis, Birgitta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Lindberg, Daniel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Stier, Jonas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    The comeback effect: How happy are people who have recovered from a COVID-19 infection?2022In: International Journal of Wellbeing, E-ISSN 1179-8602, Vol. 12, no 2, p. 114-133Article in journal (Refereed)
    Abstract [en]

    There is already a large body of research on the dramatic negative effects of COVID-19 on peoples’ mental and physical health. Millions of people have died, and the pandemic has negatively influenced the lives of billions of people. Luckily however, the vast majority of people infected with the virus, recovers. The happiness and wellbeing of these people have not been extensively studied. In the current paper, we ask the question: Are people who have recovered from a COVID-19 infection happier than those who have not been infected at all? Building on previous research on hedonic adaptation and counterfactual thinking, we hypothesize, and find, that those who have had an infection appear slightly happier than others.  The study relies on two surveys conducted in Sweden during the pandemic in 2020 (n=1029) and 2021 (n=1788).

  • 4.
    Edelbring, Samuel
    et al.
    Orebro Univ, Orebro, Sweden .
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Prenkert, Malin
    Orebro Univ, Orebro, Sweden .
    Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams2023In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 109, p. 70-70Article in journal (Refereed)
  • 5.
    Edelbring, Samuel
    et al.
    Örebro Universitet.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wiegleb Edström, Desiree
    Örebro Universitet.
    Vrouvides, Jennifer
    EDU Institution of Higher Education, Malta.
    Huwendiek, Sören
    University of Bern, Switzerland.
    Development of a framework for a structured clinical reasoning curriculum: Outcomes from a multiprofessional European project2021Conference paper (Refereed)
    Abstract [en]

    Background: Despite clinical reasoning standing at the core of health professions practice, it is often taught implicitly and informally within the health professions and there is a lack of its structured education. Multiple professions can gain from a supportive framework with explicit learning objectives and expressed key educational aspects. Our aim was to develop such a framework to support development of a longitudinal and adaptive clinical reasoning curriculum for students and teachers in health professions education.Summary of Work: Educators and researchers from several universities and learning institutions across Europe and the USA gathered to strengthen clinical reasoning education (DID-ACT consortium). As a part of a greater Kern-cycle of curriculum-development, participants worked in multiprofessional groups to identify resources, learning activities and assessments addressing target areas derived from a needs analysis.Summary of Results: The DID-ACT framework is based on a learner-centered and active learning pedagogical approach using contextualized patient-scenarios as point of departure. Thirty-five learning objectives were formulated regarding clinical reasoning theories, cognitive biases, about gathering, interpreting and synthesizing patient information and participation, as well as collaborative aspects of clinical reasoning. Learning activities and assessment methods were constructively aligned using a competence-based approach. Progression was described at novice, intermediate and advanced student levels, and at a teaching level.Discussion and Conclusions: Whereas competence-based learning objectives and curricular goals relating to clinical reasoning exist, DID-ACTs collaborative effort presents a novel contribution. It adds to previous work in its explicit focus on clinical reasoning and multiprofessional approach. The presented framework will be used to develop blended learning for students and educators within the consortium and can contribute to future standardized clinical reasoning curricula.Take-home Messages: Clinical reasoning is often taught implicitly and informally within the health professions. A collaborative effort has developed a curricular framework to buttress students clinical reasoning and support educators. This framework highlights key curricular aspects and presents a range of resources, learning activities and assessments.

  • 6.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Clinical reasoning focused on clients’ behaviour change in physiotherapy: Development and evaluation of the Reasoning 4 Change instrument2019Doctoral 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.

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  • 7.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Reflections on qualitative meta-synthesis studies: 'getting the search strategy right'2017In: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 22, no 5-6, p. 219-220Article in journal (Other academic)
  • 8.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Students’ clinical reasoning focused on client behaviour change assessed with the web-based Reasoning 4 Change instrument.2019In: AMEE2019, 24-28 Aug, Vienna, Austria. / [ed] International Association for Medical Education, 2019, p. 883-883Conference paper (Refereed)
    Abstract [en]

    Background;

    With the recognition of the impact of lifestyle-related behaviours on health and illness there is a need to advance the clinical reasoning of health professionals in general and physiotherapy students in specific. Enabling such advancements requires robust assessments and knowledge regarding factors associated with physiotherapy students’ clinical reasoning outcomes. The aim of this project was to develop a web-based clinical reasoning instrument to assess physiotherapy students’ clinical reasoning and investigate individual- and curriculum level predictors of their clinical reasoning outcomes.

     

    Summary of work;

    A new clinical reasoning instrument was developed based on theory, evidence and expert opinions. Reliability and validity of the instrument were evaluated including physiotherapy students and physiotherapists. 151 physiotherapy students in their final semester at the eight entry-level programmes in Sweden responded the instrument and data were analysed with multiple regression analysis.

     

    Summary of results;

    The web-based instrument, named Reasoning 4 Change (R4C), comprise four domains related to 1) physiotherapists’ capabilities, skills, attitudes and beliefs 2) history-taking and examination, 3) analysis and 4) treatment strategies to support behaviour change. The instrument is built up of several case scenarios and incorporates a holistic, client-centred and behavioural focused clinical reasoning process. The instrument demonstrated satisfactory reliability and validity. Cognitions, attitudes and curricula content were significantly associated with students’ clinical reasoning outcomes in the end of their education.  

     

    Discussion and Conclusions; The R4C instrument fills a gap in education and can support investigations and evaluations of students’ clinical reasoning focused on clients’ behaviour change. To develop students’ clinical reasoning competence, cognitive, metacognitive capabilities and skills, positive attitudes, and behavioural medicine content in curricula need to be targeted.

     

    Take-home Messages: The web-based R4C instrument is ready to be used in physiotherapy education evaluation. With some modifications the instrument may be used in other health professional educations as well. To improve physiotherapy students’ clinical reasoning for the benefit of clients’ health-related behaviour change, education interventions should focus on developing students’ analytical and reflective capabilities and skills. Also, a learning environment that support positive attitudes towards the integration of biopsychosocial and behavioural considerations in clinical reasoning should be encouraged.

  • 9.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Boersma, Katja
    Örebro University, Sweden.
    Overmeer, Thomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Assessing clinical reasoning in physical therapy: discriminative validity of the Reasoning 4 Change instrument2022In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 117, p. 8-15Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate discriminative validity of the Reasoning 4 Change (R4C) instrument by investigating differences in clinical reasoning skills between first semester, final semester physical therapy students and physical therapy experts.

    Design:Cross-sectional design

    Setting: University and physical therapy practiceParticipantsStudents from the first (n = 87) and final semester (n = 47) of an entry-level physical therapy program and experts in physical therapy with a behavioral medicine approach (n = 14).

    Methods: The students and experts answered the web-based R4C instrument on one occasion. The R4C instrument includes four domains designed to assess physical therapists’ clinical reasoning skills with a focus on supporting clients’ behavior change and has demonstrated acceptable content validity, convergent validity and reliability. Data was analyzed with one-way analysis of variance and Games-Howell post hoc test.

    Results: Differences in all domains and subscale scores were found between the three groups. Pairwise comparisons demonstrated that experts scored higher (better clinical reasoning skills) than first semester students in all domains and subscales; and higher scores than final semester students, except for two subscales. Final semester students scored higher than first semester students, except for one subscale.

    Conclusions: The findings highlight differences in clinical reasoning skills focusing on clients’ behavior change among physical therapy students with different degrees of training and education in clinical reasoning and physical therapists with extensive experience and expertise. The results provide evidence for the discriminative validity of the R4C instrument which support the use of the R4C instrument in education, research and clinical practice.

  • 10.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    Univ British Columbia, Canada.
    Factors influencing physical therapists' clinical reasoning: qualitative systematic review and meta-synthesis2017In: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 22, no 1-2, p. 60-75Article in journal (Refereed)
    Abstract [en]

    Background: The capacity of physical therapists to reason effectively in patient management is essential to maximizing outcomes. Although conceptual frameworks of clinical reasoning exist, their theoretical foundations are insufficiently validated to establish those factors that are paramount in guiding physical therapists' clinical reasoning. Studies on how physical therapists clinically reason constitute important means of identifying constructs of such reasoning. Objective: This systematic review aimed to synthesize and interpret the findings of qualitative studies designed to examine factors that are inherent in physical therapists' clinical reasoning with respect to their knowledge, experiences, and practices. Methods: Searches of studies were carried out in four databases, gray literature, and reference lists. Two reviewers independently assessed methodological quality of the studies using the Critical Appraisal Skills Program (CASP) and performed the analysis: extraction and comparative appraisal of findings, identification of themes, reciprocal translation synthesis, and identification of categories and subcategories. Results: Ten studies were included. Four themes of factors influencing physical therapists' clinical reasoning emerged, namely, Physical therapist as a source, Patient as a source, Elements of the reasoning process, and Context. Conclusions: The identified themes validated some constructs underlying existing clinical reasoning frameworks. Most influencing factors were related to the physical therapist, which highlights opportunities to improve effective reasoning at this level. The notion that this process is recurrent, multifaceted, and contextual lends itself to changing in accordance with the needs of the patient, consistent with a biopsychosocial perspective. How clinicians weigh biomedical and psychosocial elements in their reasoning however warrants further study.

  • 11.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Factors influencing physiotherapists' clinical reasoning: A meta-synthesis.2015In: Physiotherapy 2015, Stockholm, Sweden., 2015Conference paper (Refereed)
  • 12.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Factors influencing physiotherapists' clinical reasoning: a meta-synthesis2015In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 101, p. e360-e361Article in journal (Refereed)
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  • 13.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Augmented behavioral medicine competencies in physical therapy students' clinical reasoning with a targeted curriculum: a final-semester cohort-comparison study2022In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 38, no 12, p. 2007-2018Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge regarding the impact of curricula with behavioral medicine content and competencies (BMCC) on physical therapy (PT) students’ clinical reasoning skills is lacking. Objectives: The primary objective was to compare the clinical reasoning skills, focusing on clients’ behavioral change, of entry-level PT students with or without BMCC in their curricula. The second-ary objective was to compare students’ attitudes and beliefs in a biomedical and biopsychosocial practice orientation.Methods: Swedish final-semester PT students (n = 151) completed the Reasoning 4 Change (R4C) instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists. A blueprint was used for curricular categorization. The independent t-test was used.Results: Students attending programs with BMCC curricula (n = 61) had superior scores compared with students without BMCC curricula (n = 90) in the following R4C variables, all of which were related to clinical reasoning focused on behavioral change: Knowledge, Cognition, Self-efficacy, Input from the client, Functional behavioral analysis, and Strategies for behavioral change. Students who did not receive BMCC curricula scored higher in the R4C contextual factors and reported a greater biomedical practice orientation than students receiving BMCC curricula. There was no difference in the biopsychosocial practice orientation between groups.Conclusions: Our findings support the benefit of structured entry-level PT curricula with BMCC on final-semester students’ clinical reasoning skills focused on behavioral change and their level of biomedical practice orientation. Further, our findings elucidated educational opportunities to augment students’ self-efficacy and strengthen their behavioral competencies in clinical reasoning. For the generalizability of the results further research in other contexts is needed.

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  • 14.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Business, Society and Engineering. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elisabeth
    Department of Physical Therapy, Faculty ofMedicine, University of British Columbia, Vancouver, BC, Canada.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    A clinical reasoning model focused on clients' behaviour change with reference to physiotherapists: Its multiphase development and validation2015In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 31, no 4, p. 231-243Article in journal (Refereed)
    Abstract [en]

    Background and purpose: A biopsychosocial approach and behaviour change strategies have long been proposed to serve as a basis for addressing current multifaceted health problems. This emphasis has implications for clinical reasoning of health professionals. This study's aim was to develop and validate a conceptual model to guide physiotherapists' clinical reasoning focused on clients' behaviour change. Methods: Phase 1 consisted of the exploration of existing research and the research team's experiences and knowledge. Phases 2a and 2b consisted of validation and refinement of the model based on input from physiotherapy students in two focus groups (n=5 per group) and from experts in behavioural medicine (n=9). Results: Phase 1 generated theoretical and evidence bases for the first version of a model. Phases 2a and 2b established the validity and value of the model. The final model described clinical reasoning focused on clients' behaviour change as a cognitive, reflective, collaborative and iterative process with multiple interrelated levels that included input from the client and physiotherapist, a functional behavioural analysis of the activity-related target behaviour and the selection of strategies for behaviour change. Conclusions: This unique model, theory- and evidence-informed, has been developed to help physiotherapists to apply clinical reasoning systematically in the process of behaviour change with their clients.

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  • 15.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Business, Society and Engineering. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elisabeth
    Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change2018In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 34, no 5, p. 367-383Article in journal (Refereed)
    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.

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  • 16.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Dean, Elizabeth
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Dept Phys Therapy, Vancouver, BC, Canada..
    Hällman, Olle
    Uppsala Univ, Dept Informat Technol, Uppsala, Sweden..
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'2018In: AIMS PUBLIC HEALTH, ISSN 2327-8994, Vol. 5, no 3, p. 235-259Article in journal (Refereed)
    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.

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  • 17.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    A clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists: Its multiphase development and validation2014In: Abstract book. The International Conference on Health and Social Welfare and Coproduction. Mälardalen University, Eskilstuna, Sweden. 9-10 sept 2014, 2014Conference paper (Refereed)
  • 18.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    An innovative instrument to assess physiotherapists’ clinical reasoning focused on clients’ behaviour change: Its development and validation.2016In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 102, no s1, p. e155-e155Article in journal (Refereed)
  • 19.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Development of a model of Clinical Reasoning with focus on patients’ Activity-related Behaviour and Behaviour change.2013In: Abstrakt bok. Sjukgymnastdagarna 2-4 oktober 2013, 2013, p. 110-111Conference paper (Refereed)
  • 20.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Development of a tool for assessing physiotherapy students’ clinical reasoning with focus on patients’ behavioural change2013In: Nordic Advances in Health Care Sciences Research. November 13-14 2013 in Lund. Abstract book, 2013, p. 13-13Conference paper (Refereed)
  • 21.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Improving complex and effective clinical reasoning: Implications for health professionals’ education curricula2020In: AMEE2020 Abstract book, 2020, p. 442-442Conference paper (Refereed)
    Download (pdf)
    AMEE2020 Abstract book
  • 22.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Predictors of clinical reasoning focused on clients’ behavior change among physical therapy students2018In: Raisonnement Clinique 2018: Textes del la 4e Conférence Internationale de Montréal sur le Raisonnment Clinique. / [ed] Dyer, Joseph-Omer, 2018Conference paper (Refereed)
    Abstract [en]

    Although physical therapy students need to be well prepared to integrate strategies to effect health-related behavior change into their clinical reasoning, educators lack knowledge regarding which factors contribute to such competence. This study’s aim was to investigate the degree to which knowledge, cognitive, psychological and contextual factors as well as curriculum orientation influences students’ clinical reasoning focused on behavior change.

    151 physical therapy students in the final semester completed the web-based Reasoning 4 Change instrument (1). 61 students attended a physical therapy education program with a behavioral medicine approach. Hierarchical multiple regression analysis was used to investigate the degree to which curriculum orientation, self-rated knowledge, cognition, metacognition, attitudes, self-efficacy and contextual factors influence three outcomes of the clinical reasoning process, i.e., Input from Client, Functional Behavioral Analysis (FBA) and Strategies for Behavior Change (SBC).

    37% of the total variance in Input from Client was explained by all variables (p<.001), except contextual factors. Cognitive and metacognitive factors and attitudes were most important. Attending a physical therapy program with a behavioral medicine curriculum orientation was the only variable in the model that explained FBA (adjusted R2=.04;p<.05) and SBC (adjusted R2=.04;p<.01).

  • 23.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hochwälder, Jacek
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students2019In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 99, no 8, p. 964-976Article in journal (Refereed)
    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.

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    fulltext
  • 24.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlestav, M.
    Department of Neurology and Rehabilitation Medicine, Örebro University Hospital, Örebro, Sweden.
    Edelbring, S.
    School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    A tension between surrendering and being involved: An interview study on person-centeredness in clinical reasoning in the acute stroke setting2023In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 112, article id 107718Article in journal (Refereed)
    Abstract [en]

    Objective: To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the acute phase of stroke care. Methods: An explorative qualitative design was used. Individual interviews were conducted with 11 stroke survivors in the acute phase of care and analyzed using reflexive thematic analysis. Results: The analysis identified five themes: What's going on with me?; Being a recipient of care and treatment; The need to be supported to participate; To be seen and strengthened; and Collaboration and joint understanding. Conclusion: Stroke survivors experience many attributes of person-centeredness in the acute phase of care but, according to their stories, their participation in clinical reasoning can be further supported. The tension between surrendering and the desire to be more actively involved in the care needs to be considered to facilitate participation in clinical reasoning. Practice Implications: Stroke survivors’ participation in clinical reasoning in the acute phase can be facilitated by health professionals noticing signs prompting a shift towards increased willingness to participate. Furthermore, health professionals need to take an active role, sharing their expertise and inviting the stroke survivors to share their perspective. The findings can contribute to further develop person-centered care in acute settings. 

  • 25.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Prenkert, Malin
    Örebro University, Sweden.
    Edelbring, Samuel
    Örebro University, Sweden.
    Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams2022In: ICCH2022. International Conference on communication in Healthcare 2022. Abtract book., 2022, p. 125-126Conference paper (Refereed)
    Abstract [en]

    Background: Although person-centered care is prioritized in healthcare, challenges remain before such care is integrated in everyday communication and practice. One way to strengthen person-centered care is that health professionals’ clinical reasoning (i.e., assessment and management) is pervaded by patient participation and individualized to patient needs. Interprofessional team meetings, focusing on goals and management planning, is an opportunity to improve person-centeredness. However, there is a lack of understanding of how person-centeredness is created in the clinical reasoning of teams. This study aims to explore how clinical reasoning is performed from a person-centered perspective in team meetings with patients with stroke and next of kin.

    Methods: Explorative qualitative design employing a thematic analysis of audio recorded communication at three team meetings. In total, three patients, two next of kin, and 15 professionals representing eight health professions, participated in the meetings.

    Findings: Four themes and eight subthemes were established: a) Emphasizing the patient’s resources; b) Struggling to find a common understanding, including subthemes: Unite the person’s narrative, the relative’s view, and the expertise of the interprofessional team, missed opportunities to clarify patient needs and wishes, and active listening and receptiveness; c) Balancing the patient’s goals and professionals’ goals, including subthemes: Shared goals, the professionals’ view of appropriate goals, and the professionals’ assessment governs achievement of goals; d) Ambiguity in decisions about the management plan, including subthemes: Initiating shared decision making and lack of clarity and consensus.

    Discussion: This study reveals how the patient, next of kin and team contribute to shared understanding of the patient’s problem. Goals were guided by the patient’s and professionals’ expertise. To improve person- centeredness in clinical reasoning, the team need to further put the patient’s personal goals and perception of goal-achievement in the forefront as well as improve communication skills to catch patient needs and facilitate shared decisions.

  • 26.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kerstis, Birgitta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Stier, Jonas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hellström, Charlotta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dahlen, M.
    Department of Marketing and Strategy, Stockholm School of Economics, Sweden.
    Lindberg, Daniel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Changes in Physical Activity and Sedentary Behavior before and during the COVID-19 Pandemic: A Swedish Population Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 5, article id 2558Article in journal (Refereed)
    Abstract [en]

    Governments have enforced measures to limit the spread of COVID-19 with varying degrees of success, which could affect people’s physical activity (PA) and sedentary behavior. This study aimed to examine changes in PA levels, types of PA, and sedentary behavior in the Swedish population before and during the COVID-19 pandemic. Associations between changed PA levels and demographical and behavioral determinants were also investigated. In December 2020, 1035 individuals (18–79 years old) completed a survey about their PA and sedentary behavior before and during the pandemic. Factors influencing their PA were also explored. Fifty-one percent of the sample reported reduced total PA, 18% had no change, and 31% increased their PA. Overall, organized PA decreased the most and sedentary behavior increased. The youngest and oldest age groups reported the greatest reduction in PA, while middle-aged groups reported the most increased PA. Men reported a larger increase in sedentary behavior than women. Mental and physical capability was associated with change in PA. In conclusion, this study indicates that, during the COVID-19 pandemic, the majority of the Swedish population have decreased PA levels with a concurrent increase in sedentary behavior, which may have negative health consequences. Interventions are recommended to address both PA and sedentary behavior, specifically to strengthen people’s ability to perform PA and focusing on the youngest and oldest age groups. 

  • 27.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kerstis, Birgitta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Stier, Jonas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hellström, Charlotta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dahlen, Mikael
    Stockholm School of Economics. Department of Marketing and Strategy. Stockholm, Sweden..
    Lindberg, Daniel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    The impact of the COVID-19 pandemic on Swedes’ physical activity and sedentary behaviour2022Conference paper (Refereed)
    Abstract [en]

    Background: Despite the proven health benefits of physical activity (PA), more than a quarter of the world’s adult population is insufficiently physically active, which increases the risk of diseases and premature death. During the COVID-19 pandemic governments have implemented enforced measures to limit the spread of the virus, which could affect people’s PA.  Aim: This study aimed to examine changes in PA levels, types of PA, and sedentary behavior in the Swedish population before and during the COVID-19 pandemic. Associations between demographical and behavioral determinants, and changes in PA were also investigated. Method: In December 2020, 1.035 individuals (18-79 y) completed a survey about PA and sedentary behavior, at present and before the pandemic. Factors influencing their PA were also explored.  Results: Fifty-one percent of the sample reduced total PA, 18% had no change and 31% increased PA. Overall, organized PA, for example at fitness centers and sport training, decreased the most, and sedentary behavior increased. The youngest and the oldest age groups reported the greatest reduction of PA, while the middle age groups reported the most increased PA. Mental and physical capability was associated with PA change. Conclusion: During the pandemic, most of the Swedish population have decreased PA levels with a concurrent increase in sedentary behavior. This may have both a short-and long-term negative health impact on individuals’ and populations’ health.  Implications for caring in a changing world: As physical inactivity already is a global public health problem during non-pandemic circumstances this study’s findings call for further actions during and after the pandemic to support people in maintaining or increasing daily PA and decreasing sedentary behavior. Interventions in health care are recommended to strengthen peoples’ ability to perform PA, focus on the youngest and oldest age groups, and be applied on an individual basis as well as in organizational contexts.

  • 28.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
    Prenkert, Malin
    Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Edelbring, Samuel
    Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
    Reasoning about reasoning - using recall to unveil clinical reasoning in stroke rehabilitation teams2024In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    PurposeThe study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin.Materials and methodsAn explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed.ResultsA main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions.ConclusionsInterprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning. The findings provide insights into the clinical reasoning process of interprofessional stroke teams, which can increase awareness and support the development of competencies among health care providers.To increase patient participation in the clinical reasoning process, stroke teams are recommended to clarify the function of goals and the decision-making process in management.Stimulated recall is recommended as a reflective activity in the work of stroke teams to develop awareness and skills in clinical reasoning performed in collaboration between health care providers and patients.

  • 29.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Rønn Richardsen, Kåre
    Oslo Metropolitan University, Norge.
    Værge Østergaard, Gert
    University College of Northern Denmark, Denmark.
    Hirvonen, Armi
    JAMK University of Applied Sciences, Finland.
    Active learning strategies to promote student-centred learning in anatomy: A Nordic approach2021Conference paper (Refereed)
    Abstract [en]

    Background: Understanding of anatomy is challenging in health education, students frequently adopting a surface approach to learning. Despite the effectiveness of student-centred learning (SCL), anatomy still heavily relies on a teacher-centred approach. Active learning strategies offer opportunities to enhance students learning. In 2020, educators from three Nordic countries created a network called I-SAIL (Nordic Initiative for promoting Student Activities for Independent and Lifelong Learning in Physiotherapy), with the goal to design, implement and evaluate SCL in anatomy education. The aim of the first project year was to support teachers in their transition from teacher- to student-centred learning via innovative methods and investigate teachers experiences within this process of change. Summary of Work: Following the identification of institutional needs, experiences and research findings, methodology for SCL was developed. Interviews with three teachers were conducted to explore experiences from SCL implementation.Summary of Results: An on-line guide for blended learning, on-line training on SCL and peer-supervision was developed to support teachers. Participant teachers implemented pilot learning activities in anatomy using the on-line guide, e-learning platforms, videos and case studies utilizing the flipped classroom method. The teachers acknowledged the value of developing competences in designing learning activities to stimulate students active learning. The teachers perceived the students as more interested, engaged and communicative than previously. Teachers reported experiences of fulfillment, leading to personal learning and increased work motivation since they had time to join discussions as students joined group work prepared. Teachers enhanced their skills in digitalization with confidence to modify teaching. In the process, peer-teacher support was identified as a means to integrate SCL in anatomy.Discussion and Conclusions: The integration of SCL in anatomy positively influenced teaching and students activity in learning. The findings underline the value of international collaboration for educational change. Joint development work tackled the common pedagogical challenges. Acknowledged limitation of the study is the lack of student feedback. This will be the focus during the project ́s second year.Take-home Messages: The project has addressed the traditional teacher-centred approach in anatomy by developing methods to support teachers in their transition towards a student-centred approach. Implemented SCL activities utilized blended learning, resulting in positive teacher experiences and increased student engagement.

  • 30.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Stier, Jonas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Så har pandemin påverkat den fysiska aktivitetsnivån2021Other (Other academic)
  • 31.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Welin, Elisabet
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Wiegleb Edström, Desiree
    Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Petreski, Tadej
    Institute for Biomedical Sciences, Faculty of Medicine, University of Maribor, Maribor, Slovenia;Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia.
    Szopa, Magdalena
    Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
    Durning, Steven J.
    Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
    Edelbring, Samuel
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Clinical Reasoning Curricula in Health Professions Education: A Scoping Review2023In: Journal of Medical Education and Curricular Development, ISSN 2382-1205, Vol. 10Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES

    This scoping review aimed to explore and synthesize current literature to advance the understanding of how to design clinical reasoning (CR) curricula for students in health professions education.

    METHODS

    Arksey and O'Malley's 6-stage framework was applied. Peer-reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies.

    RESULTS

    Twenty-six articles were included on CR in medical, nursing, physical therapy, occupational therapy, midwifery, dentistry, and speech language therapy education. The results describe: features of CR curriculum design; CR theories, models, and frameworks that inform curricula; and teaching content, methods, and assessments that inform CR curricula.

    CONCLUSIONS

    Several CR theories, teaching, and assessment methods are integrated into CR curricula, reflecting the multidimensionality of CR among professions. Specific CR elements are addressed in several curricula; however, no all-encompassing CR curriculum design has been identified. These findings offer useful insights for educators into how CR can be taught and assessed, but they also suggest the need for further guidance on educational strategies and assessments while learners progress through an educational program.

  • 32.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Welin, Elisabeth
    Örebro University, Sweden.
    Wiegleb Edström, Desiree
    Örebro University, Sweden.
    Petreski, Tadej
    University of Maribor, Slovenia.
    Szopa, Magdalena
    Jagiellonian University Medical College, Poland.
    Durning, Steven J.
    Uniformed Services University of the Health Sciences, US.
    Edelbring, Samuel
    Örebro University, Sweden.
    How can clinical reasoning teaching change from a ‘black-box phenomenon’ to a structured clinical reasoning curriculum? Insights from a scoping review.2022In: Textes de la 5e Conférence internationale de Montréal sur le raisonnement clinique, 2022, p. 56-57Conference paper (Refereed)
    Abstract [en]

    Introduction

    Clinical reasoning (CR) is scarcely explicitly taught in health profes- sions education. Barriers to teach CR include lack of awareness of teaching methods and a change-resistant teaching culture. Thus, CR often becomes a ‘black-box phenomenon’ that students need to develop informally. To advance our understanding of structured CR curriculum design in health professions education a scoping review was conducted. 

    Methodology

    Arksey and O’Malley’s six-stage framework (1) was applied. Peer- reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies, which were screened by the team.

    Results

    Twenty-six articles were selected from medical, nursing, physical ther- apy, occupational therapy, midwifery, dentistry, and speech language therapy education. The analysis identified three themes: Features of CR curriculum design; CR theories informing curricula; and CR teaching content and methods.

    Discussion

    No all-encompassing CR curriculum design was identified. However, several theories and specific methods were described supporting CR development. Dual-process theory was the most prevalent theory and active learning approaches were emphasized. Patient centeredness in CR teaching was scarcely described. The diversity of methods stresses that educators need to make the intended meaning of CR explicit in their curricular work.

    Conclusion

    Specific theories and teaching methods can support curriculum devel- opment. Lack of overall CR curriculum strategy in the literature stresses further guidance on a longitudinal CR curriculum that support stu- dents’ CR progression throughout study programs.

  • 33.
    Fritz, Johanna
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Moberg, Johan
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Från klinikbesök till klinikhandledning: Om verksamhetsförlagd utbildning i fysioterapeutprogrammet vid Mälardalens Högskola2015Report (Other academic)
    Download full text (pdf)
    fulltext
  • 34.
    Hege, Inga
    et al.
    Medical Education Sciences, University of Augsburg, Augsburg, Germany.
    Adler, Martin
    Instruct GGmbH, Munich, Germany.
    Donath, Daniel
    Faculty of Medicine and Health, EDU Higher Education Institute, Kalkara, Malta.
    Durning, Steven J.
    Uniformed Services University of the Health Sciences, Bethesda, United States.
    Edelbring, Samuel
    School of Health Sciences, Örebro University, Örebro, Sweden.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. School of Health Sciences, Örebro University, Örebro, Sweden.
    Bogusz, Ada
    Jagiellonian University Medical College, Kraków, Poland.
    Georg, Carina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Huwendiek, Sören
    Department for Assessment and Evaluation, Institute for Medical Education, Bern, Switzerland.
    Körner, Melina
    Medical Education Sciences, University of Augsburg, Augsburg, Germany.
    Developing a European longitudinal and interprofessional curriculum for clinical reasoning2023In: Diagnosis, ISSN 2194-8011, E-ISSN 2194-802XArticle in journal (Refereed)
    Abstract [en]

    Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.

  • 35.
    Hellström, Charlotta
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Vad har hänt med den fysiska aktiviteten bland befolkningen under pandemin?2022In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 99, no 2, p. 213-219Article in journal (Other academic)
    Abstract [sv]

    Coronapandemin har lett till förändrade möjligheter till en hälsosam livsstil och individers utförande av fysisk aktivitet har påverkats, särskilt inom vissa grupper inom befolkningen. Artikeln nedan har ett folkhälsovetenskapligt perspektiv och utgår från resultaten ur en undersökning som genomfördes av Novus under december 2021 samt från aktuella debattartiklar relaterade till studien. Data analyserades av forskare som representerar forskningsområdena; Hållbart arbetsliv, Livsstil och hälsa, Hälsa och välfärd för människor i utsatta och sårbara livssituationer samt Hälso- och välfärdsteknik ur ett användarperspek-tiv, vid Mälardalens universitet.

  • 36.
    Kerstis, Birgitta
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Giannotta, Fabrizia
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Stockholm Univ, Dept Publ Hlth Sci, S-10691 Stockholm, Sweden..
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hellström, Charlotta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Lindberg, Daniel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Stier, Jonas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Changes in Mental Health and Views on Communication and Activities of Public Institutions among Swedes during the COVID-19 Pandemic-A Cross-Sectional Repeated Measures Design2021In: Healthcare, E-ISSN 2227-9032, Vol. 9, no 11, article id 1498Article in journal (Refereed)
    Abstract [en]

    Although many studies have been conducted on the effects of COVID-19 on individual lives, only a few focus on the changes in mental health and views of public institutions during the pandemic. This study aimed to investigate how mental health, i.e., life satisfaction, worries, and psychological distress, and views on public institutions' communication and activities have changed among Swedes during the COVID-19 pandemic, and whether this was moderated by age and sex. In April-May 2020 (survey 1) and in January-February 2021 (survey 2), 2554 adults and 1904 newly recruited adults, respectively, anonymously completed online surveys. We found that life satisfaction and psychological distress did not change from survey 1 to survey 2. However, the level of worries increased, and the positive views of the public institutions decreased. Moreover, worries and psychological distress increased more in young adults than older adults. Finally, the change in the views of the public institutions was not related to the change in worries. Our results highlight the COVID-19 long-term impacts on individual mental health and call for the need for future research concerning the consequences for the population, especially among young adults. The results also indicate that the views on activities of public authorities decreased over time, especially among men. Given that loss of this trust can have vastly negative effects, for instance, on the vaccine campaign, it is important to monitor this trend, to increase awareness among Swedish authorities. The results also stress for institutions to provide adequate support both during the COVID-19 pandemic and in a future crisis.

  • 37.
    Lindberg, Daniel
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nilsson, Kent W.
    Center for Clinical Research, Central Hospital of Västerås, Uppsala University, SE-75236 Uppsala, Sweden;Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, SE-72134 Västerås, Sweden.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Stier, Jonas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dahlen, Micael
    Department of Marketing and Strategy, Stockholm School of Economics, SE-11383 Stockholm, Sweden.
    Kerstis, Birgitta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    How Have Physical Activity and Sedentary Behavior, Changed during the COVID-19 Pandemic? A Swedish Repeated Cross-Sectional Design Study2023In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, no 4, p. 3642-3642Article in journal (Refereed)
    Abstract [en]

    Physical activity (PA) and sedentary behavior (SB) affect people’s physical and mental health. The aim was to examine changes in PA and SB in a Swedish population: at three time points: 2019, 2020, and 2022, i.e., before and during the COVID-19 pandemic. Pre-pandemic PA and SB, i.e., 2019, were assessed retrospectively in 2020. Associations between PA and SB with sex, age, occupation, COVID-19 history, weight change, health, and life satisfaction were also examined. The design was repeated cross-sectionally. The main findings demonstrate the PA levels decreased between 2019 and 2020, and between 2019 and 2022, but not between 2020 and 2022. The SB increase was most evident between 2019 and 2020. Between 2020 and 2022, results showed a decrease in SB, but SB did not reach pre-pandemic levels. Both sexes decreased their PA over time. Although men reported more PA sex, they did not have any association with PA changes. Two age groups, 19–29 years and 65–79 years, decreased their PA over time. Both PA and SB were associated with COVID-19, occupation, age, life satisfaction, health, and weight change. This study underlines the importance of monitoring changes in PA and SB as they have relevance for health and well-being. There is a risk that the levels of PA and SB do not return to pre-pandemic levels in the population.

  • 38.
    Nordgren, Lena
    et al.
    Uppsala University, Sweden.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    The Mediating Role of Healthy Lifestyle Behaviours on the Association between Perceived Stress and Self-Rated Health in People with Non-Communicable Disease2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 19, article id 12071Article in journal (Refereed)
    Abstract [en]

    Perceived stress can affect people's lifestyle behaviours and self-rated health. A balanced, healthy lifestyle can alleviate experiences of stress. For clinicians to use evidence-based and theory-based knowledge in health dialogues with people with non-communicable diseases, and in order to develop more effective behavioural counselling, more knowledge is needed. Hence, this study aimed to examine the mediating role of sedentary behaviour, daily physical activity, physical exercise, and dietary habits on the association between perceived stress and self-rated health in people with or without one to four self-reported non-communicable diseases (myocardial infarction, stroke, hypertension, diabetes). The study used a cross-sectional design. Responses from in total 10,583 individuals were collected in 2016 and 2019 by a self-report questionnaire. A series of simple and multiple regression analyses were conducted to examine the mediating effects of healthy lifestyle behaviours on the association between perceived stress and self-rated health. The results show that the investigated healthy lifestyle behaviours partly mediated the association between perceived stress and self-rated health in people with no diagnosis, and in people with one or two diagnoses. It can be concluded that healthy lifestyle behaviours could probably be targeted in relation to the number of noncommunicable diseases that the individuals have.

  • 39.
    Rahme, Hans
    et al.
    University Hospital, Uppsala, Sweden.
    Vikerfors, Ola
    Central Hospital, Västerås, Sweden.
    Ludvigsson, Lena
    Central Hospital, Västerås, Sweden.
    Elvén, Maria
    Central Hospital, Västerås, Sweden.
    Michaëlsson, K
    University Hospital, Uppsala, Sweden.
    Loss of external rotation after opern Bankart repair: an important prognostic factor for patient satisfaction2010In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 18, p. 404-408Article in journal (Refereed)
    Abstract [en]

    The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42-87), which can be compared with 92 (range 46-100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0° of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3-22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4-4.8, P = 0.002) for every 10° of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20-0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.

  • 40.
    Sandborgh, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Dean, Elizabeth
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. University of British Columbia , Vancouver , Canada.
    Denison, Eva
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Norwegian Institute of Public Health , Nydalen , Oslo , Norway.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fritz, Johanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Moberg, Johan
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Overmeer, Thomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Örebro University, Örebro, Sweden.
    Snöljung, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program: Rationale, Process and Ten-year Review2020In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 36, no 3, p. 365-377Article, review/survey (Refereed)
    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.

  • 41.
    Sandborgh, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Snöljung, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    IMPLEMENTATION OF BEHAVIORAL MEDICINE IN A PHYSIOTHERAPY UNDERGRADUATE CURRICULUM STUDENT EVALUATIONS2018In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 25, p. S64-S65Article in journal (Other academic)
  • 42.
    Sobočan, Monika
    et al.
    University of Maribor, Slovenia.
    Petreski, Tadej
    Faculty of Medicine, University of Maribor, Slovenia .
    Edelbring, Samuel
    Faculty of Medicine and Health, Örebro University, Sweden.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kononowicz, Andrzej A.
    Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
    Huwendiek, Sören
    Institute for Medical Education, University of Bern, Bern, Switzerland.
    Hege, Inga
    Universitätsklinikum Augsburg, Augsburg, Germany.
    Understanding, developing and implementing a clinical reasoning curricula2022Conference paper (Refereed)
  • 43.
    Söderlund, Anne
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Blazeviciene, Aurelija
    Department of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Vaskelyte, Alina
    Department of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Strods, Raimonds
    Centre for Educational Growth, Riga Stradiņš University, Riga, Latvia.
    Blese, Inguna
    Centre for Educational Growth, Riga Stradiņš University, Riga, Latvia.
    Paakkonen, Heikki
    School of Business and Health Care, Arcada University of Applied Sciences, Helsinki, Finland..
    Cardoso, Daniela
    Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.
    Fernandes, Antonio
    Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.
    Kav, Sultan
    Faculty of Health Sciences, Başkent University, Ankara, Turkey.
    Baskici, Cigdem
    Faculty of Health Sciences, Başkent University, Ankara, Turkey.
    Wikström-Grotell, Camilla
    Graduate School and Research, Arcada University of Applied Sciences, Helsinki, Finland..
    Exploring the activities and outcomes of digital teaching and learning of practical skills in higher education for the social and health care professions: a scoping review2023In: Discover Education, E-ISSN 2731-5525, Vol. 2, no 1, article id 2Article, review/survey (Refereed)
    Abstract [en]

    Higher education for health care professionals faces numerous challenges. It is important to develop and apply methods supporting education, especially the practical skills. This scoping review aimed to explore the activities and learning outcomes of digital technology in practical skills teaching and learning in higher education for the social and health professions. Scoping review recommendations and the PRISMA-ScR checklist were applied. Randomized controlled trials published between 2016 and 2021 involving students in higher education who were taking courses in the social sciences and health care and reported interventions with digital technology activities and practices in practical teaching and learning were included. The CINAHL Plus, PubMed, Scopus, ERIC, and Sociological Abstracts/Social Services Abstracts databases were searched. Teaching methods were blended, e-learning or other online-based, and digital simulation-based activities. Teaching and learning environments, methods, resources, and activity characteristics varied, making a summary difficult. Interventions were developed in a face-to-face format prior to digitalization. The outcomes were measured at the knowledge level, not at the performance level. One-third of the studies showed a significant improvement in practical skills in the intervention group in comparison to the control conditions. The use of digital technology in the learning and teaching process have potential to develop of students' skills, knowledge, motivation, and attitudes. The pedagogy of technology use is decisive. The development of new digital methods for teaching and learning practical skills requires the engagement of students and teachers, in addition the researchers.

  • 44.
    Söderlund, Anne
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fritz, Johanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Implementing a behavioral medicine approach in physiotherapy for patients with musculoskeletal pain: a scoping review2020In: Pain Reports, E-ISSN 2471-2531, Vol. 5, no 5, article id e844Article, review/survey (Refereed)
    Abstract [en]

    In intervention research on musculoskeletal pain, physiotherapists often study behavioral and cognitive components. Evidence on applying these components has increased during the past decade. However, how to effectively integrate behavioral and cognitive components in the biopsychosocial management of musculoskeletal pain is challenging. The aim was to study the intervention components and patient outcomes of studies integrating behavioral and cognitive components in physiotherapy, to match the interventions with a definition of behavioral medicine in physiotherapy and to categorize the behavior change techniques targeted at patients with musculoskeletal pain in (1) randomized controlled effect trials or (2) implementation in clinical practice trials. A scoping review was used to conduct this study, and the PRISMA-ScR checklist was applied. Relevant studies were identified from the PubMed, MEDLINE, PsycINFO, CINAHL Plus, and Web of Science Core databases separately for the (1) randomized controlled effect trials and (2) implementation in clinical practice trials. Synthesis for the matching of the patient interventions with the existing definition of behavior medicine in physiotherapy showed that the interventions mostly integrated psychosocial, behavioral, and biomedical/physical aspects, and were thus quite consistent with the definition of behavioral medicine in physiotherapy. The reported behavior change techniques were few and were commonly in categories such as “information of natural consequences,” “feedback and monitoring,” and “goals and planning.” The patient outcomes for long-term follow-ups often showed positive effects. The results of this scoping review may inform future research, policies, and practice.

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  • 45.
    Söderlund, Anne
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fritz, Johanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Operationalizing behavioral medicine approach in physiotherapy - scoping review2021In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 28, no SUPPL 1, p. S102-S102Article in journal (Other academic)
  • 46.
    von Heideken Wågert, Petra
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Stier, Jonas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fysisk aktivitet hos äldre under och efter pandemin2021In: Äldre i Centrum, ISSN 1653-3585, Vol. 2, p. 64-65Article in journal (Other academic)
  • 47.
    Wagner, Felicitas
    et al.
    Institute for Medical Education, University of Bern, Bern, Switzerland.
    Durning, Steven
    Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
    Sudacka, Małgorzata
    Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
    Lison, Susanne
    Universitätsklinikum Augsburg, Augsburg, Germany.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. School of Health Sciences, Örebro University, Sweden, Örebro, Sweden.
    Huwendiek, Sören
    Institute for Medical Education, University of Bern, Bern, Switzerland.
    Needs regarding teaching and assessment of clinical reasoning: An international mixed-methods study2022In: AMEE Lyon 2022 Hybrid Conference: Abstract Book Online Programme, 2022, p. 161-162Conference paper (Refereed)
  • 48.
    Widerström, Birgitta
    et al.
    Rehabcentralen, Östersund, Sweden.
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Rasmussen-Barr, Eva
    Rehabcentralen, Östersund, Sweden.
    Boström, Carina
    Karolinska Institutet, Sweden.
    “How does physical examination findings influence physiotherapists’ decision-making when matching treatment to patients with low back pain?”2021In: Musculoskeletal Science and Practice, ISSN 2468-8630, Vol. 53, article id 102374Article in journal (Refereed)
    Abstract [en]

    Further clinical data how low-back pain (LBP) symptoms and signs manifests in physiotherapy clinical reasoning and treatment decision-making is needed. Objective: The aim was to explore and describe how symptoms and signs portrayed in three case descriptions of LBP influences physiotherapy treatment decision-making. Design: This was an exploratory interview study using inductive content analysis. Method: Fifteen semi-structured individual interviews were used to collect data of physiotherapists’ treatment decision-making regrading three diverse LBP case descriptions. The participants were men, women, experienced and novice, working in primary healthcare settings in one sparsely populated region and in one larger city in Sweden. Findings: Two overarching themes were identified influencing decision-making for the treatment of LBP:1) Explicit assessment features distinguish treatment approaches; with categories describing how symptoms and signs were used to target treatment (nature of pain induce reflections on plausible cause; narrative details trigger attention and establishes knowledge-enhancing foci; pain-movement-relationship is essential; diverse emphasis of pain modulation and targeted treatment approaches): and 2) Preconceived notion of treatment, with categories describing personal treatment rationales, unrelated to the presented symptoms and signs (passive treatment avoidance and motor control exercise ambiguity). Conclusion: This study identifies how assessment details lead to decisions on diverse treatment approaches for LBP, but also that treatment decisions can be based on preconceived beliefs unrelated to the clinical presentation. The results underpin the mix of knowledge sources that clinicians need to balance and the necessity of self-awareness of preconceptions for informed and meaningful clinical decision-making.

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