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Background: Behaviour-focused clinical reasoning is essential for effective physiotherapypractice. Physiotherapy education must equip students with competencies in psychosocialand behavioural aspects of assessment and intervention. Evidence of South Africanphysiotherapy students’ knowledge and competencies in behavioural medicine remainsunexplored.

Objectives: To assess behaviour-focused clinical reasoning competencies among final-yearphysiotherapy students at a South African university and compare these competencies withthose of final-year students from two Swedish universities with integrated behaviouralmedicine curricula.

Method: A cross-sectional comparative study design was employed. Final-year physiotherapystudents (N = 38) from a South African university completed the Reasoning 4 Change (R4C)questionnaire. Swedish comparative data (N = 61) were included. Data were analysed usingfrequencies, percentages and independent t-tests. Cohen’s d with 95% confidence intervals(CIs) was calculated.

Results: The South African cohort scored significantly lower for knowledge (mean 32.6,standard deviation [s.d.] ± 5.1 vs. 35.7 ± 4.8; p = 0.003; d = −0.63), cognition (31.7 ± 6.0 vs. 34.9± 5.8; p = 0.012; d = −0.53), input from client (34.2 ± 6.3 vs. 38.5 ± 7.2; p = 0.003; d = −0.62),functional behaviour analysis (21.8 ± 2.6 vs. 23.8 ± 2.9; p < 0.001; d = −0.71) and strategies forbehaviour change (16.2 ± 1.9 vs. 19.6 ± 3.7; p < 0.001; d = −1.07), but scored significantly higherfor self-efficacy (77.8 ± 12.5 vs. 70.4 ± 12.6; p = 0.005; d = 0.59) and contextual factors (20.2 ± 2.7vs. 14.9 ± 4.7; p < 0.001; d = 1.31).

Conclusion: Explicit behavioural medicine integration within physiotherapy education maystrengthen behaviour-focused clinical reasoning competencies.

Clinical Implications: Longitudinal integration of behavioural medicine content maystrengthen students’ behaviour-focused clinical reasoning, client engagement and behaviourchange competencies in physiotherapy practice

Background: The use of digital technology in higher education can enhance students’ motivation, knowledge and skills. In medical and nursing education, digital scenario-based simulation is an evidence-based way to improve skills and knowledge. In physiotherapy, a biopsychosocial and person-centred approach is recommended to support self-management and promote health-related behaviour changes in patients. Using Experiential Learning Theory (ELT) in developing simulation tools can support students’ learning and confidence. The aim of this study was to explore content and features desired by stakeholders for the development of a digital scenario-based simulation prototype to stimulate physiotherapy students’ learning of clinical skills.Summary of work: Four co-design workshops with 5-10 participants, including two physiotherapy students, one newly graduated physiotherapist, four educators, four clinical instructors and one representative from an educational company, were conducted. The participants discussed and presented ideas for the desired content and features of the digital scenario-based simulation. ELT and Kolb’s learning cycle were used to encourage discussion and idea presentation and in the analysis.Summary of results: The preliminary results highlight desired key content and features: interactive reality-based patient cases with video and audio recordings to create realistic experiences; individual and peer reflection through reflective questions and self-recording videos; varied examples of formulated analysis, hypotheses, SMART goals and interpretation of patient information with encouragement to formulate these independently; support for making choices, prioritizing and decision-making, with opportunities to follow up on decisions and evaluate outcomes. Participants emphasized the importance of contextual pedagogical elements providing constructive feedback, flexibility to individual needs, and user-friendly, engaging design with gamification features.Discussion and Conclusion:  Overall, the participants desired content and features that align with simulations in medical and nursing education. However, what uniquely distinguished the desired content and features for physiotherapy was the emphasis on supporting learning a holistic and person-centered approach, including setting individual goals and creating personalized treatment plans. The importance of long-term patient follow-up and outcome evaluation was also highlighted. Given that digital scenario-based simulation is relatively unexplored in physiotherapy, these findings are particularly significant. These insights may also be relevant for other health professions to adopt a holistic and person-centered approach.

Purpose

To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the subacute phase of stroke rehabilitation.

Methods

An explorative qualitative design was used. Individual interviews were conducted with 10 stroke survivors (4 women and 6 men, mean age 68 years) 4 weeks after their stroke, and follow-up interviews were conducted with 6 of them after 10 weeks. The interview settings were the patient’s home during their home rehabilitation, an inpatient and an outpatient rehabilitation unit. A reflexive thematic analysis was performed.

Results

Four themes were identified: discharge as a critical point for participation, describing a stressful time with varying involvement; supportive actions and context as crucial for participation, describing collaboration with the stroke team, the team’s consideration of the stroke survivor’s resources and needs, and a supportive home environment; the importance of goals and follow-up, describing goals as motivational and an unstructured use of goals; and difficulties in participation, describing a lack of dialogue with the stroke team and undetected resources and needs.

Conclusions

The stroke survivors experienced changes in their participation in the clinical reasoning process as their rehabilitation progressed. They moved from perceiving themselves as passengers at the time of their hospital discharge to gradually seeing themselves as the driver of their rehabilitation process. Some person-centered attributes, such as respectful relationships and a health focus, were incorporated into the clinical reasoning, while others, such as a holistic view and shared goal-setting, required further emphasis for improved person-centeredness in stroke rehabilitation.

Introduction

Musculoskeletal conditions are a significant global health problem. The demand for specialized and individualized care is increasing. This necessitates that physiotherapy (PT) education better equips students with clinical skills needed for clinical practice, during education and in future professional work.

Objective

To explore stakeholders’ perceptions of PT students’ clinical skills training needs within the musculoskeletal area in undergraduate PT education.

Methods

Semistructured focus groups and interviews were conducted with stakeholders from multiple undergraduate PT programs and clinical settings in Sweden, including PT students (n = 18), newly graduated physiotherapists (n = 3), educators (n = 5) and clinical instructors (n = 8). This study employed a qualitative design using inductive content analysis.

Results

One overarching main category, comprehensive clinical skills training in a supportive and reality-based education, and four categories emerged, each comprising 3–5 subcategories describing the stakeholders’ perceptions of PT students’ clinical skills training needs. The four categories are 1: Experiencing real or reality-based patient cases, 2: Applying knowledge and clinical skills, 3: Analyzing patient information and making clinical decisions, and 4: Having a supportive learning environment.

Conclusion

To better prepare PT students for clinical practice in the musculoskeletal area, stakeholders perceive students need comprehensive clinical skills training within a supportive and reality-based educational environment that facilitates reflective abilities. Engaging in diverse realistic patient encounters may enhance their ability to apply knowledge and skills in patient interactions, as well as strengthen their analytical and clinical decision-making abilities. Clinical reasoning and communication skills were emphasized over procedural skills.

Background: Clinical reasoning (CR) is a crucial ability that can prevent errors in patient care. Despite its important role, CR is often not taught explicitly and, even when it is taught, typically not all aspects of this ability are addressed in health professions education. Recent research has shown the need for explicit teaching of CR for both students and teachers. To further develop the teaching and learning of CR we need to improve the understanding of students' and teachers' needs regarding content as well as teaching and assessment methods for a student and trainer CR curriculum. Methods: Parallel mixed-methods design that used web-surveys and semi-structured interviews to gather data from both students (nsurvey = 100; ninterviews = 13) and teachers (nsurvey = 112; ninterviews = 28). The interviews and surveys contained similar questions to allow for triangulation of the results. This study was conducted as part of the EU-funded project DID-ACT (https://did-act.eu). Results: Both the surveys and interview data emphasized the need for content in a clinical reasoning (CR) curriculum such as “gathering, interpreting and synthesizing patient information”, “generating differential diagnoses”, “developing a diagnostic and a treatment plan” and “collaborative and interprofessional aspects of CR”. There was high agreement that case-based learning and simulations are most useful for teaching CR. Clinical and oral examinations were favored for the assessment of CR. The preferred format for a train-the-trainer (TTT)-course was blended learning. There was also some agreement between the survey and interview participants regarding contents of a TTT-course (e.g. teaching and assessment methods for CR). The interviewees placed special importance on interprofessional aspects also for the TTT-course. Conclusions: We found some consensus on needed content, teaching and assessment methods for a student and TTT-course in CR. Future research could investigate the effects of CR curricula on desired outcomes, such as patient care.

Physical activity (PA) and sedentary behavior (SB) changed during the COVID-19 pandemic; hence, this study examined PA and SB at four time points between December 2019 and December 2022. The participants’ PA decreased during the pandemic and did not recover afterwards. Among women, PA increased slightly in 2022 but not at all in men. From 2019 to 2020, SB increased and then decreased to near the pre-pandemic level in both sexes. Regarding age, PA decreased in the oldest age group (65–79 years) across all time points, while SB increased in all age groups during 2019–2020 and then returned close to pre-pandemic levels among the two middle age groups (30–64 years), but not among the youngest and oldest groups. Considering occupation, PA decreased from 2020 to December 2022 among retired and “other” participants, while SB decreased among nonmanual workers and retired participants. The regression models associated better self-reported health, male sex, and those born overseas with higher PA. Higher age, better self-reported health, poor education, and later survey time points were associated with lower SB. These findings highlight the need to return PA and SB to at least pre-pandemic levels and that subgroups may need different interventions. 

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.

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.