A scoping review of therapeutic reasoning process research

Duong, Quang Hung; Pham, To Nhu; Reynolds, Lorenna; Yeap, Yan Yan; Walker, Steven; Lyons, Kayley

doi:10.1007/s10459-022-10187-7

Cited by 3 publications

(2 citation statements)

References 104 publications

(176 reference statements)

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“…misdiagnosis, especially by students. For these reasons, we decided to focus on an important less considered variable, treatment strategy (i.e., thus putting us within the scope of therapeutic reasoning; Duong et al, 2023) and included measures addressing the recommendations of Daniel and colleagues (2019). The scoring grid for each strategy for each case is shown in Table 2.…”

Section: Instrumentsmentioning

confidence: 99%

Do intolerance of uncertainty and resource consumption actually influence the therapeutic strategies chosen by physiotherapists?

Brun,

Zerhouni,

Akinyemi

et al. 2023

Preprint

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The medical environment is prone to diagnostic errors, which can have serious consequences for patients' health status. However, healthcare professionals (HCPs) are often overconfident in their choices. In this context, there is a growing interest in the influence of variables that may negatively influence the reasoning of HCPs, namely intolerance of uncertainty (IU) and resource consumption. We challenged 127 physiotherapists to play a simulation game and choose a therapeutic strategy for three cases of low back pain of increasing difficulty (easy, medium, difficult). We measured their IU level and their resource consumption (i.e., requests for test results for each case). Our results showed that 87.4% of participants chose the most appropriate strategy for the easy case, 46.5% for the medium and 29.1% for the difficult. For the easy case, IU and resource consumption had a negative influence on the chosen therapeutic strategy, which was less adapted. Moreover, resource consumption among highly intolerant individuals had a more adverse influence on the chosen strategy. However, we did not find the same results for the medium and difficult cases. We propose hypotheses to explain this difference (i.e., system 1/system 2, consideration of the physiotherapist's speciality, perception of uncertainty). We also outline potential improvements to our tool and suggest future research avenues.

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Section: Instrumentsmentioning

confidence: 99%

Do intolerance of uncertainty and resource consumption actually influence the therapeutic strategies chosen by physiotherapists?

Brun,

Zerhouni,

Akinyemi

et al. 2023

Preprint

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“…The factors leading to the selection of motor recovery or compensation are unknown. The clinical decision-making process may be influenced by evidence-based practice recommendations and implicit, subjective theories based on clinical experience and contextual factors (6,7). The physiotherapist's expectation of good functional improvement may lead to the adoption of a restorative rather than a compensatory approach.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study

Mestanza Mattos,

Bowman,

Marazzini

et al. 2024

Front. Neurol.

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Background and purposeThis study aimed to investigate the factors that influence physiotherapists’ decision in choosing restorative or compensatory rehabilitation during gait training in people with neurological disorders (PwNDs) and the different treatments used in the approaches.MethodsThis cross-sectional analysis used the baseline data from an observational cohort study. We analyzed data from 83 PwNDs (65 people after stroke, 5 with multiple sclerosis, and 13 with Parkinson’s disease) who underwent at least 10 sessions of physiotherapy (PT) focusing on gait function. Performance was quantified using the modified Dynamic Gait Index (MDGI), three impairment domains of Fugl–Meyer Assessment for lower extremity (mFM-LL), Activities-specific Balance Confidence (ABC), modified Barthel Index (mBI), Mini-Mental State Examination (MMSE), and Motivational Index (MI). Forty-three physiotherapists completed a treatment report form categorizing the rehabilitation approach and specifying treatments used (e.g., resistance training and proprioceptive exercises).ResultsFifty-six subjects underwent restorative rehabilitation approach. The univariate predictors of restorative approach were being in the subacute phase with a disease onset of less than 180 days, (odds ratio [95%CI]; 3.27[1.19–9.24]), mFM-LL (1.25[1.11–1.44]), MMSE (0.85[0.67–1.00]), and number of sessions (1.03[1–1.01]). The backward stepwise analysis revealed an association between restorative and subacute phase (36.32[4.11–545.50]), mFM-LL (3.11[1.55–9.73]), mBI (1.79[1.08–3.77]), MMSE (0.46[0.25–0.71]), and the interaction between mFM-LL and mBI (0.99[0.98–1.00]). No statistically significant association between treatments used and approach was found (p = 0.46).Discussion and conclusionThe restorative approach was more commonly used to improve gait. The main variables associated with this approach were: being in the subacute phase of the disease, a low level of impairment, and a high level of functional independence at baseline. However, few differences were found between the treatments used for the restorative or compensatory approaches, as similar PT treatments were used for both.

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An Observational Cross-Sectional Analysis of the Correlation between Clinical Competencies and Clinical Reasoning among Italian Registered Nurses

Notarnicola,

Duka,

Lommi

et al. 2024

Healthcare

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Ability, knowledge, aptitude, and skill are the terms identified in the literature as the attributes of the concept of clinical competence. This implies that in order to act competently in their own context, the nurse must be able to make decisions which mainly depend on the ability to put clinical reasoning into practice. However, the evaluation of clinical reasoning in the various clinical-care activities of nursing competence is a necessary operation to prevent routine attitudes. From the perspective of an assessment of nursing competences, the aim of this study is to validate the relationship between the degree of competence recognized in a specific clinical setting and the amount of clinical reasoning executed by nurses. The study design was a cross-sectional observational design, following the guidelines of the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) of observational studies. Both the Italian Nurse Competence Scale and the Nurse Clinical Reasoning Scale were used. The data was collected between 25 January and 5 March 2022. Four hundred twenty-four clinical nurses participated by completing and returning the questionnaires. The instruments underwent assessment to ensure internal consistency and test–retest reliability. Their validity was tested with the validity of known content, construct, and groups. This is supported by statistically significant correlations between the different variables examined and the scores of the different dimensions of the Italian Nurse Competence Scale and the Italian Nurse Clinical Reasoning Scale. The data collected showed an excellent average level of competencies and clinical reasoning, M = range of 72.24 and 63.93, respectively. In addition, we observed satisfactory scores across all dimensions of I-NCS (significance range: 0.000–0.014) and I-NCRS (significance range: 0.000–0.004). The understanding and development of clinical reasoning has also brought out new aspects that require further research. This study provides a fresh perspective on the correlation between clinical competences and clinical reasoning, representing a novel attempt to analyze their relationship.

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A scoping review of therapeutic reasoning process research

Cited by 3 publications

References 104 publications

Do intolerance of uncertainty and resource consumption actually influence the therapeutic strategies chosen by physiotherapists?

Do intolerance of uncertainty and resource consumption actually influence the therapeutic strategies chosen by physiotherapists?

Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study

An Observational Cross-Sectional Analysis of the Correlation between Clinical Competencies and Clinical Reasoning among Italian Registered Nurses

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