Theorizing is a process whereby alternative explanations or models are considered. By the end (perhaps 10 minutes), Mrs G was able to give gentle expression to the tears that had been rising but held so far during the visit. Many other examples of exercise instruction were similar to this. The purpose of this qualitative study was to examine the clinical reasoning of expert physical therapists in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (home health) physical therapy. 2020 Feb 7;100(2):346-358. doi: 10.1093/ptj/pzz166. This process of identification, we contend, is important as the profession considers the variety and scope of its activities and seeks to answer questions such as, “How will physical therapy define itself and its role(s) in the community in an increasingly competitive health care market?” and “How can future practitioners be best educated and prepared to function in the various fields of health care in which physical therapists practice?”. Subjects: Best practices and the integration of existing evidence into clinical reasoning, along with strategies for reflection to drive professional growth, will be emphasized. GM Thus, we considered both forms of teaching, the instrumental and the communicative, essential components of sound management of M's headaches. RK .  |  Bob: h-uh. Results. Within these clinical reasoning strategies, the application of different paradigms of knowledge and their interplay within reasoning is termed “dialectical reasoning.” Dr Edwards, Mr Jones, and Dr Braunack-Mayer provided writing and project management. I don't know about the history. … They still go ahead and do the operation, they just chalk up: “Huh, there's another life I've saved.“. Methods: Guided by a grounded theory method, a multiple case study approach was used to study the clinical practice of the 6 physical therapists in the 3 fields. This study was approved by the Human Research Ethics Committee of the University of South Australia and supported by a grant from the South Australian branch of the Australian Physiotherapy Association. Mattingly Thick description is an anthropological term56 referring to an in-depth description of particular and multiple characteristics of a case (ie, a particular therapist's clinical practice) in order to induct the reader into an experience of the situation. Patient autonomy, justice, and not doing harm to patients are examples of such principles.60 On the other hand, there is a narrative (or communicative) approach to ethical decision making where the experiential and contextual elements of a given situation (or narrative) guide decisions and actions, in turn, providing perspectives on these broader rules or principles of right and wrong.61. , Shepard KF, Gwyer J, Hack LM. 2). Some of this conflict had derived from M's inability to keep her house maintained to the standards that she would like. 2 for sample questions). Miles Hypothetico-deductive or instrumental reasoning and action involves physical therapists engaging in critical reflection of the underlying assumptions (ie, hypothesis testing) behind the content and process of their own decision-making and knowledge structures. Triangulation is an important tool used in an effort to ensure rigor and involves the use of several data sources, methodological approaches, multiple analysts, and the consideration of diverse theories to explain findings in order to reduce systematic bias in the data.50,54 In our study, the different data sources were observation, interview, and written reflection. Working with neurologists and neurosurgeons on a regular basis, Narelle is aware of some of their realities. , Corbin J. Grbich Impressions from the field notes were added to these data sources. Outside of diagnosis, hypothesis formulation and testing will be required in a number of areas. Influenced by the critical social theory of the German philosopher Habermas,33 Mezirow35 distinguished between different forms of learning: instrumental learning and action, and communicative learning and action. The visit had been very problem oriented, without any particular expression of how Mr G or his wife was feeling about the situation. Two physical therapists from each list were selected at random, and all therapists agreed to participate in the study. Her response to Bob and J is not wholly based on a detached set of principles. This will facilitate efficient and effective decision-making by the clinician to optimize outcomes … Each of the 6 physical therapists in the primary sample, together with their clinical practices, constitutes a “case” for study. Journal of Physical Therapy Education. Optimizing clinical practice with case-based reasoning approach. The use of humor for this purpose also was observed. USA.gov. , Echternach JL, Riddle DL. There's none of this, “Do this because I say so.” People say “no” to you more often in this setting than they ever would, even in your rooms or as an outpatient in the hospital; definitely as an inpatient in the hospital. The aim of our study was to examine the nature and scope of clinical reasoning and knowledge used by expert clinicians in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (or home health) physical therapy. The following example was taken from field notes written while observing neurological therapist Narelle at work. The findings of this study provide a potential clinical reasoning framework for the adoption of emerging models of impairment and disability in physical therapy. Clinical reasoning strategies can be thought of as a way of thinking and taking action within clinical practice. Husband and wife related what each was doing now. Within these clinical reasoning strategies, the application of different paradigms of knowledge and their interplay within reasoning is … A model of clinical reasoning in physical therapy characterized by the notion of "clinical reasoning strategies" is proposed by the authors. L Merriam Interactive reasoning is the purposeful establishment and ongoing management of therapist-patient rapport. Results. Abridged Résumés of Participating Physical Therapistsa. . C In the second conceptual framework, we acknowledged the fluidity of clinical practice. OD AU - Hack, Laurita M. AU - Fritz, Julie M. AU - Edwards, Ian Abstract Background and purpose: Clinical reasoning is essential to physical therapist practice. A THE MANAGEMENT OF PLANTAR FASCIITIS WITH A MUSCULOSKELETAL ULTRASOUND IMAGING GUIDED APPROACH FOR INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION IN A RUNNER: A CASE REPORT. . The third wave of data collection took the form of semistructured interviews with 6 other physical therapists (2 therapists from each of the same 3 fields) 12 months after the initial fieldwork. strategies [5].  |  BACKGROUND AND PURPOSE Clinical reasoning remains a relatively under-researched subject in physical therapy. , Barrows HS. YS The remaining monographs each cover a major joint region of the body, from the cervical spine and temporomandibular joint to the foot and ankle. Within these clinical reasoning strategies, the application of different paradigms of … This in-depth description reduces the chance that identified elements of observed treatment sessions or interview comments from informants are “taken out of context” to suit the purposes of the researcher. Continued hypothesis creation and evaluation take place as examination and management are continued and the various hypotheses are confirmed or negated. DA Synthesizing refers to the process of data reduction—a merging of stories, experiences, or cases to describe a typical pattern of behavior or response. Clipboard, Search History, and several other advanced features are temporarily unavailable. Furze J, Black L, Hoffman J, Barr JB, Cochran TM, Jensen GM.  |  In the area of interaction alone, what will be the best way to gain T's confidence? Bob: What gets me is that they know what the side effects are, but they still go ahead and do the operation. Methods. The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). Do I have the operation to cut the aneurism off? Various scenarios focusing on movement as a procedure were described in the case studies. I couldn't really comment. Higgs . Consider these first exchanges in an initial treatment session with Neve (neurological therapist) and her patient, who had entered the room nervously: M: I work 2 days a week as an occasional registered nurse at St A …'s. A model of clinical reasoning in physical therapy characterized by the notion of “clinical reasoning strategies” is proposed by the authors. [as she provokes some increased tone from J's big toe muscles]. It doesn't work for me. Using clinical outcomes to explore the theory of expert practice in physical therapy. The instrumental and communicative forms of collaboration are not being set against one another, and both could occur within a single treatment session. Each conceptual framework is the result of a continued refinement of data collection, data analysis, and reference to existing theories in various fields of relevant literature. 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