Physical therapist practice in the acute care setting: a qualitative study

Area of Science:

• Rehabilitation Medicine
• Clinical Practice
• Healthcare Delivery

Background:

• Physical therapist practice in acute care is not well understood.
• There are arguments questioning the necessity of skilled physical therapy in acute settings.

Purpose of the Study:

• Describe the role of physical therapists in acute care.
• Characterize the clinical reasoning processes employed.
• Define the context of acute care physical therapy services.

Main Methods:

• Qualitative study using grounded theory.
• Convenience sample of 18 physical therapists from 3 US academic medical centers.
• Semistructured interviews analyzed via constant comparative method.

Main Results:

• Identified 8 themes: information analysis, specialized knowledge application, communication (gaining/providing), dynamic assessment, professional responsibility, complex environment, and decision-making.
• Key concerns include patient mobility and safety.
• Goals are optimal care plans and appropriate discharge settings.

Conclusions:

• Physical therapists in acute care demonstrate sophisticated clinical reasoning.
• Reasoning involves integrating medical and physical therapy knowledge.
• Dynamic assessment, rapid decision-making, and constant communication are critical in the complex acute care environment.