Clinical reasoning and patient-centred care in musculoskeletal physiotherapy in Portugal--a qualitative study

Clinical reasoning has been described as a common process that underpins the myriad of tasks in the clinicians' practice. To date clinical reasoning models have emerged from research developed in specific and well-developed health care and professional cultures, such as those in Australia and the United States, but there has been little discussion of their relevance and applicability to other cultural settings. The aim of this investigation was to explore clinical reasoning processes in a sample of experienced Portuguese musculoskeletal physiotherapists. The study focused on clinicians' interaction with their patients in order to define and manage clinical problems. Data were collected through non-participant observation, semi-structured interviews, memos and field notes, and analysed thematically to explore and interpret clinical practice and reasoning. Findings highlighted that the clinicians were more likely to carry out their reasoning approach as a purely cognitive and clinician centred process. Perspectives of clinical reasoning therefore differ between cultures and contexts of practice and this has potential implications in the way physiotherapists interpret health and illness, their role as clinicians, as well as the patient-physiotherapist relationship.