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The clinical reasoning in neurological physiotherapy: an exploratory qualitative study on the (dis)similarities
Sofia Marques1, Julie Vaughan-Graham2,3, Rui Jorge Dias Costa4
1CINTESIS@RISE, IbiMED, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
Background:
Clinical reasoning (CR) is a complex and dynamic process that relies on therapists' cognitive, metacognitive, psychomotor and affective skills. These abilities allow clinicians to synthesize patient information, apply reasoning strategies, and adapt interventions in response to evolving clinical presentations. Despite its critical role in physiotherapy, limited research has explored how neurological physiotherapists develop and apply CR.
Purpose:
To examine the CR processes of neurological physiotherapists with and without post-graduate Bobath education.
Methods:
Thirty-two experienced neurological physiotherapists were purposefully selected to participate in the study. Participants worked in rehabilitation centers, hospitals, and private clinics. A qualitative interpretive description approach was employed, in which video-recorded treatment sessions, used for stimulated recall, were immediately followed by semi-structured interviews. The interviews were transcribed verbatim and served as the raw data for thematic analysis, employing deductive and inductive methods.
Results:
The study included 32 physiotherapists. Participants worked in rehabilitation centers, hospitals, and private clinics. In the Bobath group (n = 16), four themes developed: (1) clinical practice guided by contemporary Bobath assumptions and principles; (2) the movement problem centers the CR; (3) reasoning: person-centered and multi-dimensional; and (4) influence of contextual factors. In the non-Bobath group (n = 16), the developed themes include: (1) clinical practice: an eclectic mix; (2) prioritizing independence; (3) reasoning: combination of provider-centered and person-centered; and (4) influence of contextual factors.
Conclusion:
This study highlights that CR is shaped by clinical, interpersonal, and contextual factors. Bobath-educated therapists demonstrated a movement-centered approach to their reasoning, while NBG's CR revolves around task-independence and exercise-oriented strategies. Further research is needed to explore these aspects of CR.
