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Assessing clinical reasoning in physical therapy: Discriminative validity of the Reasoning 4 Change instrument. Physiotherapy 2022; 117:8-15. [DOI: 10.1016/j.physio.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/17/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022]
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Elvén M, Dean E, Söderlund A. Augmented behavioral medicine competencies in physical therapy students' clinical reasoning with a targeted curriculum: a final-semester cohort-comparison study. Physiother Theory Pract 2021; 38:2007-2018. [PMID: 33663336 DOI: 10.1080/09593985.2021.1895387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Knowledge regarding the impact of curricula with behavioral medicine content and competencies (BMCC) on physical therapy (PT) students' clinical reasoning skills is lacking. Objectives: The primary objective was to compare the clinical reasoning skills, focusing on clients' behavioral change, of entry-level PT students with or without BMCC in their curricula. The secondary objective was to compare students' attitudes and beliefs in a biomedical and biopsychosocial practice orientation.Methods: Swedish final-semester PT students (n = 151) completed the Reasoning 4 Change (R4C) instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists. A blueprint was used for curricular categorization. The independent t-test was used.Results: Students attending programs with BMCC curricula (n = 61) had superior scores compared with students without BMCC curricula (n = 90) in the following R4C variables, all of which were related to clinical reasoning focused on behavioral change: Knowledge, Cognition, Self-efficacy, Input from the client, Functional behavioral analysis, and Strategies for behavioral change. Students who did not receive BMCC curricula scored higher in the R4C contextual factors and reported a greater biomedical practice orientation than students receiving BMCC curricula. There was no difference in the biopsychosocial practice orientation between groups.Conclusions: Our findings support the benefit of structured entry-level PT curricula with BMCC on final-semester students' clinical reasoning skills focused on behavioral change and their level of biomedical practice orientation. Further, our findings elucidated educational opportunities to augment students' self-efficacy and strengthen their behavioral competencies in clinical reasoning. For the generalizability of the results further research in other contexts is needed.
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Affiliation(s)
- Maria Elvén
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Implementing a behavioral medicine approach in physiotherapy for patients with musculoskeletal pain: a scoping review. Pain Rep 2021; 5:e844. [PMID: 33490840 PMCID: PMC7808688 DOI: 10.1097/pr9.0000000000000844] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/11/2020] [Accepted: 07/07/2020] [Indexed: 01/24/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. The interventions in the scoping review were in agreement with the definition of behavioral medicine in physiotherapy, but reported behavior change techniques were few. In intervention research on musculoskeletal pain, physiotherapists often study behavioral and cognitive components. Evidence on applying these components has increased during the past decade. However, how to effectively integrate behavioral and cognitive components in the biopsychosocial management of musculoskeletal pain is challenging. The aim was to study the intervention components and patient outcomes of studies integrating behavioral and cognitive components in physiotherapy, to match the interventions with a definition of behavioral medicine in physiotherapy and to categorize the behavior change techniques targeted at patients with musculoskeletal pain in (1) randomized controlled effect trials or (2) implementation in clinical practice trials. A scoping review was used to conduct this study, and the PRISMA-ScR checklist was applied. Relevant studies were identified from the PubMed, MEDLINE, PsycINFO, CINAHL Plus, and Web of Science Core databases separately for the (1) randomized controlled effect trials and (2) implementation in clinical practice trials. Synthesis for the matching of the patient interventions with the existing definition of behavior medicine in physiotherapy showed that the interventions mostly integrated psychosocial, behavioral, and biomedical/physical aspects, and were thus quite consistent with the definition of behavioral medicine in physiotherapy. The reported behavior change techniques were few and were commonly in categories such as “information of natural consequences,” “feedback and monitoring,” and “goals and planning.” The patient outcomes for long-term follow-ups often showed positive effects. The results of this scoping review may inform future research, policies, and practice.
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Geidl W, Wais J, Fangmann C, Demisse E, Pfeifer K, Sudeck G. Physical activity promotion in daily exercise therapy: the perspectives of exercise therapists in German rehabilitation settings. BMC Sports Sci Med Rehabil 2019; 11:28. [PMID: 31827805 PMCID: PMC6886191 DOI: 10.1186/s13102-019-0143-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/17/2019] [Indexed: 12/21/2022]
Abstract
Background This study aims to explore exercise therapists' perspectives on the topic of physical activity promotion (PAP) with a focus on identifying (i) the intervention content and methodological approaches used for promoting physical activity (PA) in daily practice and (ii) the barriers and facilitators that affect PAP. Methods This qualitative study comprised the heads of exercise therapy departments (n = 58; 41% women; mean age = 45 years) from different rehabilitation clinics in Germany. Each participant took part in a semi-structured focus-group discussion on PAP in exercise therapy. The findings of the focus groups were processed and interpreted using a conventional qualitative content analysis. Results The exercise therapists demonstrated detailed didactic-methodological strategies and action orientations for PAP. The identified core topics of the content and methods of PAP were (1) conceptualization, (2) exercise and PA for enjoyment and pleasure, (3) education with practice-theory combinations, (4) media and materials for self-directed training, and (5) strategies to enhance personal responsibility and independence. The core topics for the associated barriers and facilitators were (1) structural conditions, (2) the role of exercise therapists, (3) the interdisciplinary rehabilitation team, (4) rehabilitant experiences and expectations, and (5) aftercare services. Conclusion The topic of PAP is addressed with a high level of variability; exercise therapists involved in this study identify various methods and content for the promotion of PA within their individual practices. However, they display a limited awareness of existing evidence- and theory-based concepts for the promotion of PA as well as underlying theories of behavioural change. This variability may be due to the lack of a defined common framework for promoting PA, insufficient emphasis being placed on PA promotion in the current curricula and training, or extensive conceptual differences within German exercise therapy departments (e.g. different weighting of PAP).
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Affiliation(s)
- Wolfgang Geidl
- 1Department of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Judith Wais
- 2Institute of Sport Science, Department of Education and Health Research, Eberhard Karls University Tübingen, Wächterstraße 76, 72074 Tübingen, Germany
| | - Cheyenne Fangmann
- 2Institute of Sport Science, Department of Education and Health Research, Eberhard Karls University Tübingen, Wächterstraße 76, 72074 Tübingen, Germany
| | - Ewnet Demisse
- 1Department of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Klaus Pfeifer
- 1Department of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Gorden Sudeck
- 2Institute of Sport Science, Department of Education and Health Research, Eberhard Karls University Tübingen, Wächterstraße 76, 72074 Tübingen, Germany
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Elvén M, Hochwälder J, Dean E, Söderlund A. Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students. Phys Ther 2019; 99:964-976. [PMID: 30869789 PMCID: PMC6665874 DOI: 10.1093/ptj/pzz044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/03/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. OBJECTIVE This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-à-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. DESIGN This study used an exploratory cross-sectional design. METHODS The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. RESULTS All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R2 = 0.04; SBC change in R2 = 0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. LIMITATIONS The limitations of this study are that it was cross-sectional. CONCLUSIONS Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.
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Affiliation(s)
- Maria Elvén
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden,Address all correspondence to Ms Elvén at:
| | - Jacek Hochwälder
- Division of Psychology, School of Health, Care and Social Welfare, Mälardalen University
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University
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Geidl W, Deprins J, Cassar S, Streber R, Portenlänger F, Sudeck G, Pfeifer K. Exercise therapy and physical activity promotion: do exercise therapists assess or receive information on clients’ relevant personal factors? A national survey from Germany. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1617776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Wolfgang Geidl
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Judith Deprins
- Department of Education and Health Research, Eberhard Karls University, Tübingen, Germany
| | - Samuel Cassar
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - René Streber
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Florian Portenlänger
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Gorden Sudeck
- Department of Education and Health Research, Eberhard Karls University, Tübingen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Elvén M, Hochwälder J, Dean E, Hällman O, Söderlund A. Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'. AIMS Public Health 2018; 5:235-259. [PMID: 30280115 PMCID: PMC6141557 DOI: 10.3934/publichealth.2018.3.235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/29/2018] [Indexed: 01/22/2023] Open
Abstract
Background and aim: 'Reasoning 4 Change' (R4C) is a newly developed instrument, including four domains (D1-D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1-D4); inter-rater reliability (D2-D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (α range: 0.67-0.91), satisfactory test-retest reliability (ICC range: 0.46-0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94-1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06-0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.
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Affiliation(s)
- Maria Elvén
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Jacek Hochwälder
- Division of Psychology, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Elizabeth Dean
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Olle Hällman
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Sandborgh M, Dean E, Denison E, Elvén M, Fritz J, Wågert PVH, Moberg J, Overmeer T, Snöljung Å, Johansson AC, Söderlund A. Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review. Physiother Theory Pract 2018; 36:365-377. [DOI: 10.1080/09593985.2018.1488192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maria Sandborgh
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Elizabeth Dean
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eva Denison
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
- Division of health sciences, Norwegian Institute of Public Health, Nydalen, Oslo, Norway
| | - Maria Elvén
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Johanna Fritz
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Petra von Heideken Wågert
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Johan Moberg
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Thomas Overmeer
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
- Centre for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Åsa Snöljung
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Ann-Christin Johansson
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
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