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Marques S, Vaughan-Graham J, Costa R, Figueiredo D. The Bobath concept (NDT) in adult neurorehabilitation: a scoping review of conceptual literature. Disabil Rehabil 2024:1-12. [PMID: 38984750 DOI: 10.1080/09638288.2024.2375054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE This scoping review aims to describe how Bobath concept is conceptualized, operationalized, and studied in adult neurorehabilitation. METHODS The Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines were adopted. Non-scientific and research articles were searched in electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, ScienceDirect, and Physiotherapy Evidence Database (PEDro), with the keywords "Bobath" or "Neurodevelopmental Treatment", published in English, Spanish, and Portuguese, between 2013 and 2023. RESULTS Of the 78 publications identified, 31 articles addressed the conceptual underpinnings of Bobath concept (seven theoretical papers, seven Delphi/surveys/mixed methods studies, four qualitative studies, one scoping review, 10 letters to the editor, and two editorials), comprising five themes: (a) theoretical principles; (b) clinical principles; (c) clinical reasoning; (d) conceptualizing movement; and, current (e) evidence debate. The revised definition and the Model of Bobath Clinical Practice provide a clarification of the unique aspects of Bobath concept. A new clinical skill was identified beyond facilitation - visuospatial kinesthetic perception - as well as how Bobath experts conceptualize movement, which are all integral to clinical reasoning. CONCLUSIONS This review provides an updated Bobath clinical framework that gathers the theoretical foundations and clinical practice principles that require careful consideration in the design of future intervention studies.Implications for rehabilitationThis scoping review consolidates the clinical and theoretical principles of contemporary Bobath practice, providing a clear framework for clinicians.The Model of Bobath Clinical Practice (MBCP) framework enables detailed documentation of movement analysis and movement diagnosis, guiding clinical reasoning and interventions.This review identifies fundamental principles and practices to inform future Bobath intervention studies, ensuring their clinical relevance.A framework with specific recommendations has been developed to guide Bobath intervention studies, enhancing the integration of clinical practice, education, and research.
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Affiliation(s)
- Sofia Marques
- Department of Medical Sciences, CINTESIS@RISE, IbiMED, University of Aveiro, Aveiro, Portugal
| | - Julie Vaughan-Graham
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Rui Costa
- IbiMED, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Daniela Figueiredo
- CINTESIS@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Bergström A, Mondaca M, Nilsson I, Guidetti S, Rosenberg L. Phronesis: Recognising a neglected dimension of knowledge within occupational therapy research. Scand J Occup Ther 2024; 31:2341782. [PMID: 38630858 DOI: 10.1080/11038128.2024.2341782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Phronesis is a way of knowing, implying wisdom, experiences, and reflections that guide our judgements. Phronesis, important for learning, is a neglected form of knowledge when applied to research. AIM To examine how phronesis is conceptualised and practiced in three research projects. METHOD Data from eight interviews with researchers involved in three research projects was generated. The interview material was analysed. A theoretical matrix of contemporary understanding of phronesis was applied to the material. RESULT Examples of phronesis from three research projects in occupational therapy are presented according to categories of contemporary phronesis; acknowledging embodiment, embracing humility, using perceptiveness, and practicing reflexivity. SIGNIFICANCE This unique approach of analysing research projects contributes to the understanding of phronesis and its implications for research, providing valuable insights into the researchers' praxis in their respective projects. CONCLUSION There is a need for a greater recognition of phronesis as a dimension of knowledge within all types of research, and within the discipline. By not recognising phronesis as a legitimate form of knowledge, the discipline perpetuates a superiority of knowledge from episteme that dominates our ways of learning about the world around us and where the type of knowledge gleaned from phronesis is consequently marginalised.
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Affiliation(s)
- Aileen Bergström
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Huddinge, Sweden
| | - Margarita Mondaca
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Huddinge, Sweden
- Division of Occupational Therapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Ingeborg Nilsson
- Division of Occupational Therapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- School of Health and Welfare, Halmstad, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Huddinge, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, and Theme Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Rosenberg
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Huddinge, Sweden
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Castelli L, Giovannini S, Iacovelli C, Fusco A, Pastorino R, Marafon DP, Pozzilli C, Padua L. Training-dependent plasticity and far transfer effect enhanced by Bobath rehabilitation in Multiple Sclerosis. Mult Scler Relat Disord 2022; 68:104241. [PMID: 36274281 DOI: 10.1016/j.msard.2022.104241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a disease that often results in motor and/or cognitive disability. Despite the increasing availability of effective drug therapies, rehabilitation is very important means of counteracting the progression of disability and improving physical function, impacting social participation and improving quality of life. Several rehabilitation approaches can be used in the context of neuro-motor rehabilitation, but there is insufficient evidence for them in the literature. OBJECTIVES This study has the twofold purpose of: (i) investigate whether rehabilitation according to Bobath Concept can improve balance and some aspects of cognitive function in MS patients; (ii) explore whether the ability to improve postural control, an indirect index of adaptive neuroplasticity, is preserved in MS patients and whether it can be improved with rehabilitation. METHOD This is an independent wait-listed study. Forty people with MS (pwMS) were enrolled: patients in the Bobath group underwent 8 weeks of rehabilitation according to the Bobath Concept. For aim 1, pwMS were assessed at baseline (T0), at the end of the 8 weeks of treatment (T1) and after 8 weeks of observation (T2) with motor and cognitive scales. For aim 2, the same 40 pwMS were matched with healthy controls and were subjected to a postural learning task using the force platform at T0, T1 and T2. RESULTS Patients in Bobath group scored better on balance and cognitive function at T1, but this improvement was not maintained at T2. All patients were less accurate than controls in the postural learning task at each assessment; however, patients also demonstrated an increase in accuracy after training, similar to that of healthy controls. The learning curve was better for patients randomized to the active group than the waitlist at T1 time, but this advantage was not maintained at the T2 assessment. CONCLUSION In light of the results, this study supports the use of rehabilitation according to Bobath Concept to improve balance control and some executive functions in MS. Despite worse baseline performance, pwMS were able to learn a postural control task on par with healthy controls. Also, supports the hypothesis that adaptive plasticity is preserved despite MS and can be promoted by rehabilitation.
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Affiliation(s)
- Letizia Castelli
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; UOS Riabilitazione Post-acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
| | - Chiara Iacovelli
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Denise Pires Marafon
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University, Roma, Italy
| | - Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Fowers BJ, Novak LF, Calder AJ, Sommer RK. Beyond an abstract and technical conception of psychotherapy: The indispensable role of practical wisdom. THEORY & PSYCHOLOGY 2022. [DOI: 10.1177/09593543221115372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The work of psychotherapy is complex and seems to resist algorithmic formulation. Psychotherapy theory, technique, and research help to manage this complexity to some degree, but clinical excellence also seems to require clinical judgment, and this judgment cuts across therapeutic theories. However, the content and process of clinical judgment remain relatively untheorized, often relegated to the “art of psychotherapy.” This article focuses on elucidating clinical judgment in terms of the neo-Aristotelian concept of practical wisdom, which includes recognizing what is salient, integrating multiple considerations, infusing emotional experience with reason, and pursuing an intervention plan with discernment and flexibility. The argument is that practical wisdom provides a rich description of the work of clinically adept therapists by more clearly portraying therapists’ decisions and activities than the general, unsystematic concept of clinical judgment or in terms of the many theories of psychotherapy.
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Vaughan-Graham J, Cheryl C, Holland A, Michielsen M, Magri A, Suzuki M, Brooks D. Developing a revised definition of the Bobath concept: Phase three. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1832. [PMID: 31889391 DOI: 10.1002/pri.1832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/17/2019] [Accepted: 12/13/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To develop a revised definition of the Bobath concept that incorporates the perspectives of members of the International Bobath Instructors Training Association (IBITA). METHODS A three-phase consensus building design utilizing (i) focus groups; (ii) survey methods; and, (iii) real-time Delphi. This paper presents the findings from the real-time Delphi, an iterative process to collect and synthesize expert opinions anonymously, provide controlled feedback, with the overall goal of achieving consensus. RESULTS One hundred and twenty-one IBITA members participated in the real-time Delphi. Over three Delphi Rounds, consensus was reached on six overarching conceptual statements and 11 statements representing unique aspects of Bobath clinical practice. One statement that aimed to describe the Bobath clinical term of "placing" was eliminated in Round One due to participant reservations that a text description was insufficient for this term. Seven statements underwent minor wording revisions in Round Two and Three to improve sentence clarity. CONCLUSION Using the real-time Delphi, we were successful in gaining consensus in an expert group on a series of statements on which a revised definition of the Bobath concept could be based.
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Affiliation(s)
- Julie Vaughan-Graham
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada
| | - Cott Cheryl
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada
| | - Ann Holland
- Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | | | - Alba Magri
- Studio Erre- Physiotherapy Clinic, Via della Badia, 18, Brescia-, Italy
| | - Mitsuo Suzuki
- Rokujizo Genenal Hospital, 9 Naramchi, Rokujizo Uji-shi, Kyoto, Japan
| | - Dina Brooks
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada
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Abstract
Human movement is complex, presenting clinical and research challenges regarding how it is described and investigated. This paper discusses the commonalities and differences on how human movement is conceptualized from neuroscientific and clinical perspectives with respect to postural control; the limitations of linear measures; movement efficiency with respect to metabolic energy cost and selectivity; and, how muscle synergy analysis may contribute to our understanding of movement variability. We highlight the role of sensory information on motor performance with respect to the base of support and alignment, illustrating a potential disconnect between the clinical and neuroscientific perspectives. The purpose of this paper is to discuss the commonalities and differences in how movement concepts are defined and operationalized by Bobath clinicians and the neuroscientific community to facilitate a common understanding and open the dialogue on the research practice gap.
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Tamás É, Södersved Källestedt ML, Hult H, Karlgren K, Allvin R. Closing the Gap: Experienced Simulation Educators' Role and Impact on Everyday Health care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:36-41. [PMID: 30768445 PMCID: PMC6400642 DOI: 10.1097/ceh.0000000000000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Trained simulation educators (SEs) usually work both at simulation centers and in everyday health care, and thus, they possess dual expertise. Experienced SEs are known to grow confident with their expanding experience, but evidence is scarce about how this affects their development as clinical professionals. The aim of this study was to explore how experienced SEs describe their role within the context of everyday health care. METHODS An explorative descriptive study including 14 semistructured interviews and 27 questionnaires was conducted with 41 experienced SEs. An inductive thematic analysis was used to identify and analyze patterns describing SEs' perceptions of the influence of their educational work on everyday health care. RESULTS The SEs' descriptions of their encounters during everyday clinical work, which were affected by the fact that they had experience of facilitating simulation training, were gathered into three main themes with three of their own subthemes: education (educational needs, routines/guidelines, and being a resource), nontechnical skills (communication, feedback, and leadership/coworkership), and clinical proficiency (situational insight, role model, and confidence in clinical practice). The insights gained and actions taken as clinical professionals are all intended to be implemented with the ultimate aim of safe patient care. DISCUSSION All the aspects of the SEs' work are perceived to be successfully translated into clinical practice and can be summarized by the main themes of education, nontechnical skills, and clinical proficiency as delineated by this study. These themes are demonstrated at the individual, team, and organizational levels through increased competence and confidence.
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Affiliation(s)
- Éva Tamás
- Dr. Tamás: Department of Cardiovascular Diseases, Institute of Medicine and Health, Medical Faculty, University of Linköping, Linköping, Sweden. Dr. Södersved Källestedt: Clinical Skills Center, Center for Clinical Research, Uppsala University, Västerås, Sweden. Dr. Hult: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Dr. Karlgren: Department of Learning, Informatics, Management, and Ethics and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. Dr. Allvin: Clinical Skills Center, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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Vaughan-Graham J, Cott C, Holland A, Michielsen M, Magri A, Suzuki M, Brooks D. Developing a revised definition of the Bobath concept. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1762. [PMID: 30556333 DOI: 10.1002/pri.1762] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/27/2018] [Accepted: 11/08/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study was developed as a consensus-building exercise within the International Bobath Instructors Training Association (IBITA) to develop a revised definition of the Bobath concept. METHODS A three-phase design utilizing (a) focus groups, (b) survey methods, and, (c) real-time Delphi. This paper details Phase 1 and 2. RESULTS Forty IBITA members participated in five focus groups. Eight broad themes were developed from the focus groups from which the survey statements were developed. There was a high level of agreement on all nine survey statements identifying overarching constructs and on 12 of the 13 statements identifying unique aspects of Bobath clinical practice. Lower scores were attributed to lack of understanding of the term humanistic, Bobath clinical practice addressing multiple domains such as impairments, activities, and participation and limited agreement on the description of the term "placing." CONCLUSION Focus groups and a web-based survey were successful in soliciting the opinions of IBITA members on themes and statements of importance for the development of a revised Bobath definition. The results of Phase 1 and 2 will inform Phase 3, a real-time Delphi, to gain consensus within IBITA on statements on which a revised Bobath definition is to be based.
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Affiliation(s)
| | - Cheryl Cott
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Ann Holland
- Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Alba Magri
- Physiotherapy Clinic, Studio Erre, Brescia, Italy
| | | | - Dina Brooks
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Silva A, Vaughan-Graham J, Silva C, Sousa A, Cunha C, Ferreira R, Barbosa PM. Stroke rehabilitation and research: consideration of the role of the cortico-reticulospinal system. Somatosens Mot Res 2018; 35:148-152. [DOI: 10.1080/08990220.2018.1500363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Augusta Silva
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research - Center of Human Movement and Human Activity, Porto, Portugal
| | | | - Claudia Silva
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research - Center of Human Movement and Human Activity, Porto, Portugal
| | - Andreia Sousa
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research - Center of Human Movement and Human Activity, Porto, Portugal
| | - Christine Cunha
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research - Center of Human Movement and Human Activity, Porto, Portugal
- Sport Faculty – University of Porto, Porto, Portugal
| | - Rosália Ferreira
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research - Center of Human Movement and Human Activity, Porto, Portugal
- Sport Faculty – University of Porto, Porto, Portugal
| | - Pedro Maciel Barbosa
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research - Center of Human Movement and Human Activity, Porto, Portugal
- Institute of Public Health - University of Porto, Porto, Portugal
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Michielsen M, Vaughan-Graham J, Holland A, Magri A, Suzuki M. The Bobath concept - a model to illustrate clinical practice. Disabil Rehabil 2017; 41:2080-2092. [PMID: 29250987 DOI: 10.1080/09638288.2017.1417496] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background and purpose: The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath concept in terms of contemporary neurological rehabilitation. The utilisation of a framework to illustrate the clinical application of the Bobath concept provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The development process culminating in the model of Bobath clinical practice is described. Case description: The use of the model in clinical practice is illustrated using two cases: a client with a chronic incomplete spinal cord injury and a client with a stroke. Discussion: This article describes the clinical application of the Bobath concept in terms of the integration of posture and movement with respect to the quality of task performance, applying the Model of Bobath Clinical Practice. Facilitation, a key aspect of Bobath clinical practice, was utilised to positively affect motor control and perception in two clients with impairment-related movement problems due to neurological pathology and associated activity limitations and participation restrictions - the outcome measures used to reflect the individual clinical presentation. Implications for Rehabilitation The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath-concept. The model of Bobath clinical practice provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The clinical application of the Bobath-concept highlights the integration of posture and movement with respect to the quality of task performance. Facilitation, a key aspect of Bobath clinical practice, positively affects motor control, and perception.
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Affiliation(s)
| | | | - Ann Holland
- c Neurorehabilitation and Therapy Services , University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Alba Magri
- d Studio Erre - Physiotherapy Clinic , Brescia , Italy
| | - Mitsuo Suzuki
- e Department of Rehabilitation , Bobath Memorial Hospital , Osaka , Japan
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Mepsted R, Tyson S. The Bobath concept. A guru-led set of teachings unsupported by emerging evidence. A response to Vaughan-Graham and Cott. (J Eval Clin Pract. 2016. doi: 10.1111/jep.12751). J Eval Clin Pract 2017; 23:1127-1128. [PMID: 28726254 DOI: 10.1111/jep.12791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/28/2022]
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Vaughan-Graham J, Cott C. Author response to "Letter to Editor by Roger Mepsted". J Eval Clin Pract 2017; 23:1125-1126. [PMID: 28418187 DOI: 10.1111/jep.12751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 12/31/2022]
Affiliation(s)
| | - Cheryl Cott
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
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Loughlin M, Bluhm R, Buetow S, Borgerson K, Fuller J. Reasoning, evidence, and clinical decision-making: The great debate moves forward. J Eval Clin Pract 2017; 23:905-914. [PMID: 28960730 DOI: 10.1111/jep.12831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023]
Abstract
When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical import, is currently the preoccupation of some of the most influential and insightful contributors to the on-going evidence-based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life.
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Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
| | - Robyn Bluhm
- Department of Philosophy, Lyman Briggs College, Michigan State University, East Lancing, Michigan, USA
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | | | - Jonathan Fuller
- African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa.,Toronto Philosophy of Medicine Network, University of Toronto, Toronto, Canada
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Mepsted R. Letter in response to Vaughan-Graham and Cott (2016) Phronesis: Practical wisdom the role of professional practice knowledge in the clinical reasoning of Bobath instructors, J. Eval. Clin. Pract., doi: 10.1111/jep.12641. J Eval Clin Pract 2017; 23:1124. [PMID: 28276168 DOI: 10.1111/jep.12724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022]
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