Adoption of the Rehabilitation Treatment Specification System (RTSS) can compel physiotherapists to reflect on, and clinically reason, how to rehabilitate

Gareth Jones, Jamie Gibson
Purpose:

The aim of this study was to pilot a re-designed teaching programme and explore its preliminary efficacy in encouraging uptake within 3 diverse physiotherapy inpatient specialisms. Our objectives were to evaluate the teaching programme’s effect on RTSS uptake, and to explore it’s hypothesized effect on clinical reasoning.

Methods:

A pilot, pre-post study was undertaken in a UK acute-care hospital. Twenty-six inpatient physiotherapists working in Elective Orthopaedics, Head/Neck Surgery, and Older Persons Medicine teams were recruited. They were exposed to ten, one-hour, weekly teaching sessions including lectures and case-based learning. Lectures introduced RTSS constructs and its application to case examples as well as documentation workshops and e-learning. Measures were completed pre-intervention, post-intervention, and at two-months follow-up. Assessments of RTSS uptake was gained through frequency-count of RTSS terminology in case-notes and Clinical Reasoning through use of the Self-Assessment of Clinical Reasoning and Reflection (SACRR) tool and a Clinical Reasoning Rubric of emergent reasoning quality in case notes.

Results:

There were modest but significant increases in median total controlled-vocabulary observed in case-notes within all clinical teams. For all PTs there was significant improvement in median (IQR) total SACCR scores (max 130) [pre-intervention (96.0 (93.8-101.3)), post (102.0 (96.8-104.0)), follow-up (102.0 (97.0-105.0)) [𝜒2(2)=9.051, =0.011]], but no significant changes within teams. SACCR subscale analyses revealed significant change in the Knowledge Application and Self-Reflection domains. There were no significant differences in clinical reasoning quality according to the rubric in any teams’ case-notes, except the Head and Neck Team for problem lists [(2)=13.148, =0.001] and treatment goals [(2)=6.593 =0.037]. Pairwise comparisons confirmed all significant changes were sustained at follow-up.

Conclusion(s):

The teaching programme demonstrated preliminary efficacy in improving adoption and clinical reasoning across physiotherapy specialisms. Improvement in self-reported clinical reasoning was associated with applying theoretical knowledge in designing rehabilitation treatment and in self-reflection, presumably because clinicians were compelled to theorise when using the RTSS, and reflect using realistic cases respectively. This manifested as improved quality of problem lists and goals within the smallest teams (Head/Neck surgery) notes. Further determination of valid measurement of RTSS clinical reasoning effect is required, as well as the relationship of the RTSS with established clinical rehabilitation frameworks.

Implications:
  • The RTSS presents a novel framework for reasoning physiotherapy treatments
  • Teaching interventions based on pedagogical theory can support clinical adoption of the RTSS
  • RTSS clinical teaching interventions and adoption may improve clinical reasoning domains
  • Implementation of the RTSS requires contextually specific investigation and intervention
Funding acknowledgements:
NIHR: National Institute for Health and Care Research
Keywords:
Clinical Reasoning
Rehabilitation
Treatment specification
Primary topic:
Disability and rehabilitation
Second topic:
Education: clinical
Third topic:
Research methodology, knowledge translation and implementation science
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Ethical approval was granted by the Guy’s and St. Thomas’ NHS Foundation Trust Therapies and Rehabilitation Directorate Governance Committee
Provide the ethics approval number:
12584
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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