CLINICAL DECISION MAKING AND FACTORS AFFECTING IT: A QUALITATIVE STUDY OF PHYSIOTHERAPISTS WITH DIFFERENT LEVELS OF EXPERIENCE

J. Dsa^1,2, R. Krishnamurthy³

Background: In physiotherapy practice, clinical decision making is an essential aspect in treating patients. It is well recognized that prior experience evolves clinical decision making process. However, literature does not explain whether the length of time or type of experience are critical factors or not. At the same time, literature identifies difference in decision making among clinicians with different levels of experience. How and when this difference develops is not known. This study is carried out to explore various components in decision making process among physiotherapists with different levels of education and experience.

Purpose: To identify factors influencing clinical decision making process among physiotherapists during entry level, mid level and experienced clinical practitioner.

Methods: Qualitative study using observation during evaluation and treatment sessions and semi structured interviews was conducted. Purposive sampling technique was used for participation of an entry level, mid level and clinical practitioner. Each participant were currently treating patients with spinal cord injury in an inpatient rehabilitation setting of a tertiary care hospital. Observational data were carried out by videotaping each participant's evaluation and treatment session with their respective patient. Consents were taken from both the patient and therapist. Certain portions of the videotape were selected for the review. The interview was conducted within 1 week of videotaping the evaluation and treatment session.  Semi structured interview questions consisted of 8 questions. The questionnaire was found during a literature search of clinical decision making. In depth content analysis was carried out to identify major themes, and categorize it in relation to the research question.

Results: Clinical decision making process factored on patients current status (impairment and functional limitation)  during treatment and intervention by all participants. Entry level and mid level relied more on theoretical knowledge and observation of senior professionals. Experienced practitioner relied on their own previous encounters treating similar conditions. Only entry level participant mentioned evidence based practice and mid level discussed theoretical knowledge of research in academic experience.

Conclusion(s): In this study, factors influencing clinical decision making is based on patient centric goals, academic knowledge, past clinical experience and evidence based practice. However, there is a clear need to bridge the gap between theoretical knowledge of evidence based practice and clinical implementation of it.

Implications: Findings can be used to facilitate clinical decision making as an important education topic for undergraduate students so as to establish it from the early years of experience as a physiotherapist. Also, this study emphasis the need to discuss clinical reasoning and decision making process during daily clinical practice in the form of case discussion or journal club. However, further studies in this aspect are warranted to generalize the results.

Funding, acknowledgements: We wish to acknowledge the contribution of both the patients and physiotherapists who so willingly participated in the study.

Keywords: Clinical decision making, Physiotherapy, Education

Topic: Education: clinical

Did this work require ethics approval? Yes

Institution: Father MullerMedical College Hospital

Committee: Father Muller Institutional Ethics Committee

Ethics number: FMMC/FMIEC/2149/2015