This project aimed to describe conceptual frameworks relevant to clinical reasoning and to characterize the components of the clinical reasoning process in (1) conceptual frameworks developed to guide clinical reasoning in neurological physiotherapy and (2) in the clinical practice of neurological physiotherapy. Additionally, we intended to assess commonalities and differences between theory and practice, and map study findings to standards of clinical practice.
This scoping review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review guidelines. The protocol was registered with OSF. Six databases were searched in July 2022 and July 2024: using the keywords ‘clinical reasoning’, ‘clinical decision making’ and ‘neurological physiotherapy’ as well as indexing. Inclusion criteria: papers describing conceptual frameworks informing the clinical reasoning process and Clinical practice studies that described clinical reasoning processes in neurological physiotherapy, in the adult population. Covidence was used to screen all papers using two reviewers.
30 included papers, 13 papers describing conceptual frameworks and 17 clinical practice studies. Twenty- five conceptual frameworks were identified and mapped against the World Physiotherapy Standards (2011) and Physiotherapy Practice Thresholds in Australia & Aotearoa New Zealand (2023). The International classification of functioning was referred to in the conceptual framework but not the clinical practice studies. The most included clinical reasoning components were initial information gathering, objective examination, movement analysis, predicted patient performance and evaluation/reassessment. No included papers or studies identified all of the components described in the standards and practice thresholds.
This review aimed to outline the conceptual frameworks in neurological physiotherapy and to identify key components of the clinical reasoning process. Five components were cited in over 70% of the studies: information gathering; hypothesis formation; collaboration with clients; movement analysis/diagnosis; and evaluation/reassessment. None of the included papers or studies included all components identified by WPT and the Physiotherapy Practice Thresholds in Australia & Aotearoa New Zealand.
This review aimed to outline the conceptual frameworks in neurological physiotherapy and to identify key components of the clinical reasoning process. Five components were cited in over 70% of the studies: information gathering; hypothesis formation; collaboration with clients; movement analysis/diagnosis; and evaluation/reassessment. Further research is required to develop a comprehensive clinical reasoning framework for neurological physiotherapy.
Clinical reasoning
Physiotherapy
