To develop a framework for determining physical capacity to support physiotherapists in their clinical reasoning process when treating hospitalized patients.
A framework was developed using a multi-method approach. The Medical Research Council framework for complex interventions was used to guide the development of the framework. First, the scientific literature was searched for existing frameworks for clinical reasoning in physiotherapy. These methods were inventoried and relevant elements were extracted. Second, a first draft of the framework was developed by a group of experts. Third, the framework was tested in practice, leading to a final version.
A total of 17 frameworks were identified in the literature, but none were specifically designed for general use in hospitals to assess a patient's physical capacity. Key elements from the identified frameworks included the use of ICF (International Classification of Functioning) terminology, a patient management model, and regular monitoring of clinical parameters. Field testing of the initial draft by 18 physiotherapists and 3 trainees at Amsterdam University Medical Centre led to improvements in the final version for clinical use. The framework begins by considering the patient's background and characteristics, followed by the first step: assessing clinical health status. Step 2 involves a physical examination, which is followed by the physiotherapy intervention. Throughout the intervention, relevant clinical symptoms, such as heart rate and oxygen saturation, are monitored, this is step 3 of the framework. After each step, clinical reasoning occurs, with the framework providing guiding questions to help the physiotherapist make an accurate assessment of the patient’s physical capacity.
A physical capacity framework to support physiotherapists in their clinical reasoning process when treating hospitalized patients was developed. The final framework can guide the steps to be taken during patient management in order to determine the patients’ physical capacity and to achieve an adequate training stimulus, which can be adapted based on monitoring information. In the future, an (international) multicentre working group consisting of health professionals from different disciplines, researchers and patients could be established, to conduct a qualitative study on the use (MRC phase 4) and implementation of the framework in clinical practice (MRC phase 5).
By using this framework, all physiotherapists working in a hospital, regardless of the patient population, can determine the physical capacity of each individual patient and adjust their training loading accordingly. The framework can also be used as a teaching tool to train junior physiotherapists or those with little experience in hospital care.
physical capacity
hospital physiotherapy
