Bessems C1, Heij W2, Nijhuis-van der Sanden R2, Hoogeboom T2
1Avans University of Applied Sciences, Breda, Netherlands, 2Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
Background: Exercise is considered one of the most effective strategies to counter adverse effects of frailty. Physical therapists play a pivotal role in encouraging frail older adults to take up exercise. In the Netherlands, both general physical therapists (PT's) and physical therapists specialized in geriatrics as evidenced by a master degree (PTG's) treat this patient group.
Purpose: Aim of this study was to identify similarities and differences in their clinical reasoning in daily clinical practice.
Methods: A prospective qualitative descriptive study design was used. Participants were invited by advertisements in several local partnerships of physical therapists working with older adults, connections of the Avans University of Applied Sciences, Radboud university medical center and Dutch Association of physical therapists working in Geriatrics (NVFG) and calls on social media. A total of 15 physical therapists (ten PTG's, five PT's) working in primary healthcare participated in semi structured focus groups interviews separated based on specialization. Therapists were given vignette cases which described a variety of (pre-)frail patients. For each case, the groups were asked how they would have treated each individual and its context. Analysis consisted of open coding, creating categories and abstraction.
Results: Ten PTG's (mean age 37.8 years with on average 12.5 years of working experience) participated in two focus groups consisting of five therapists each. The five PT's (mean age 51.2 with an average of 21.4 years working experience) participated in one focus group, since their data was sufficient. Themes of which both PTG's and PT's agreed upon were the
(a) influence of multimorbidity and polypharmacy,
(b) the role of the informal caregiver,
(c) the multidisciplinary approach and consultation with other healthcare professionals and
(d) which measurements to conduct during the physical assessment.
However, the PTG's came up with a few additions which regular PT's did not mention:
(I) the use of multidimensional measurements on physical, psychological and social domain,
(II) structural incorporating measurements in treatment and give frequent feedback on its results,
(III) shared decision making in therapy goal setting,
(IV) a tailored personalized treatment which incorporates learning- and compensation strategies based on principles of motor skill learning, instead of pre-defined intervention programs and
(V) the therapist in a more coaching and educative role aimed at the patient adopting a more active lifestyle.
Conclusion(s): This study has identified similarities and differences in daily clinical practice between PT's and PTG's. Findings suggest PTG's make use of a different approach as a therapist and a more extensive framework while clinical reasoning during treatment, but it is unclear if these differences lead to better outcomes in favor of one of the groups.
Implications: Physical therapists need to be aware their treatment is affected by internal- (experience, education, personal preferences) and external factors (physical therapy practice, patient context, patient characteristics). These need to be acknowledged and matched properly between patient and therapist.
Keywords: frailty, clinical reasoning, qualitative vignette study
Funding acknowledgements: No funding acquired.
Purpose: Aim of this study was to identify similarities and differences in their clinical reasoning in daily clinical practice.
Methods: A prospective qualitative descriptive study design was used. Participants were invited by advertisements in several local partnerships of physical therapists working with older adults, connections of the Avans University of Applied Sciences, Radboud university medical center and Dutch Association of physical therapists working in Geriatrics (NVFG) and calls on social media. A total of 15 physical therapists (ten PTG's, five PT's) working in primary healthcare participated in semi structured focus groups interviews separated based on specialization. Therapists were given vignette cases which described a variety of (pre-)frail patients. For each case, the groups were asked how they would have treated each individual and its context. Analysis consisted of open coding, creating categories and abstraction.
Results: Ten PTG's (mean age 37.8 years with on average 12.5 years of working experience) participated in two focus groups consisting of five therapists each. The five PT's (mean age 51.2 with an average of 21.4 years working experience) participated in one focus group, since their data was sufficient. Themes of which both PTG's and PT's agreed upon were the
(a) influence of multimorbidity and polypharmacy,
(b) the role of the informal caregiver,
(c) the multidisciplinary approach and consultation with other healthcare professionals and
(d) which measurements to conduct during the physical assessment.
However, the PTG's came up with a few additions which regular PT's did not mention:
(I) the use of multidimensional measurements on physical, psychological and social domain,
(II) structural incorporating measurements in treatment and give frequent feedback on its results,
(III) shared decision making in therapy goal setting,
(IV) a tailored personalized treatment which incorporates learning- and compensation strategies based on principles of motor skill learning, instead of pre-defined intervention programs and
(V) the therapist in a more coaching and educative role aimed at the patient adopting a more active lifestyle.
Conclusion(s): This study has identified similarities and differences in daily clinical practice between PT's and PTG's. Findings suggest PTG's make use of a different approach as a therapist and a more extensive framework while clinical reasoning during treatment, but it is unclear if these differences lead to better outcomes in favor of one of the groups.
Implications: Physical therapists need to be aware their treatment is affected by internal- (experience, education, personal preferences) and external factors (physical therapy practice, patient context, patient characteristics). These need to be acknowledged and matched properly between patient and therapist.
Keywords: frailty, clinical reasoning, qualitative vignette study
Funding acknowledgements: No funding acquired.
Topic: Older people; Primary health care; Service delivery/emerging roles
Ethics approval required: No
Institution: Radboud university medical center
Ethics committee: CRCN: Clinical Research Center Nijmegen
Reason not required: No ethical approval was required since no data of patients were used, no participants were at risk due to exposure to an intervention. Informed consent was received from all participants.
All authors, affiliations and abstracts have been published as submitted.
