FACTORS INFLUENCING PERCEIVED CLINICAL DECISION-MAKING SKILLS IN STROKE REHABILITATION AMONG PHYSICAL THERAPY INTERNS OF ILOCOS NORTE, PHILIPPINES

C. Macalma^1,2, C.J. Escuadra³, A.M. Aseron³

Background: As valid decisions will lead to effective and efficient physical therapy (PT) stroke examination, evaluation, diagnosis, prognosis, intervention and outcomes measurement, clinical decision-making (CDM) skills are significant part of a PT student repertoire. Understanding CDM skills and factors that contribute to their development among students is significant in integrating learning strategies and assessments for neurologic PT curriculum.  

Purpose: To determine the CDM skills and the different factors that influence it among PT  interns in neurologic practice, specifically, stroke rehabilitation.

Methods: This cross-sectional study involved the assessment of PT interns from Ilocos Norte, Philippines using self-administered CDM tool and CDM factors questionnaire. Descriptive and inferential statistics (Pearson and Spearman tests) were utilized in analysing data collected. Alpha was set at 0.05.

Results: A total of 54 students participated in the study with mean age of 21.74 + 1.08 with male to female ratio of 1:2.86. Self-assessed CDM skills related with intervention, outcome measurement and evaluation in stroke rehabilitation were rated high (can be done independently) while CDM skills related with diagnosis and prognosis, were generally perceived to still need assistance or supervision from clinical instructors. Specific education training on stroke rehabilitation (education), actual patient interaction (experience) and opportunity to observe and mirror a physical therapy clinical instructor (modelling) were the most reported perceived factors related with their CDM skills. Correlation matrix revealed that perceived examination skills are significantly correlated (p<0.05) with locus of control of students (r2: 0.33), environment (r2: 0.32), and previous patient experience (r2: 0.31). While perceived diagnosis and prognosis skills are significantly correlated with environment (r2: 0.32), and instructor (r2: 0.28) and locus of control (r2: 0.30), respectively.  

Conclusion(s): This research revealed that PT interns in Ilocos Norte reported that they can independently perform CDM skills related with intervention, outcome measurement and evaluation in stroke rehabilitation. Though specific education training on stroke rehabilitation (education), actual patient interaction (clinical PT experience) and opportunity to observe and mirror a physical therapy clinical instructor (modelling) were the most perceived factors related with their CDM skills, further analyses revealed that locus of control of students, environment, previous patient experience were significantly correlated with perceived examination skills; while environment, instructor and locus of control were significantly correlated with perceived diagnosis and prognosis skills, respectively. These findings further demonstrate that several factors in CDM skills development are unique depending on interaction of these factors in consideration with the learning, space, and time of an individual learner.

Implications: The contextualized knowledge of the factors influencing CDM skills in stroke rehabilitation from the study may provide educators in the academe and clinical instructors insights to further modify their training programs that will help maximize student learning experience. Findings of the study suggest that combination of different strategies that will give students several and unique learning opportunities including different learning factors may best help in improving CDM skills.

Funding, acknowledgements: None

Keywords: Clinical decision-making skills, Health Education, Stroke rehabilitat

Topic: Education: clinical

Did this work require ethics approval? Yes

Institution: University of Santo Tomas

Committee: UST Graduate School Ethics Review Committee

Ethics number: GS-2019-PN031