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Title: Clinical reasoning in musculoskeletal physiotherapy in Portugal
Author: Cruz, Eduardo José Brazete Carvalho
ISNI:       0000 0004 2691 701X
Awarding Body: University of Brighton
Current Institution: University of Brighton
Date of Award: 2010
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Clinical reasoning refers to the process in which practitioners, interacting with their patients, structure meaning, goals, and health management strategies based on clinical data, patient/client choices, and professional judgment and knowledge (Higgs & Jones, 2000, p. 11). Recent literature in physiotherapy and other allied health professions describes clinical reasoning as moving between cognitive and decision-making processes required to optimally diagnose and manage impairment and physical disabilities (hypothetic-deductive), and those required to understand and engage with patients' experience of disabilities and impairments (narrative reasoning). Clinical reasoning has been described as a universal process, common to all clinicians, in particular in the musculoskeletal area. However, clinical reasoning models emerged from research developed in specific and well-developed health care and professional cultures, such as Australia and United States, but there has been little discussion of their relevance and applicability to other cultural groups. Since research literature concerning physiotherapy in Portugal is almost non-existent, the aims of this study were twofold. The first aim was to explore clinical reasoning processes in a sample of Portuguese expert physiotherapists and secondly, to identify the current perspective of clinical reasoning held by educators and students, and how it is promoted in the undergraduate curriculum. The focus of the study was musculoskeletal physiotherapy. The research was influenced by the interpretative/constructivist paradigm of inquiry. The study consisted of three parts. In part one, the clinical reasoning approach of a sample of Portuguese expert therapists in musculoskeletal physiotherapy was investigated. The study focused on Portuguese clinicians' interaction with their patients in order to define and manage clinical problems. Data was collected through non-participant observation, semi-structured interviews, memos and field notes, and analysed thematically to identify and compare the practice and reasoning approach used. In part two, the generic aspects of undergraduate physiotherapy curricula in Portugal were analysed to provide a first insight of how educational programmes are organized and delivered in Portugal. Then, current musculoskeletal physiotherapy curricula in Portuguese entry-level physiotherapy programs were analysed by a questionnaire survey and documentary analysis. The specific aim was to capture the educational process and actions underlying current educational practice across undergraduate courses. In part three (Study 3 and 4), a sample of musculoskeletal lecturers and a sample of near graduate students were selected against criteria relating to the diversity of institutions that offer undergraduate physiotherapy courses (private versus public institutions) and length of time as a Physiotherapy education provider. Each course was examined from lecturer and student perspectives (through individual interviews and focus groups) to see what kind of clinical reasoning approach were most emphasised in relation to physiotherapy intervention in musculoskeletal conditions. Data were transcribed and subjected to thematic analysis. Findings showed some similar characteristics in the reasoning process of this group of Portuguese expert physiotherapists in the study when compared with other studies in the musculoskeletal physiotherapy field. However, findings also highlighted that Portuguese physiotherapists were more likely to use and value an instrumental approach to clinical practice. There was little evidence of patients sharing their perspectives about their problems or participating in clinical decisions made. An instrumental approach to reasoning and practice was also dominant in current Portuguese musculoskeletal programs as well in educators' and students' perspectives. The focus was on diagnostic and procedural strategies of reasoning with little emphasis on promoting student competences to involve patients in the decision making process. In this sense, the practice and reasoning of this sample could be seen as more instrumental than communicative. Perspectives on clinical reasoning differ between cultures and contexts of practice and this has implications for the quality of health care education and service delivery. This research has identified the current model of clinical reasoning in Portuguese Physiotherapy practice. The findings have significant implications for clinical practice in musculoskeletal physiotherapy, curriculum development, and wider education and health service policy.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: B000 Health Professions