Abstract
Purpose of study
To explore the clinical reasoning strategies used by extended scope physiotherapists (ESPs) when assessing patients with low back pain.
Background
Extended scope physiotherapists commonly work in back pain services and their training emphasises the acquisition of clinical skills and possible diagnostic tests (including MRI) to aid clinical reasoning and diagnosis. Whilst there has been some exploration of reasoning strategies of other professional groups (notably medically qualified) to date, the clinical reasoning strategies of ESP clinicians have not been reported.
Methods
A qualitative study, with three focus groups, explored clinical reasoning by ESPs and non-ESPs, to compare how these clinicians assess patients' with back pain. This informed a second study, using a ‘think-aloud’ technique with 10 participants from four NHS sites, examining their reasoning strategies, immediately after completing initial consultations. Analysis was informed by a grounded theory approach.
Results
Themes identified relating to clinical reasoning were prior thinking, patient interaction, gut-feeling, and formal testing. The differences in practice between ESP and non-ESP appeared to be driven by differences in accountability, safety and external influences. A key difference between the accounts of clinical reasoning provided by ESPs and non-ESPs centred on the role and appropriateness of ‘gut feeling’ in diagnostic decision making. The analysis explores the apparent tension between this instinctive contribution to reasoning and evidence-based practice. The paper explores the legitimacy of gut feeling.
Conclusions
Extended scope physiotherapists appear to employ different clinical reasoning strategies to their non-ESP colleagues, highlighting the additional burden of responsibility and tension created by the use of gut feeling.
No conflicts of interest
No funding obtained
This abstract has not been previously published in whole or in part; nor has it been presented previously at a national meeting.
