Department of Physical Therapy, Nazareth College, Rochester, NY, USA.
Disabil Rehabil Assist Technol. 2021 Jan;16(1):1-8. doi: 10.1080/17483107.2019.1647568. Epub 2019 Aug 20.
A complete description of the process of physical therapy clinical reasoning for walking assistive devices in patients with stroke and brain injury has never been undertaken. Describing the clinical reasoning process used in post-acute inpatient rehabilitation is important to shed light on the clinical activities and factors used in practice, prevent device abandonment, and, inform entry-level clinical training. The two purposes were first, to describe the clinical reasoning process used during inpatient rehabilitation for walking assistive devices in patients with stroke and brain injury, and second, to determine whether clinical reasoning differed by two facility types and by diagnosis.
A mixed methods study of 67 participants in either an online survey or focus groups.
A consistent and comprehensive method to determine the need and justification for a walking assistive device regardless of diagnosis or facility type was found. The clinical reasoning process included five primary factors, considered throughout the rehabilitation stay (safety, balance, cognition, strength, and function). The three therapist-related factors (experience/preference, training parameters, and use of objective tools), and seven patient-related factors (experience/preference, fluctuations, fear, age, diagnosis/comorbidities, discharge environment, and payer) individualized care. Definitions of the five primary factors were derived from participants' responses.
Results from this study revealed complexity in the clinical reasoning process used in physical therapy practice to determine the best walking assistive device for patients with stroke and brain injury during inpatient rehabilitation. Information from this study can inform post-acute physical therapy practice and education, and may reduce device abandonment. Implications for rehabilitation Clinical reasoning (CR) is a complex process in which a clinician must consider multiple factors, which requires non-linear and iterative thinking, and involves many people, making it shared among the patient, caregivers, and the healthcare team. Describing the actual CR process used by physiotherapists when prescribing a walking assistive device (WAD) will identify the factors considered, thus more accurately explain the process of care. Such a description could lead to better justification of rehabilitation for patients with stroke and brain injury, and furthermore, determine whether treatments are rendered consistently and when, if ever, divergent approaches occur. Better understanding of the CR process of WAD prescription may also reduce the possibility of device abandonment.
对于脑卒中或脑损伤患者的步行辅助器具，物理治疗临床推理的全过程描述从未进行过。描述急性期后住院康复中使用的临床推理过程对于了解临床活动和实践中使用的因素、防止器械废弃以及为入门级临床培训提供信息非常重要。这两个目的是：第一，描述脑卒中或脑损伤患者在住院康复中使用步行辅助器具的临床推理过程；第二，确定临床推理是否因两种设施类型和诊断而异。
对 67 名参与者进行了混合方法研究，包括在线调查或焦点小组。
发现了一种无论诊断或设施类型如何，都能一致且全面地确定使用步行辅助器具的必要性和合理性的方法。临床推理过程包括五个主要因素，这些因素在整个康复期间都被考虑在内（安全性、平衡、认知、力量和功能）。三个与治疗师相关的因素（经验/偏好、培训参数和使用客观工具）和七个与患者相关的因素（经验/偏好、波动、恐惧、年龄、诊断/合并症、出院环境和付款人）使个体化护理成为可能。五个主要因素的定义是从参与者的回答中得出的。
本研究结果揭示了物理治疗实践中用于确定脑卒中或脑损伤患者在急性期后康复期间最佳步行辅助器具的临床推理过程的复杂性。该研究的信息可以为急性期后物理治疗实践和教育提供信息，并可能减少器械废弃。
临床推理（CR）是一个复杂的过程，临床医生必须考虑多个因素，这需要非线性和迭代思维，并且涉及许多人，使它在患者、照顾者和医疗团队之间共享。描述物理治疗师在开步行辅助器（WAD）时实际使用的 CR 过程将确定考虑的因素，从而更准确地解释护理过程。这种描述可以更准确地为脑卒中或脑损伤患者的康复提供理由，并进一步确定治疗是否一致，以及何时出现分歧。更好地了解 WAD 处方的 CR 过程也可能降低器械废弃的可能性。
