Observational movement analysis and clinical reasoning about the sit to stand movement in a person with stroke: Exploring perspectives of student and expert neurological physiotherapists

Rationale, aims and objectives: Observational movement analysis (OMA) is an integral component of neurological physiotherapy assessment, therefore understanding its related clinical reasoning is an important aspect of clinical practice. Limited knowledge exists on how these skills are developed. Exploring the clinical reasoning associated with OMA in student and expert physiotherapists will inform the development of these critical skills in physiotherapy curricula. The purpose of this research study was to explore OMA and its associated clinical reasoning in student and expert neurological physiotherapists, and to compare and contrast the two groups. Methods: A qualitative interpretive descriptive approach was implemented, using semi-structured online interviews and stimulated recall using eye-gaze behaviour following viewing of a video of a person with stroke performing sit-to-stand. A purposive sampling strategy was used. Interview transcriptions provided the raw data, which was analyzed inductively and independently by two groups of researchers. Results: Five first-year student physiotherapists enrolled in a physiotherapy master’s program and five experienced physiotherapists working clinically in the field of neurorehabilitation with 8-17 years of experience participated voluntarily. Three consistent themes developed from both groups: (I) systematic approach; (II) knowledge; (III) movement performance. Students utilized hypothetico-deductive clinical reasoning while experts combined forward reasoning and reflection-in-action. Conclusion: This study provides insight on the clinical reasoning underlying expert and student OMA. Early clinical exposure incorporating reflective activities will facilitate contextualizing and synthesizing multiple aspects of the clinical presentation. This encourages students to utilize various perspectives of movement, such that the concept of ‘movement diagnoses’ can be facilitated during OMA skill development. Additionally, fostering a philosophy of ‘continuing professional development’ during entry-to-practice physiotherapy programs will promote a lifetime learning approach to physiotherapy practice, essential for optimal patient care. Further investigation is warranted on how forward reasoning can be fostered during OMA in entry-to-practice physiotherapy programs.