Abstract
Introduction: Physical therapists in Myanmar use a prescriptive model of Clinical Decision Making (CDM). Improving CDM effectiveness is one essential factor in professionalizing practice and enhancing patient outcomes. This study assesses the changes in CDM skills and behaviors using the PRECEDE-PROCEED planning Model (PPM).Methods: In the PRECEDE planning phases, we investigated the current clinical decision making knowledge, and process, clinical practice culture, and contributing factors of CDM among Myanmar physical therapists. A qualitative approach consisted of 18 in-depth interviews and one focus group discussion was used. In the PROCEED evaluation and implementation phases, we developed and presented the CDM educational book at CDM workshop, which was a 4-day intensive program in Yangon, Myanmar with 34 participants. The participant's CDM knowledge and processes were assessed before and after the educational program to explore the potential impact on implementing CDM which can ultimately improve patient care in the health settings of Myanmar.Results: In the PRECEDE phases, we explored the predisposing and reinforcing factors of Myanmar physical therapists' CDM. We found that CDM models and deliberative decision making process that is used internationally were not followed by Myanmar physical therapists who followed the physician's prescriptions. Teaching and learning emphasize a stimulus-response-repeat-outcome cycle without internal processing or application to clinical situations. Using the PROCEED model components, we developed a 14 chapters CDM workbook and a 4-day workshop as a behavioral change intervention. Participants' prior technical CDM behavior was transformed into professional CDM behavior that included an understanding of clinical practice models and improvement in the cognitive process of CDM processes. The workbook coupled with the intensive active-learning, hands-on workshop of examination and intervention procedures were effective in improving CDM.Discussion: The application of PPM provided a through understandings of current CDM process of Myanmar therapists and aided in the development of the tailored CDM educational program to improve participants' CDM. Using the PPM model for developing a set of Physical Therapy educational content and curriculum was new. The application of PPM was beneficial to use accepted clinical practice models, standardized tests and measures, set goals and clinical outcomes, reassessed to determine change and implement evidence-based practice.
Highlights
Physical therapists in Myanmar use a prescriptive model of Clinical Decision Making (CDM)
In phase 4, we identified the predisposing, reinforcing and enabling factors of Myanmar physical therapists’ behavior, knowledge, and attitudes on clinical decision making based on the data from a content analysis of 18 in-depth interviews
Chapter 12: Therapeutic Procedures (Intervention procedures according to the Intervention Model) Chapter 13: Home exercise and community care Chapter 14: Your whole patient factors influencing the possible outcomes?; [6] How do you know the patient is improving?; [7] What is the difference between examination and evaluation?; and [8] If the patient does not improve as you expect what do you do? In this phase, we explored the gaps between what was planned and what spontaneously emerged in the CDM workshop and including the relations between the components of the whole CDM program
Summary
Physical therapists in Myanmar use a prescriptive model of Clinical Decision Making (CDM). Myanmar’s economy is slowly improving, leading to the development of non-communicable diseases (NCDs) as the new epidemic amongst the affluent population. For the lower-middle income countries, the treatment choice for NCDs depends on their economic status. Among the treatment choices for a wide spectrum of diseases, Physical Therapy has been increasingly demanded. Physical therapists were in the frontline for the treatment of poliomyelitis which is an acute viral disease and results in a motor paralysis, followed by muscular atrophy and often permanent deformities [4]. As the profession evolves and develops, physical therapists treat the patients to optimize function and ability for physical well-ness and mental and social well-being to improve the quality of life (QOL)
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