Clinical reasoning processes in physiotherapists' assessment of unilateral neglect: Part two

Abstract

Physiotherapists do not always differentiate between the different types of unilateral neglect (ULN) when performing neurological assessments. This study explored the clinical decision-making processes used by 14 Australian neurological physiotherapists when assessing ULN after stroke. The method and background to this study was detailed in part one. Briefly, participants observed a videotape of an experienced therapist assessing a stroke patient with left ULN. The videotape was paused at intervals and participants recorded their thoughts pertaining to the patient at that time. Afterwards, physiotherapists were asked questions in relation to their clinical decisions and were instructed to classify the behaviour of the patient using a glossary of diagnoses. The findings revealed that physiotherapists used both hypothetico-deductive and pattern recognition models of clinical reasoning. Hypotheses concerning neglect were generated early in the assessment. Only a small number of physiotherapists were able to refine their neglect-related hypotheses in light of new information. Types of neglect were rarely considered in the decision-making process. Neglect behaviour was more precisely characterized when therapists were provided with the glossary. Although relevant cues were obtained for neglect-related hypothesis formation, a lack of specialized knowledge may limit the ability of physiotherapists to make detailed characterizations of neglect behaviour. A glossary comprising definitions of the different types of neglect improved the ability of clinicians to accurately characterize neglect behaviour, suggesting that education may enhance diagnostic reasoning ability of physiotherapists in the assessment of ULN.