Physical Therapists' Clinical Reasoning and Decision-Making Processes When Mobilizing Patients Who Are Critically Ill: A Qualitative Study

Abstract

Purpose: Although mobilization is a widely practiced intervention for patients who are critically ill, the clinical reasoning and decision-making processes used by physical therapists to maximize its effectiveness warrants elucidation. This study's purpose was to investigate factors guiding physical therapists' clinical reasoning and decision-making processes when initiating and progressing mobilization in patients who are critically ill. Methods: In a 2-phased qualitative research design, 12 physical therapists working in a tertiary care university hospital were observed before, during, and after a mobilization session with 1 patient, followed by a semistructured interview. Results: Six categories (patient; intensive care unit-context; physical therapist; transfer; FITT parameters [frequency, intensity, type, and time]; and expected outcome) and 4 encompassing factors (safety and well-being; continuous assessment and intervention intertwined; individualized and response-driven intervention; and barriers and solutions) emerged as important in guiding participants' clinical reasoning when mobilizing their patients. Conclusions: The categories and encompassing factors identified, influenced, and guided participants in their clinical reasoning and decision-making when they initiated mobilization and progressed its parameters. The approach was goal-oriented and tailored to each patient's needs based on moment-to-moment evaluation of responses. The categories and factors that emerged favored a response-driven rather than a protocol-driven approach to mobilizing patients who are critically ill.