Factors That Influence the Clinical Decision Making of Physical Therapists in Choosing a Balance Assessment Approach

• Published in: Physical therapy Vol. 89; no. 3; pp. 233 - 247
• Main Authors: McGinnis, Patricia Q, Hack, Laurita M, Nixon-Cave, Kim, Michlovitz, Susan L
• Format: Journal Article
• Language: English
• Published: United States American Physical Therapy Association 01.03.2009; Oxford University Press
• Subjects: Adult; Clinical medicine; Colleges & universities; Data analysis; Data collection; Decision Making; Diagnosis; Equilibrium (Physiology); Health education; Human subjects; Humans; Influence; Methods; Models, Theoretical; New England; Outpatient care facilities; Parkinson's disease; Physical Examination; Physical therapists; Physical therapy; Physical Therapy Modalities; Postural Balance; Practice; Professional Role; Sensation Disorders - diagnosis; New England; United States
• ISSN: 0031-9023; 1538-6724; 1538-6724
• DOI: 10.2522/ptj.20080131

Many methods for examining patients with balance deficits are supported by the literature. How or why therapists choose specific balance assessment methods during examination of patients remains unclear. The aims of this study were: (1) to explore decision making during examination of patients with balance deficits, (2) to understand the selection and use of assessment methods from the clinician's perspective, and (3) to explore why specific methods were selected. A qualitative design using a grounded theory approach permitted exploration of clinical decision making. Eleven therapists were purposefully selected (6 from outpatient offices, 5 from inpatient rehabilitation settings) to participate in repeated interviews. Credibility of the findings was established through low-inference data, member check, and triangulation among participants and multiple data sources. A highly individualized approach to patient examination based on therapists' practical knowledge emerged from the data, with limited influence of the literature. Movement observation was the primary assessment and diagnostic tool. When selecting assessment approaches for specific patients, the perceived value of information gathered mattered more than testing time. A 3-stage model of assessment decision making portrayed both the process and reasons influencing therapists' choices. In the context of the complex and busy nature of clinical practice, therapists gathered data that they considered meaningful during patient examination. The findings provide insight into factors influencing assessment decisions and suggest mechanisms to foster translation of research into clinical practice.