Development of a physical capacity framework to support clinical reasoning of physiotherapists treating hospitalised patients

Figures & data

Figure 1. Flow of studies identified. Started with 302 records identified by Pubmed and nine additional records by searching for citations. Screened a total of 311 titles and abstracts and excluded 277 records. Thirty-four full-text papers were reviewed, after which 17 were excluded. Seventeen papers were finally included in the study.

Table 1. Data extraction form.

Author (year)	Description	Target population	Setting	Users
Atkinson et al. (2011) [9]	A clinical reflection tool and a guide for mentors, protégés and clinical discussion to make decisions about patient care and for professional development.	Patients	Physiotherapy throughout the continuum of care including acute care, inpatient rehabilitation, general outpatient rehabilitation and sports medicine	Novice and experts PTs
Baker et al. (2017) [13]	A teaching and learning tool for facilitating clinical reasoning within the patient encounter and clinical case analysis in one physiotherapy education program.	No specific population mentioned	Manual physiotherapy practice	Manual PTs
Borchers et al. (2019) [17]	A Parkinson disease (PD) specific clinical decision making tool for PTs for the purposes of stratification patients with PD into multilevel group classes.	Patients with PD	Group training in primary care	PTs and instructors of group training
Camp et al. (2015) [6]	A clinical Decision Making Tool for Safe and Effective prescription of Exercise in Acute Exacerbations of COPD to guide health care professionals in the assessment, prescription, monitoring and progression of exercise and activity.	Patients with COPD	Hospital	HCP’s
Donaghy and Morss (2000) [20]	A framework to facilitate and assess reflective practice within the discipline of physiotherapy.	Patients	Teaching practice physiotherapy students	physiotherapy students
Elven et al. (2015) [21]	A clinical reasoning model to assist PTs in understanding and implementing behaviour change strategies in their clinical reasoning process.	Patients	General physiotherapy practice	PTs
Hanekom et al. (2011) [15]	A clinical management algorithm for early physical activity and mobilisation for patients on the ICU.	Patients on ICU	ICU	Clinicians
Hart et al. (2019) [22]	A Rehabilitation Treatment Specification System (RTSS) to specify and characterise any treatment employed in rehabilitation via three elements of treatment therapy: targets, ingredients and (hypothesized) mechanisms of action.	Patients with a rehabilitation treatment	Rehabilitation	Rehabilitation professionals from any discipline in any setting or format
Jones (1992) [23]	A clinical reasoning model for manual therapy. The model emphasises the development, testing and modification of hypothesis that should take place through all aspects of the patient encounter including the interview, physical examination and ongoing management.	Patients	Patient care	PTs
Laurent et al. (2020) [18]	An algorithm for early exercise therapy in ICU patients that integrates both progression and intensity of training.	Patients on ICU	ICU	Clinicians
Masley et al. (2011) [7]	A theoretical model about the role of PTs, the clinical reasoning processes and the context for providing physiotherapy in the acute care setting.	Acute care patients	Acute care unit	Acute care PTs
Rothstein et al. (2003) [10]	A Hypothesis-Oriented Algorithm for clinicians to facilitate the use of science and evidence in practice, and to do so in a manner that is not intrusive on clinical practice.	All patients regardless of age or disorder	All settings	Clinicians and students
Rundell et al. (2009) [19]	An integrated model of PTs clinical reasoning incorporating the WHO-ICF and potential complementary clinical reasoning models.	Patients low back pain	physiotherapy practice	PTs
Rushton et al. (2013) [24]	A framework to guide clinical reasoning for the assessment of the cervical spine region for potential cervical artery dysfunction prior to planned ortho manual therapy interventions.	Patients	Ortho Manual physiotherapy practice	Manual PTs
Schenkman et al. (2006) [12]	An unifying framework for application to decision making in the management of individuals who have neurologic dysfunction.	Individuals who has neurologic dysfunction	Not mentioned	Future clinicians and PTs
Van der Leeden et al. (2017) [25]	A framework to support clinical decisions for tailoring exercise interventions to common comorbidities and cancer treatment-induced adverse effects.	Patients with breast cancer undergoing chemotherapy	Not mentioned	HCPs
Van der Leeden et al. (2018) [26]	A strategy to structure the clinical reasoning process when prescribing exercise therapy for the individual patient.	Patients with an index disease and comorbidity	Anywhere HCP work with patients	HCPs

PT = physiotherapist, HCP = health care professional, ICU = intensive care unit.

Table 2. Clinical parameters.

Monitoring parameters	Resting phase	Exercise phase	Recovery phase
Heart rate (beat per minute)
Blood pressure (systolic/diastolic)
Saturation (%)
Respiratory rate (breath per minute)
Rate of perceived exhaustion (Borg 6–20)
Pain (Numeric Rating Score 0–10)
Vegetative signs^#

^#for example: sweating, pallor, dizziness, etc.

Figure 2. Final version of the physical capacity framework.

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