Clinical reasoning of Filipino physical therapists: Experiences in a developing nation

ABSTRACT

Clinical reasoning is essential for physical therapists to engage in the process of client care, and has been known to contribute to professional development. The literature on clinical reasoning and experiences have been based on studies from Western and developed nations, from which multiple influencing factors have been found. A developing nation, the Philippines, has distinct social, economic, political, and cultural circumstances. Using a phenomenological approach, this study explored experiences of Filipino physical therapists on clinical reasoning. Ten therapists working in three settings: 1) hospital; 2) outpatient clinic; and 3) home health were interviewed. Major findings were: a prescription-based referral system limited clinical reasoning; procedural reasoning was a commonly experienced strategy while diagnostic and predictive reasoning were limited; factors that influenced clinical reasoning included practice setting and the professional relationship with the referring physician. Physical therapists’ responses suggested a lack of autonomy in practice that appeared to stifle clinical reasoning. Based on our findings, we recommend that the current regulations governing PT practice in the Philippines may be updated, and encourage educators to strengthen teaching approaches and strategies that support clinical reasoning. These recommendations are consistent with the global trend toward autonomous practice.

KEYWORDS:

• Clinical reasoning
• clinical decision making
• filipino
• physical therapy

Acknowledgments

We would like to acknowledge the research students of UPM-CAMP who participated in this study during the data gathering and analysis stages. We also thank Professor Rolando Lazaro and Professor Ma. Concepcion C. Cabatan for their assistance in editing the manuscript.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

The study reported in this paper was funded in part by the 2009 Gawad Centenaryo (Centennial Award) Professorial Chair, awarded to the first author.

Notes

¹ Hospital policies did not allow conduct of observations, while home-based clients did not consent on having someone observe their therapy session. Consent was obtained only for observing one session with each outpatient therapist. Research assistants videotaped each session to minimize a potentially intimidating situation should a senior physical therapist (i.e., researchers) conduct the observation. The researchers subsequently viewed the videos, and generated questions for the participants in relation to the actions and decisions that were apparent during the observed session. The videos were transcribed and accounted for in the analysis for the outpatient clinicians.

Additional information

Funding

The study reported in this paper was funded in part by the 2009 Gawad Centenaryo (Centennial Award) Professorial Chair, awarded to the first author.