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

Abstract

BackgroundMany 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.ObjectivesThe 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.DesignA qualitative design using a grounded theory approach permitted exploration of clinical decision making.MethodsEleven 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.ResultsA 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.ConclusionsIn 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.