The clinical reasoning processes of extended scope physiotherapists assessing low back pain

Abstract

The role of the extended scope physiotherapist has developed relatively recently within health-care. The extended role has utilised the skills of allied health professionals including physiotherapists, and given them autonomy to use knowledge and clinical acumen to request investigations such as Magnetic Resonance Imaging (MRI) as part of the diagnostic process. These requests and processes are delivered outside their traditional scope of practice. Further knowledge on how these practitioners clinically reason is therefore needed as there is little within the literature regarding reasoning in this specific group of clinicians. This research aids in the development of future roles, the governance of services, whilst supporting the training of clinical reasoning for new recruits to this work. This qualitative study has explored the processes by which extended scope physiotherapists clinically reason decisions regarding patients reporting low back pain. The study has used a multiple case study design informed by grounded theory methodology with focus groups and semi-structured interviews as a method to investigate these processes. The themes identified included prior thinking, patient interaction, formal testing, time, safety and accountability, external/internal and gut feeling. Subtle differences in clinical reasoning were seen in the focus group study between ESP and non-ESP clinicians. The processes of clinical reasoning are presented that suggests how these clinicians reason whilst highlighting how they differ to non-extended scope physiotherapists.

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ORCID for L. Roberts: orcid.org/0000-0003-2662-6696

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