title: Community occupational therapists' clinical reasoning: identifying tacit knowledge.
abstract: BACKGROUND
  Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community-dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions.
  
  
  OBJECTIVE
  To synthesise current knowledge about community occupational therapists' clinical reasoning.
  
  
  METHODS
  A scoping study of the literature on community occupational therapists' clinical reasoning was undertaken.
  
  
  RESULTS
  Fifteen textbooks and 25 articles, including six focussing on community occupational therapists' clinical reasoning, were reviewed. Community occupational therapists' clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists' clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear.
  
  
  CONCLUSIONS
  Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.
authors.affiliation: School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 rue Belvédère Sud, Sherbrooke, Québec, Canada. annie.carrier@usherbrooke.ca
authors.forename: Annie
authors.initials: A
authors.lastname: Carrier
authors.forename: Mélanie
authors.initials: M
authors.lastname: Levasseur
authors.forename: Denis
authors.initials: D
authors.lastname: Bédard
authors.forename: Johanne
authors.initials: J
authors.lastname: Desrosiers
mesh_terms: D002983:Clinical Competence; D003071:Cognition; D003153:Community Health Services; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009788:Occupational Therapy / Q000379:methods*; D010347:Patient Care Planning; D011340:Problem Solving