title: Why do we do as we do? Factors influencing clinical reasoning and decision-making among physiotherapists in an acute setting.
abstract: BACKGROUND
  Despite the current movement for health-care to become more informed by evidence, knowledge on effective implementation of evidence-based practice is scarce. To improve research application among physiotherapists, the process of implementation and clinical reasoning needs to be scrutinized. The aim of this study was to identify various experiences of factors that influence the physiotherapist's clinical reasoning in specialist care.
  
  
  METHODS
  A phenomenographic approach was chosen.
  
  
  METHODS
  Eleven physiotherapists at two acute care hospitals in nn.
  
  
  METHODS
  Data was obtained by observations and interviews. Phenomenographic data analysis identified various experiences of clinical decision-making.
  
  
  METHODS
  The Ethical Review Board of the nn approved the study.
  
  
  RESULTS
  The observations and the interviews enabled identification of various experiences that influenced clinical decision-making. The physiotherapists' clinical reasoning was perceived to be constrained by contextual factors. The physiotherapists collected current information on the patient by using written and verbal information exchange and used this to generate an inner picture of the patient. By creating hypotheses that were accepted or rejected, they made decisions in advance of their interventions. The decisions were influenced by the individual characteristics of the physiotherapist, his/her knowledge and patient perceptions.
  
  
  CONCLUSIONS
  Clinical reasoning is a complex and constantly evolving process. Contextual factors such as economy and politics are not easily changed, but factors such as the patient and the physiotherapist as a person are more tangible.
authors: Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
authors: Ulrika
authors: U
authors: Holdar
authors: Lars
authors: L
authors: Wallin
authors: Susanne
authors: S
authors: Heiwe
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D055317:Evidence-Based Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007858:Learning; D059825:Physical Therapists / Q000523:psychology*; D026761:Physical Therapy Specialty / Q000193:education; D010818:Practice Patterns, Physicians'; D011361:Professional Competence; D012189:Retrospective Studies
keywords: Acute care; clinical reasoning; evidence based practice; phenomenography