title: The clinical reasoning that guides therapists in interpreting errors in real-world performance.
abstract: OBJECTIVE
  The objective of this study was to examine the reasoning used by clinicians when deciding whether errors observed during the performance of everyday activities were made by clients with acquired brain injury (ABI) or by healthy controls.
  
  
  METHODS
  Ninety clinicians observed 27 short video clips of subjects (ABI, healthy controls), carrying out the Baycrest Multiple Errands Test. On the basis of their observations, they classified subjects into either an ABI or healthy control group and specified their reasons. Their reasoning was analyzed using qualitative content analysis.
  
  
  RESULTS
  The majority of the coded material explaining the reasoning behind correct attributions of performance errors to people with ABI related to 3 general themes: (1) inefficient executive functioning, (2) task-related difficulty, and (3) prediction of impact on independence in everyday activities. Clinicians were most successful at identifying neurological subjects when subjects either omitted tasks or took an excessive amount of time to complete the test.
  
  
  CONCLUSIONS
  Correctly interpreting performance errors in real-world tests relies on clinicians' observational and clinical reasoning skills combined with their theoretical knowledge of constructs underlying the evaluation. Some clinical signs bear more weight than others when clinicians interpret performance errors to determine whether the behavior is pathological.
authors.affiliation: Occupational Therapy Program, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada (Dr Bottari and Ms Wai Shun); Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada (Dr Bottari and Mss Iliopoulos and Wai Shun); Rotman Research Unit, Baycrest, Toronto, Canada (Dr Dawson); Department of Occupational Science and Occupational Therapy, and Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, Canada (Dr Dawson); Toronto Rehabilitation Institute, Toronto, Canada (Dr Dawson).
authors.forename: Carolina
authors.initials: C
authors.lastname: Bottari
authors.forename: Georgia
authors.initials: G
authors.lastname: Iliopoulos
authors.forename: Priscilla Lam
authors.initials: PL
authors.lastname: Wai Shun
authors.forename: Deirdre R
authors.initials: DR
authors.lastname: Dawson
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D002983:Clinical Competence; D003657:Decision Making; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009484:Neuropsychology; D009788:Occupational Therapy; D011597:Psychomotor Performance; D013647:Task Performance and Analysis