title: The clinical reasoning processes of extended scope physiotherapists assessing patients with low back pain.
abstract: BACKGROUND
  Employing allied health professionals in extended scope roles has developed relatively recently in health-care. Within physiotherapy, the extended role has provided clinicians with autonomy to use knowledge and clinical acumen to request investigations such as Magnetic Resonance Imaging (MRI) and X-ray as part of the diagnostic process, a practice beyond the traditional scope of physiotherapy. In these advancing roles, little is written about the clinical reasoning processes that clinicians use in managing patients with musculoskeletal pain and knowledge of these processes would advance training for new recruits to this arena.
  
  
  METHODS
  This qualitative study has explored the processes by which extended scope physiotherapists (ESPs) clinically reason their decisions regarding patients reporting low back pain in a musculoskeletal outpatient setting. The study used a multiple case study design informed by grounded theory methodology, using focus groups (involving ESPs and non-ESPs/musculoskeletal physiotherapists) and semi-structured interviews with a think-aloud method (ESPs only) to investigate these processes.
  
  
  CONCLUSIONS
  The themes identified include: prior thinking; patient interaction; formal testing; time; safety and accountability; external and internal factors; and gut-feeling (which challenges current physiotherapy models of reasoning). Extended scope physiotherapists reported experiencing greater stress due to higher levels of perceived accountability, safety requirements and internal drivers for competence than non-ESPs. Further research is indicated to explore the role of gut-feeling in musculoskeletal physiotherapy clinical reasoning.
authors: University of Southampton, Faculty of Health Sciences, Building 67, Highfield, Southampton, SO17 1BJ, UK. Electronic address: neil.langridge@southernhealth.nhs.uk.
authors: Neil
authors: N
authors: Langridge
authors: University of Southampton, Faculty of Health Sciences, Building 67, Highfield, Southampton, SO17 1BJ, UK.
authors: Lisa
authors: L
authors: Roberts
authors: University of Southampton, Faculty of Health Sciences, Building 67, Highfield, Southampton, SO17 1BJ, UK.
authors: Catherine
authors: C
authors: Pope
mesh_terms: D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000534:rehabilitation*; D008297:Male; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000534:rehabilitation; D059825:Physical Therapists / Q000523:psychology*; D026741:Physical Therapy Modalities / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011340:Problem Solving; D017009:Professional Autonomy; D011361:Professional Competence; D036301:Qualitative Research
keywords: Back; Pain; Physiotherapy; Reasoning