title: Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study.
abstract: The goal of this study was to examine which motor learning options are applied by experienced physiotherapists in neurological rehabilitation, and how they choose between the different options.
  
  
  
  A descriptive qualitative approach was used. A purposive sample of five expert physiotherapists from the neurological ward of a rehabilitation center participated. Data were collected using nine videotaped therapy situations. During retrospective think-aloud interviews, the physiotherapists were instructed to constantly "think aloud" while they were watching their own videos.
  
  
  
  Five "operators" were identified: "act", "know", "observe", "assess" and "argue". The "act" operator consisted of 34 motor learning options, which were clustered into "instruction", "feedback" and "organization". The "know", "observe", "assess" and "argue" operators explained how therapists chose one of these options. The four operators seem to be interrelated and together lead to a decision to apply a particular motor learning option.
  
  
  
  Results show that the participating physiotherapists used a great variety of motor learning options in their treatment sessions. Further, the decision-making process with regard to these motor learning options was identified. Results may support future intervention studies that match the content and process of therapy in daily practice. The study should be repeated with other physiotherapists. Implications for Rehabilitation The study provided insight into the way experienced therapist handle the great variety of possible motor learning options, including concrete ideas on how to operationalize these options in specific situations. Despite differences in patients' abilities, it seems that therapists use the same underlying clinical reasoning process when choosing a particular motor learning option. Participating physiotherapists used more than the in guidelines suggested motor learning options and considered more than the suggested factors, hence adding practice based options of motor learning to the recommended ones in the guidelines. A think-aloud approach can be considered for peer-to-peer and student coaching to enhance discussion on the motor learning options applied and the underlying choices and to encourage research by practicing clinicians.
authors.affiliation: a Research Centre for Autonomy and Participation of People with a Chronic Illness , Zuyd University of Applied Sciences, Faculty of Health, University of Applied Sciences , Heerlen , the Netherlands.|b Department Physiotherapy, Faculty of Health, University of Applied Sciences , Heerlen , the Netherlands.|c Department of Brain Injury , Adelante Rehabilitation Centre , Hoensbroek , the Netherlands.|d CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , the Netherlands.
authors.forename: Melanie
authors.initials: M
authors.lastname: Kleynen
authors.affiliation: a Research Centre for Autonomy and Participation of People with a Chronic Illness , Zuyd University of Applied Sciences, Faculty of Health, University of Applied Sciences , Heerlen , the Netherlands.|d CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , the Netherlands.
authors.forename: Albine
authors.initials: A
authors.lastname: Moser
authors.affiliation: a Research Centre for Autonomy and Participation of People with a Chronic Illness , Zuyd University of Applied Sciences, Faculty of Health, University of Applied Sciences , Heerlen , the Netherlands.
authors.forename: Frederike A
authors.initials: FA
authors.lastname: Haarsma
authors.affiliation: a Research Centre for Autonomy and Participation of People with a Chronic Illness , Zuyd University of Applied Sciences, Faculty of Health, University of Applied Sciences , Heerlen , the Netherlands.|d CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , the Netherlands.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Beurskens
authors.affiliation: a Research Centre for Autonomy and Participation of People with a Chronic Illness , Zuyd University of Applied Sciences, Faculty of Health, University of Applied Sciences , Heerlen , the Netherlands.|b Department Physiotherapy, Faculty of Health, University of Applied Sciences , Heerlen , the Netherlands.|d CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , the Netherlands.
authors.forename: Susy M
authors.initials: SM
authors.lastname: Braun
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009048:Motor Skills; D009426:Netherlands; D000066530:Neurological Rehabilitation; D059825:Physical Therapists / Q000523:psychology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Physiotherapy; decision-making; interview; learning; motor skill