Clinical reasoning focused on clients’ behaviour change and treatment orientation in the transition from a physiotherapy student to a clinically working physiotherapist : A longitudinal study

Sammanfattning: Background: The present study evaluated physiotherapists' clinical reasoning focused on clients’ behaviour change and treatment orientation in the transition from university to work. It further investigated how self-efficacy, attitudes and contextual factors influence clinical reasoning and treatment orientation. Methods: In a longitudinal design, the clinical reasoning focused on clients’ behaviour change and treatment orientation of physiotherapists (n = 24) were assessed over approximately two years, using the R4C instrument and the PABS-PT. Non-parametric statistical analysis was applied as well as a simple regression model. Results: Participants showed a significant decrease in the clinical reasoning focused on clients’ behaviour change regarding the R4C domains assessment, analysis and treatment. Physiotherapists’ self-efficacy at graduation showed no influence on their assessment, analysis and treatment in clinical practice. Their attitudes at graduation explained 35,1% of the variation in assessment ability. Treatment orientation showed no significant changes. The contextual factors in clinical practice and attitudes at graduation showed no influence on treatment orientation. Conclusion: The physiotherapists in this study show a persistent tendency to apply the biopsychosocial model. Due to the decrement in clinical reasoning focused on clients’ behaviour change, research is warranted regarding determinants of physiotherapists’ clinical reasoning skills in this transition.