PHYSIOTHERAPY 101

Importance of clinical reasoning

Helps understand the patient, their context and clinical problems to guide evidence-informed practice.

Critical Thinking

The analysis and evaluation of thinking with the aim of improving it

Purpose

Goal or objective of your thinking

Question

Questions you set out to answer the problem or

issue and further guide your thinking

Information

Data, facts, evidence, experiences required to answer questions

Concepts

Ideas, theories, laws and principles that underpin our thinking

Inferences

Interpretations or conclusions you make when you try to figure something out or make a judgement

Assumptions

Beliefs you take for granted

Points of view

The perspective from which you consider something or your frame of reference

Implications

Outcomes that logically follow from thoughts

Intellectual standards of critical thinking

Standard and questions that might be asked to help you assess a person’s quality of analytical thinking

Clarity

Certainty of meaning, no ambiguity or vagueness

Accuracy

Free from errors, mistakes or distortions

Precision

Exact to the appropriate level of detail, specific

Relevance

Logical relationship with the matter under consideration

Depth

Extent of complexity (e.g. number of factors and inter relationships) recognised and addressed in an issue, problem or topic

Breadth

Encompassing multiple viewpoints

Logical

The parts of the thinking/analysis make sense together, no contradictions

Significance

Importance to the matter under consideration

Fairness

Free from bias, dishonesty, favouritism, self-interest, deception, injustice

Egocentrism

Is the tendency to pursuit one’s own desires and needs without regard to the rights and needs of others

Sociocentrism

Is focussed on pursuit of group goals without regard to the rights and needsIs focussed on pursuit of group goals without regard to the rights and needs of those outside the group of those outside the group

Intellectual virtues

The traits of mind and character necessary for fair minded, open, truth-seeking critical thinking. Intellectual virtues are the ultimate goal of applying the intellectual standards to the elements of thinking

Fair-mindedness

Having the disposition to treat all perspectives or viewpoints alike (e.g. against the intellectual standards), without bias to one's own interests

Intellectual humility

Having awareness of the limits of one's knowledge and awareness of the risk of bias and limitations of one's viewpoint

Intellectual courage

The willingness to consider and fairly evaluate ideas, beliefs or viewpoints to which we disagree and haven’t given a fair hearing

Intellectual Autonomy

Having rational control of one's belief, values and inferences

Intellectual Empathy

Putting yourself in the place of others to fully understand their perspective

Intellectual Perseverance

Willingness to pursue intellectual standards of thinking and truth despite difficulties, obstacles and frustrations (e.g. complexity of issue, opposition of others)

Intellectual Integrity

Being consistent in the intellectual standards you apply, holding yourself to the same rigorous standards of evidence and proof you hold others to.

Confidence in reason

Belief in the value and importance of reason (to yourself and to society) over unquestioning acceptance of explanations, points of view, solutions, etc

Biomedical model

Model where disease and illness were primarily attributed to pathogens, genetic or developmental abnormalities or injury. This model previously dominated medicine and physiotherapy practice

Biopsychosocial Perspective

Recognises that disability is the result of the cumulative effects of the biological health condition and contextual factors including individual personal influences (incorporating psychological) and environmental influences (physical and social)

Body functions

Physiological functions of body systems

Body Structures

Anatomical parts of the body

Capabilities

What a person can do either without difficulty or with modification

Disability

Any condition that makes it more difficult for a person to do certain activities or interact with the world around them

Environmental Factors

Encompass the physical environment a person lives, works and exercises or trains in, and the social environment

Health

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Health Conditions

Are the problems for which people seek medical and allied health professionals assessment, opinion and management. Health conditions manifest as symptoms (such as pain, shortness of breath, fatigue, etc) and altered function (such as altered ability to walk) that can be influenced by each of the three key factors in the ICF framework – biological, personal, environmental

Impairment

Problem in a body function or structure

Participation

Refers to being involved in something that is meaningful to a person in their life

Participation Restriction

Identifies when a person cannot be involved in something meaningful to them because of a health condition

Psychological Influences

Fall within the ‘Personal’ contextual factors. Include individual-level cognitive processes such as coping style, attitudes, beliefs and self-efficacy that can influence a person’s behaviour in relation to their health

Social Influences

Are processes of a society in which a person is born, raised, live and work that affect the person’s access to resources for good health (social determinants), and the influences of cultural groups on a person’s beliefs and values about health.

Clinical Reasoning

A reflective process of inquiry and analysis carried out by a health professional in collaboration with the patient or client with the aim of understanding the person, their context and their clinical problem(s) in order to guide evidence-informed practice

Data Collection

The information obtained and used for the purpose of understanding the person and their health problem(s)

Deduction

Making decisions based on established premise(s) or criteria

Induction

Judgements made that generalise from limited information

Cognition

The ability to perceive and interpret potentially relevant information, interpret information; ability to test their hypotheses through further assessments, and the ability to synthesis all of this into their overall analysis

Metacognition

The ability to reflect and critique yourself in the moment and in hindsight

Critical thinking outcome

Fosters healthy scepticism that appraises information for its accuracy, precision, completeness, relevance, and significance to facilitate understanding and well-informed judgements

Assumptions Dangers

Without scrutiny such assumptions make us vulnerable to misinterpretations and inaccurate judgments based on inaccurate and biased ‘knowledge’ such as unsubstantiated views and popular opinions

Critical Thinking Benefits

Awareness of assumptions, paying attention to the context of our idea generation, sceptical of single answers to problems and claims of universal truth, ability to analyse others arguments, less susceptible to manipulation, and open to alternative behaviours and understandings

Improving thinking skills

Through generic activities that require analysis or problem solving such as word games or problem puzzles

What is the objective of this …?

Purpose

What needs to be answered to understand this issue?

Questions

What do I need to answer the question(s)?

Information

What principle/theory are you basing that hypothesis or analysis on?

Concepts

Is that judgement supported by the data?

Inferences

What am I/they taking for granted?

Assumptions

Is there another way to look at this situation?

Points of view

What are the potential consequences of doing or not doing…?

Implications

Someone is sleeping “rough”, therefore they’re unable to support themself

Reasonable inference

A person I’m talking to doesn’t respond to something I say therefore they’re not interested in what I’m saying

Poor inference

A person is at a public protest, therefore they likely support that view

Reasonable inference

A person is obese, therefore they are lazy with a poor diet

Poor inference

A person has tats and a leather jacket, therefore that person is a bikie

Poor inference

How could we check if that is true?

Accuracy

When you say …, can you be more explicit?

Precision

How does … relate to the problem?

Relevance

What other factors do you need to consider?

Depth

How important is that compared to other factors?

Significance

Could you express that another way?

Clarity

Are there other perspectives that could be considered?

Breadth

Does all of this make sense together?

Logic

Am I representing the viewpoints of others?

Fairness

Not giving up when trying to work through a difficult, complex problem?

Intellectual perseverance

Making the effort to fully understand and evaluate the opposing view and similarly critiqued your own?

Intellectual courage

Being aware of the limitations of your knowledge or viewpoint?

Intellectual humility

Not accepting what you hear and read without questioning it?

Intellectual autonomy

Trying to understand others (circumstances, experiences, points of view) even when they significantly differ from your own?

Intellectual empathy

Fairly and critically considering the opposing view?

Fair-mindedness

Believing it is important for everyone to be able to critically think for themselves?

Confidence in reason

Recognising times where your thinking/analysis could have been better?

Intellectual integrity

One system questions

Established procedure for finding answer with a generally agreed correct answer.

What is the size of this room? What is the sum of 250 and 460? What is the hospital protocol for x?

One system questions

No system questions

Answered in accordance with a person’s subjective preference such that there is no correct answer

What is your favourite food? Do you like opera? What are your goals you hope to achieve from therapy?

No system questions

Is abortion justifiable? Are humans causing global warming? and, How should chronic pain (or any condition) be managed?

Conflicting system questions

Conflicting system questions

Multiple competing viewpoints within which an answer could be pursued. There are better and worse answers but no verifiable correct ones