An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments

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Accepted Manuscript (AM)
Author(s)
Tuttle, Neil
Hazle, Charles
Year published
2019
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Background: Most literature on decision processes within physiotherapy relates to “reasoning that results in action” – decisions based on information including assessments that are gathered prior to treatment decisions. A process of “reasoning in interaction” that is often used, particularly by expert clinicians, has received less attention. Objective: To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting. Methods: The theory is: If an impairment that can be directly targeted by treatment (i.e. pain or limitation of passive movement) is related to patient’s active ...
View more >Background: Most literature on decision processes within physiotherapy relates to “reasoning that results in action” – decisions based on information including assessments that are gathered prior to treatment decisions. A process of “reasoning in interaction” that is often used, particularly by expert clinicians, has received less attention. Objective: To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting. Methods: The theory is: If an impairment that can be directly targeted by treatment (i.e. pain or limitation of passive movement) is related to patient’s active impairments and functional limitations, then moment-to-moment changes in the targeted impairment can be used as feedback to guide real-time treatment modification before formal reassessment of functional limitations and other impairments. Results: Applying the theory to manual therapy results in parameters of techniques such as force, speed, direction and duration no longer being pre-determined, but rather being continually adjusted in real-time according to feedback from the patient through both therapist perception (changes in movement quantity or quality) and patient verbal responses. Conclusion: A process of continuous decision-making is described that the authors believe is used by many experienced clinicians but has not previously been adequately described in the literature.
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View more >Background: Most literature on decision processes within physiotherapy relates to “reasoning that results in action” – decisions based on information including assessments that are gathered prior to treatment decisions. A process of “reasoning in interaction” that is often used, particularly by expert clinicians, has received less attention. Objective: To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting. Methods: The theory is: If an impairment that can be directly targeted by treatment (i.e. pain or limitation of passive movement) is related to patient’s active impairments and functional limitations, then moment-to-moment changes in the targeted impairment can be used as feedback to guide real-time treatment modification before formal reassessment of functional limitations and other impairments. Results: Applying the theory to manual therapy results in parameters of techniques such as force, speed, direction and duration no longer being pre-determined, but rather being continually adjusted in real-time according to feedback from the patient through both therapist perception (changes in movement quantity or quality) and patient verbal responses. Conclusion: A process of continuous decision-making is described that the authors believe is used by many experienced clinicians but has not previously been adequately described in the literature.
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Journal Title
Physiotherapy Theory and Practice
Copyright Statement
© 2019 Taylor & Francis. This is an Accepted Manuscript of an article published by Taylor & Francis in Physiotherapy Theory and Practice on 06 Aug 2019, available online: https://doi.org/10.1080/09593985.2019.1650405
Note
This publication has been entered into Griffith Research Online as an Advanced Online Version.
Subject
Clinical sciences
Sports science and exercise
Science & Technology
Life Sciences & Biomedicine
Rehabilitation
Clinical reasoning
spinal mobilization