Development of a physical capacity framework to support clinical reasoning of physiotherapists treating hospitalised patients

Applying an appropriate physiotherapy intervention to a hospitalised patient can be challenging because the clinical status can change rapidly, affecting the patient’s physical capacity. Determining the appropriate type and dose of the physiotherapy intervention requires dynamic assessment of physical capacity and adequate clinical reasoning by the physiotherapist. To develop a framework for determining physical capacity to support physiotherapists in their clinical reasoning process when treating hospitalised patients. A framework was developed using a multi-method approach. First, the scientific literature was searched for existing frameworks for clinical reasoning in physiotherapy. These methods were inventoried and relevant elements were extracted. Second, a first draft of the framework was developed by a group of experts. Third, the framework was tested in practice, leading to a final version. A total of 17 frameworks were identified from the literature. No framework was found for generic use in the hospital for the purpose of determining patient’s physical capacity. Relevant elements from the identified frameworks were: the use of ICF terminology, the use of a patient management model, and frequent monitoring of clinical parameters. Field testing of the first draft of the framework led to improvement of the framework for use in clinical practice. A framework was developed to support physiotherapists in their clinical reasoning process when treating hospitalised patients. The framework can provide guidance for determining the patient’s physical capacity to allow for an adequate training stimulus.

对住院患者实施适宜的物理治疗 (physiotherapy) 干预颇具挑战，这是由于患者的临床状态变化迅速，会影响其身体机能。确定物理治疗干预的适宜类型与剂量，需要物理治疗师 (physiotherapist) 对患者身体机能进行动态评估，并开展充分的临床推理。本研究旨在构建用于评估患者身体机能的框架，以辅助物理治疗师在治疗住院患者时开展临床推理工作。研究采用多方法学路径开发该框架：首先，通过检索科学文献，收集现有物理治疗临床推理相关框架，对其中的方法进行梳理并提取核心要素；其次，由专家团队起草框架初稿；最后，在临床实践中对框架进行验证，最终形成终版框架。本次文献检索共识别出17款相关框架，但未发现可在医院通用、用于评估患者身体机能的框架。所识别框架的核心要素包括：采用国际功能、残疾和健康分类 (International Classification of Functioning, Disability and Health) 术语体系、应用患者管理模型，以及对临床参数进行定期监测。对框架初稿的现场测试，使该框架得以优化以适配临床实践需求。本研究开发的这款框架，可辅助物理治疗师在治疗住院患者时开展临床推理，为评估患者身体机能以制定适宜的训练刺激强度提供指导。