Contextual factors influencing Canadian physiotherapists’ clinical reasoning about older adult clients’ finances and economics: A qualitative descriptive study

While physiotherapy can be beneficial for older adults, many experience financial barriers to accessing physiotherapy services. There is limited published evidence regarding how physiotherapists consider client finances in their work.
This study aimed to explore Canadian physiotherapists’ current practice regarding the inclusion of clients’ financial or economic context in clinical reasoning and to identify possible ways to improve physiotherapy services access.
We interviewed nine physiotherapists practicing in Manitoba, Canada, using an in-depth semi-structured guide. We recorded and transcribed each interview and then analyzed transcripts thematically, building upon reflexive thematic analysis and framework approaches.
We generated three themes through our analysis: (1) considering older adults’ finances in clinical reasoning depends on contextual factors internal and external to the physiotherapists, (2) learning about clients’ finances influenced physiotherapists’ clinical reasoning, and (3) physiotherapists used varied approaches to address the needs of clients with limited finance. Internal factors included physiotherapists not knowing how to discuss finances with clients and physiotherapists’ need to make a liveable wage. External factors included limited resources available to address the needs of clients with limited finances and physiotherapists’ caseloads.
Including older adults’ finances in clinical reasoning is a complex process. There may be a need for systemic changes, such as provision of workplace processes and resources, to encourage physiotherapists to include clients’ finances in clinical reasoning. The findings point to the need for educational programs for physiotherapists to ensure comfort and confidence with including finances as part of their standard practice.