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This Article Full Text Full Text (PDF) The Bottom Line All Versions of this Article: ptj.20080131v1 89/3/233    most recent Submit a response Read responses to this article Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McGinnis, P. Q Articles by Michlovitz, S. L Search for Related Content PubMed PubMed Citation Articles by McGinnis, P. Q Articles by Michlovitz, S. L Related Collections Balance Professional Issues Clinical Decision Making Examination/Evaluation: Other Social Bookmarking                      What's this?

Factors That Influence the Clinical Decision Making of Physical Therapists in Choosing a Balance Assessment Approach

PQ McGinnis, PT, PhD, is Associate Professor of Physical Therapy, Richard Stockton College of New Jersey, PO Box 195, Pomona, NJ 08240 (USA).
LM Hack, PT, DPT, PhD, MBA, FAPTA, is Professor, Department of Physical Therapy, Temple University, Philadelphia, Pennsylvania.
K Nixon-Cave, PT, PhD, PCS, is Associate Professor, University of the Sciences in Philadelphia, and Physical Therapy Manager, Children's Hospital of Philadelphia.
SL Michlovitz, PT, PhD, CHT, is Adjunct Associate Professor, Department of Rehabilitation Medicine, Columbia University, New York, New York.

Address all correspondence to Dr McGinnis at: Patricia.McGinnis{at}stockton.edu

Background: Many methods for examining patients with balance deficits are supported by the literature. How or why therapists choose specific balance assessment methods during examination of patients remains unclear.

Objectives: The aims of this study were: (1) to explore decision making during examination of patients with balance deficits, (2) to understand the selection and use of assessment methods from the clinician's perspective, and (3) to explore why specific methods were selected.

Design: A qualitative design using a grounded theory approach permitted exploration of clinical decision making.

Methods: Eleven therapists were purposefully selected (6 from outpatient offices, 5 from inpatient rehabilitation settings) to participate in repeated interviews. Credibility of the findings was established through low-inference data, member check, and triangulation among participants and multiple data sources.

Results: A highly individualized approach to patient examination based on therapists’ practical knowledge emerged from the data, with limited influence of the literature. Movement observation was the primary assessment and diagnostic tool. When selecting assessment approaches for specific patients, the perceived value of information gathered mattered more than testing time. A 3-stage model of assessment decision making portrayed both the process and reasons influencing therapists’ choices.

Conclusions: In the context of the complex and busy nature of clinical practice, therapists gathered data that they considered meaningful during patient examination. The findings provide insight into factors influencing assessment decisions and suggest mechanisms to foster translation of research into clinical practice.

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