Physical therapist's clinical reasoning in patients with gait impairments from hemiplegia

Abstract

Background: During stroke rehabilitation, physical therapists (PTs) perform gait analysis and design treatments based on this analysis. Objectives: To investigate the current trends in PTs clinical reasoning in assessing and managing gait in persons with hemiplegia. Design: A qualitative study using a phenomenological approach using a semi-structured interview protocol with FG. Methods: Participants consisted of expert and novice PTs working in a neurologic rehabilitation setting. FG were conducted in person and via web. Constant comparative qualitative analysis was used to analyze the qualitative data. Results: A total of 22 PTs participated in five FG (2 novice and 3 expert groups). From the analysis of qualitative data, five themes emerged. Novice and experienced clinicians: 1) take a systematic approach to examination and evaluation of persons with hemiplegia; 2) are in agreement in common gait deficits found in persons with hemiplegia; 3) may differ in their approach to treatment based on the amount of experience of the clinician; 4) generally agree on the manner in which orthotics are used in the management of persons with hemiplegia; and 5) demonstrate professional accountability to patients concerning the use of orthotic devices. Conclusions: This qualitative study provided insight into the variability in PTs' strategies for gait analysis, and their identification and interpretation of common deviations and impairments in persons with hemiplegia following stroke. Reluctance to utilize orthotics for patients with hemiplegia was a consistent theme across FG.

Keywords: Clinical reasoning; gait; gait analysis; hemiplegia; stroke.