Clinical Decision Making by Experienced and Inexperienced Pediatric Physical Therapists for Children With Diplegic Cerebral Palsy

Abstract

Background and Purpose. This qualitative study was designed to explore, identify, and describe clinical decision-making processes used by pediatric physical therapists. Subjects. Clinical decision-making processes of three experienced therapists and three inexperienced therapists were assessed as they worked with 18 children with diplegia. Methods. Retrospective think-aloud procedures were used to elicit verbalizations, which were transcribed, coded, and analyzed. Results. Four characteristics of clinical decision making were identified: (1) Movement scripts provided insights into the clinical application of cognitive schemata based on previous experiences, (2) procedural changes occurred rapidly during within-session decision making, (3) psychosocial sensitivity was important for positive interaction during therapy, and (4) self-monitoring appeared to be pivotal in making clinical decisions as therapists self-assessed their practice. Contrasting data illustrated similarities and differences of experienced and inexperienced clinicians. Conclusion and Discussion. Findings are generally consistent with existing clinical decision-making literature and provide important information for physical therapy practice, research, and education.