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In this paper, we present findings from literature which suggests an intrinsic relationship in patients with chronic pain between the development of rigid and limited perspectives based on the interpretation of experience and the development of decreased repertoires of movement patterns. We present a research-based clinical reasoning model for conceptualising the teaching of movement for patients with chronic pain and contend that therapists can intentionally teach movement using fundamentally different reasoning and learning processes. We propose that these different kinds of learning will assist clinicians to translate the findings of diverse and complex pain research to clinical practice and, in particular, the teaching of these patients both new perspectives and movement patterns.

Most physiotherapists would agree on the need to establish effective working relationships with their patients in order to achieve successful outcomes in therapy. Collaboration, as an entity in clinical practice, has continued to increase in importance due to a changing climate of healthcare. Traditional models of physiotherapy treatment based on the medical model and delivered in acute settings are giving way to newer models of practice, such as health promotion, that are patient or client centred and increasingly located in community settings. At the same time, the notion of patient compliance with physiotherapy advice and exercises, deriving from a medical model of practice, is being superseded by the notion of collaborative decision making (or reasoning) in physiotherapy. Recent physiotherapy literature suggests that collaborative decision making is an advanced clinical skill, while also casting doubt on just how well or consistently physiotherapists are able to set goals with their patients and nurtu...

PhD Doctorate One of the goals for physical therapist graduates of professional entry-level education programs is development of the ability to practice effectively in the present health care environment. Another goal is for graduates to develop the ability to continue to learn and grow as professionals throughout their careers, and to contribute to the evolution of their profession in the future. The clinical reasoning and associated experiential learning of new graduates can be viewed as a practical demonstration of both of these goals. This research explored student physical therapists? understanding and learning of clinical reasoning during their professional entry education.

Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community. Refereed/Peer-reviewed

2005

2005

2004