Phronesis: practical wisdom the role of professional practice knowledge in the clinical reasoning of Bobath instructors

Rationale, aims, and objectives Clinical reasoning is an essential aspect of clinical practice, however is largely ignored in the current rehabilitation sciences evidence base. Literature related to clinical reasoning and clinical expertise has evolved concurrently although rehabilitation reasoning...

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Veröffentlicht in:Journal of evaluation in clinical practice 2017-10, Vol.23 (5), p.935-948
Hauptverfasser: Vaughan‐Graham, Julie, Cott, Cheryl
Format: Artikel
Sprache:eng
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Zusammenfassung:Rationale, aims, and objectives Clinical reasoning is an essential aspect of clinical practice, however is largely ignored in the current rehabilitation sciences evidence base. Literature related to clinical reasoning and clinical expertise has evolved concurrently although rehabilitation reasoning frameworks remain relatively generic. The purpose of this study was to explicate the clinical reasoning process of Bobath instructors of a widely used neuro‐rehabilitation approach, the Bobath concept. Methods A qualitative interpretive description approach consisting of stimulated recall using video‐recorded treatment sessions and in‐depth interviews. Purposive sampling was used to recruit members of the International Bobath Instructors Training Association (IBITA). Interview transcripts were transcribed verbatim providing the raw data. Data analysis was progressive, iterative, and inductive. Results Twenty‐two IBITA instructors from 7 different countries participated. Ranging in clinical experience from 12 to 40 years, and instructor experience from 1 to 35 years. Three themes were developed, (a) a Bobath clinical framework, (b) person‐centered, and (c) a Bobath reasoning approach, highlighting the role of practical wisdom, phronesis in the clinical reasoning process. In particular the role of visuospatial‐kinesthetic perception, an element of technical expertise, was illuminated as an integral aspect of clinical reasoning in this expert group. Conclusions This study provides an interpretive understanding of the clinical reasoning process used by IBITA instructors illustrating an inactive embodied view of clinical reasoning, specifically the role of phronesis, requiring further investigation in nonexpert Bobath therapists, as well as in novice and experienced therapists in other specialty areas.
ISSN:1356-1294
1365-2753
DOI:10.1111/jep.12641