Validation of a Clinical Decision-Making Tool Using Rasch Analysis
Autonomous physical therapy (PT) practice, characterized by independent, self-determined, professional judgment and action, is one of the major emphases of the American Physical Therapy Association's (APTA) Vision Statement for the PT profession.1,2 Physical therapy programs are challenged to develop autonomous practitioners who engage in critical inquiry and demonstrate sound clinical decision-making (CDM) skills.3 Clinical decision-making involves critical thinking and problem solving and is both essential and key to effective patient care. Despite the importance of developing sound clinical decision-making skills in Doctor of Physical Therapy (DPT) students, no validated CDM tool exists in PT. The purpose of this study was to validate a CDM tool developed to assess CDM and clinical skills in DPT students.
This is a prospective cross-sectional study. The survey tool was createrd adapting sample behaviors from the APTA's Clinical Performance Instrument.4 The survey consisted of 25 items related to CDM and clinical skills assessed on a 6-point Likert scale. Data was collected in a pilot study and a follow-up study on DPT students. Surveys were sent to students at all levels of the program: 1st year, 2nd year, at the beginning of their terminal internship, mid-way through their internship (point of graduation from the program), and at the end of their year-long internship. A total of 178 student completed surveys. A Rasch analysis was performed using WINSTEPS version 3.81.0.
Analyses used were: item infit, item dimensionality, person map, item map, and probability curve. Unidimensionality of the survey was assessed using item infit and resulted in 3 outliers. The results of the item dimensionality also supported one construct (CDM) on the survey. The person map demonstrated that students in the latter part of the program scored higher than 1st and 2nd year students. The item map identifies the level of difficulty for each survey item. The item map results indicated that most of the survey items hovered around the mean and several were redundant. The probability curve showed that there was no distinction between scores 2 and 3 on the Likert scale. By collapsing scores 2 and 3 the results showed a distinction between all scores.
Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education
The results showed that the survey measured one construct: CDM. Students in the latter part of the program scored higher than students in the 1st and 2nd years of the program. The survey lacked items correlating to higher and lower levals of CDM. Collapsing the Likert scale to 5 descriptors produced more distinct scores. Results support modification in the survey that include higher and lower level items This study supports the future of PT education because sound CDM is a cornerstone of autonomous practice. Developing a tool that measures CDM across the continuum of PT education will better inform those involved in PT education and assist rograms in developing outcome measures.
1. Vision 2020. American Physical therapy Association (APTA) Web site. http://www.apta.org/vision2020/. Updated 2013. Accessed 12/5/2014.
2. Vision statement of the physical therapy profession. American Physical Therapy Association (APTA) Web site. http://www.apta.org/Vision/. Updated 2014. Accessed 12/5/2014.
3. Deusinger, S. S., Crowner, B., Burlis, T., & Stith, J. (2014). Meeting contemporary expectations for physical therapists: Imperatives, challenges, and proposed solutions for professional education. Journal of Physical Therapy Education, 28(1b), 56-61.
4. Roach KE, Frost JH, Francis NJ, Giles S, Nordrum JT, Delitto A. Validation of revised physical therapy clinical performance instrument (PT CPI): Version 2006. Phys Ther. 2012; 92(3):416-428.