Clinical Reasoning Using a Human Movement System Evaluation: A Comparison of Student and Licensed Clinicians
Purpose/Hypothesis: The purpose of this study was to compare the clinical decision-making skills of physical therapy students to a licensed therapist while using the Human Movement System evaluation in a neurologically involved patient population. Number of Subjects: Forty-six second- and third-year Doctor of Physical Therapy students and one licensed physical therapist with 11 years of experience participated in the study. Materials and Methods: Students conducted initial evaluations for twelve individuals with neurologic diagnoses being treated at a university-based pro bono clinic. Evaluations were conducted using a Movement System evaluation form with 8 diagnoses based on the work of Scheets and colleagues. Each client was evaluated by two 2nd-year and two 3rd-year DPT students simultaneously but independently. Each student determined the most appropriate Movement System diagnosis and reported it to researchers. An experienced clinician then made an independent Movement System diagnosis after reviewing objective data (manual muscle test grades, range of motion, sensation) and video of all examination components, including transfers, gait, and balance and provided rationale to researchers. Follow-up interviews were conducted by researchers to gather qualitative data regarding students' rationale for selecting the diagnosis. Comparisons were made between students' and clinician's classifications and rationale. Results: While Force Production Deficit was chosen most frequently, the students chose it for 61% of clients compared to 46% for the clinician. In contrast, the clinician chose Movement Pattern Coordination Deficit more frequently than did the students (36% vs. 17%). The clinician and 22% of students described a comprehensive clinical-decision making approach, considering quality of movement and underlying contributing deficits, but many students described choosing a diagnosis based on the most obvious findings, such as weakness. Conclusions: Both students and the clinician were able to use the Human Movement System classifications to identify primary movement deficits for individuals with neurologic diagnoses. However, the practicing clinician provided superior clinical reasoning both ruling in and ruling out potential movement deficits. The student physical therapists tended to choose the more obvious FPD diagnosis due to it being the most apparent impairment, regardless of whether the lack of force production was due to a different movement deficit. Clinical Relevance: The Human Movement System classification provides a framework for evaluating the movement deficits in individuals with neurologic conditions. Instruction and practice is required in order for novice students to develop a comprehensive approach for evaluation, diagnosis, and intervention.