Evidence map›Paper›PMID 40598033›Full record

ArticleBMC medical education2025

Entry to practice physiotherapy students' use of the international IFOMPT cervical framework to inform clinical reasoning: a qualitative case study design.

Katie L Kowalski, Heather Gillis, Paul Parikh, Katherine Henning, Jackie Sadi, Alison Rushton

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Article in BMC medical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1 · What the graph read from it

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1 citing paper in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Katie L KowalskiSchool of Physical Therapy, Western University, London, Ontario, Canada. kkowals7@uwo.ca.
Heather GillisSchool of Physical Therapy, Western University, London, Ontario, Canada.
Paul ParikhSchool of Physical Therapy, Western University, London, Ontario, Canada.
Katherine HenningSchool of Physical Therapy, Western University, London, Ontario, Canada.
Jackie SadiSchool of Physical Therapy, Western University, London, Ontario, Canada.
Alison RushtonSchool of Physical Therapy, Western University, London, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDeveloping clinical reasoning within entry to practice physiotherapy education is essential to safe and competent practice. For example, identifying the need for referral if the diagnostic process identifies red flags (e.g., serious spinal pathology). The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework supports evidence-based clinical reasoning in assessment and management of the cervical spine region, considering the potential for vascular pathology.

objectiveTo explore the influence of the Framework on clinical reasoning processes of students enrolled in an entry to practice physiotherapy program.

methodsThe COnsolidated criteria for REporting Qualitative research informed the design and reporting of this qualitative think aloud case study using interpretive description. Participants (students enrolled in an entry to practice physiotherapy program) learned about the Framework through standardized teaching. Clinical reasoning was explored using two cervical spine cases. Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model guided transcript coding and analysis. Thematic analysis employed a hybrid approach (inductive and deductive) to understand the use of the Framework at key steps in clinical reasoning processes. Multiple strategies enhanced trustworthiness (e.g., regular team debriefs, reflexive engagement).

resultsFor all participants (n = 10), the Framework supported hypothetico-deductive clinical reasoning processes, reflecting a continuum of novice proficiency. The Framework informed generating a vascular hypothesis in the patient history and testing this hypothesis using patient history questions and appropriate physical examination tests. Variable sequences of logic and difficulties with cue interpretation and synthesis were common, leading to a lack of clarity and support for diagnosis and management for some students. Clinical reasoning processes were informed by variable depth and breadth of Framework knowledge and supported by limited personal characteristics (e.g., reflection on action).

conclusionsThe Framework is a valuable learning resource in entry to practice physiotherapy education to initiate structured clinical reasoning processes for assessing and managing cervical spine presentations, considering the potential for vascular pathology. Owing to a continuum of novice clinical reasoning, using the Framework in entry to practice physiotherapy education requires tailoring to the level of the learner. Future research should explore students' perspectives of the value of the Framework to inform their clinical reasoning.

Indexed as

Cervical VertebraeClinical ReasoningPhysical TherapistsPhysical Therapy ModalitiesPhysical Therapy SpecialtyClinical CompetenceFemaleHumansMaleQualitative ResearchCase studyClinical reasoningEducational researchEntry to practice physiotherapy educationInternational IFOMPT cervical frameworkInterpretive descriptionPhysiotherapyQualitative researchThink aloud method

Identifiers

PMID40598033
PMCPMC12211889

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.