Evaluating the clinical decision making of physiotherapists in the assessment and management of paediatric shoulder instability

Abstract

Objective: To elicit what information and clinical decision-making processes physiotherapists use in the assessment and management of paediatric shoulder instability.

Design: Qualitative study. A modified nominal focus group technique, involving three clinical vignettes, was used to elicit physiotherapists' decision-making processes.

Setting: Physiotherapy departments from across four separate clinical sites.

Subjects: Twenty-five physiotherapists, (18F:7M), ranging from two to 29 years post qualification.

Outcomes measures: Thematic analysis. The initial round of coding was used to draw up a quantitative assessment of the diagnoses and map information used for clinical decision-making against the International Classification of Functioning (ICF) framework.

Results: The themes identified related to 'Differences in diagnoses, classification and diagnostic processes', 'Diagnostic process occurs over a long period of time', 'Management and prognosis are influenced by a number of factors' and 'Diagnostic test choices and prognosis influenced by factors beyond the patient injury'.

Conclusion: Current methods of assessment are prone to bias and error and may lead to inconsistent or delayed provision of essential care. Further work is needed to develop methods of measurement and frameworks which can accurately identify relevant physiological mechanisms and personal factors associated with shoulder instability as a part of the assessment/diagnostic process.

Keywords: Clinical decision making; Instability; Paediatric rehabilitation; Physiotherapy; Upper extremity (arm).