Clinical reasoning in assessing and managing cervical spine presentations
The IFOMPT Cervical Framework aids evidence-based clinical reasoning in cervical spine presentation. This project explored use of the Framework on clinical reasoning and perceptions of the value of the Framework to inform clinical reasoning in entry level and postgraduate physiotherapy students. The Framework can support development of clinical reasoning, tailored according to level of practice.
Project status: In progress
Examination of the cervical spine can be complex. Vascular pathologies of the head / neck are rare but can present as musculoskeletal pain. The International IFOMPT (International Federation of Orthopedic Manipulative Physical Therapists) Cervical Framework enables evidence-based clinical reasoning to guide assessment and management of the cervical spine considering potential for vascular pathology. It aims to support students and practitioners in safe, efficient and effective practice.
This project aimed to explore experiences of physiotherapy students using the IFOMPT Framework to inform clinical reasoning.
Students enrolled in the Master of Physical Therapy (MPT) Program and Advanced Health Care Practice (AHCP) Program (Comprehensive Musculoskeletal Physiotherapy or Sport and Exercise Medicine Fields) at Western University were invited to participate.
Two cervical spine cases were analyzed using think-aloud methodology to explore use of the Framework to inform clinical reasoning. Semi-structured interviews explored students’ perceptions of the value of the Framework to inform clinical reasoning. MPT and AHCP students clinical reasoning and perceptions were compared.
The Framework supported clinical reasoning in MPT and AHCP students, illustrating differences according to level of practice. The Framework is a valuable physiotherapy educational resource. Different approaches are required in its educational delivery for MPT and AHCP students to develop sound clinical reasoning.
CANSpine Researchers
Katie Kowalski
Alison Rushton
Paul Parikh
Collaborators
Heather Gillis
Jackie Sadi
Sitha Soung
Purpose
This research aimed to explore the experiences of entry level and postgraduate level physiotherapy students in using the International IFOMPT Cervical Framework to inform clinical reasoning.
Findings
This project is still in progress, but early results indicate clinical reasoning processes across MPT and AHCP students reflected a novice - expert continuum. Students primarily used a hypothetico-deductive approach through a biopsychosocial lens. For both MPT and AHCP students, the clinical history section of the Framework held the greatest value, informing hypothesis generation in the patient history and selection of physical examination tests to evaluate potential for a vascular hypothesis. AHCP students demonstrated greater focus and prioritization to their clinical examination, to inform clarity and support for diagnosis and management. For AHCP students, the Framework facilitated prioritization of patient safety during planning and performing the physical examination, adaptability of assessment, and self-analysis with a critical approach to practice. For MPT students, use of the Framework was superficial and limited in scope.
Impact
The IFOMPT Cervical Framework was designed to aid clinical reasoning and evidence-based practice in the assessment and management of cervical spine presentations. It can inform physiotherapy curriculum and serve as a valuable educational resource for development of clinical reasoning in physiotherapy students, tailored to the student’s level of practice.
Key Publications
Rushton A, Carlesso LC, Flynn T, Hing WA, Rubinstein SM, Vogel S, Kerry R. Position Statement: International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Musculoskeletal Intervention: International IFOMPT Cervical Framework. Journal of Orthopaedic & Sports Physical Therapy. 2023 Jan;53(1):7-22.
Funding
Bev Padfield Clinical Research Award, London Orthopaedic Unit of the Canadian Physiotherapy Association
