Clinical Decision Making by Experienced and Inexperienced Pediatric Physical Therapists for Children With Diplegic Cerebral Palsy

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Abstract
Background and Purpose. This qualitative study was designed to explore, identify, and describe clinical decision-making processes used by pediatric physical therapists. Subjects. Clinical decision-making processes of three experienced therapists and three inexperienced therapists were assessed as they worked with 18 children with diplegia. Methods. Retrospective think-aloud procedures were used to elicit verbalizations, which were transcribed, coded, and analyzed. Results. Four characteristics of clinical decision making were identified: (1) Movement scripts provided insights into the clinical application of cognitive schemata based on previous experiences, (2) procedural changes occurred rapidly during within-session decision making, (3) psychosocial sensitivity was important for positive interaction during therapy, and (4) self-monitoring appeared to be pivotal in making clinical decisions as therapists self-assessed their practice. Contrasting data illustrated similarities and differences of experienced and inexperienced clinicians. Conclusion and Discussion. Findings are generally consistent with existing clinical decision-making literature and provide important information for physical therapy practice, research, and education.

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