Author: Jill Garner
Garner, Jill, 2025 Understanding assessment and clinical reasoning in neurological physiotherapy: bridging practice and education, Flinders University, College of Nursing and Health Sciences
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Neurological conditions are a growing global concern, affecting over 3.4 billion people worldwide and representing the leading cause of disability and hospitalisation. These conditions present complex challenges across physical, cognitive, behavioural, and perceptual domains, significantly impacting quality of life and community participation. Management often requires a multidisciplinary team, with physiotherapists playing a pivotal role. In neurological physiotherapy, assessment serves as the cornerstone of effective treatment, informing clinical reasoning and guiding tailored management plans. However, a notable gap exists in the evidence base regarding specific methods and content of assessment and clinical reasoning in neurological physiotherapy practice, extending to how these critical skills are taught in pre-registration university programs.
This thesis aimed to understand assessment and clinical reasoning in neurological physiotherapy through five interconnected studies. A systematic review (Study 1) identified the five most frequently assessed domains in clinical practice: function, postural alignment and symmetry, gait, balance, and muscle strength. There was minimal evidence for factors impacting inclusion of assessment domains. This informed a national survey (Study 2) investigating physiotherapy assessment practices, barriers, and enablers in clinical settings. The survey revealed variability in assessment practices, with barriers and enablers related to therapist caseload, knowledge, and intrinsic patient factors.
Gaps identified in the survey led to a scoping review (Study 3) exploring clinical reasoning in practice and examining theoretical frameworks. Twenty-five conceptual clinical reasoning frameworks were identified, with the International Classification of Functioning reported most frequently. Key components of clinical reasoning included initial information gathering, objective examination, movement analysis, predicted patient performance, and evaluation/reassessment.
Building on these findings, a mixed-methods study (Study 4) explored the teaching of neurological assessment in pre-registration physiotherapy courses. Curriculum content was found to be taught using foundational modules, with themes of expectations, scaffolding, context, complexity, and clinical reasoning identified. Finally, a qualitative study (Study 5) explored physiotherapy students' perspectives on neurological assessment and clinical reasoning, revealing five major themes: process and components of assessment, treatment planning, patient-centred care, learning clinical reasoning, and assumptions and biases.
The thesis findings highlight a gap between clinical practice and education in neurological physiotherapy assessment and clinical reasoning. To bridge this gap, an evidence-based framework derived from identified frameworks and components could guide students and clinicians, providing a more consistent approach to the clinical reasoning process. This aligns with the clinical reasoning components outlined by WCPT (2011) and the physiotherapy threshold requirements (Physiotherapy Board of Australia and New Zealand, 2023).
In conclusion, this comprehensive exploration of assessment and clinical reasoning in neurological physiotherapy underscores the need for greater alignment between clinical practice and educational approaches. By addressing this gap, we can better prepare future physiotherapists to meet the complex challenges of neurological assessment and treatment, ultimately improving patient care and outcomes.
Further research is needed to:
• Develop an evidence-based framework in neurological physiotherapy, which reflects the clinical reasoning components outlined by World Physiotherapy and the physiotherapy threshold requirements of Australia and New Zealand.
• Explore scaffolded teaching of clinical reasoning in neurology and assess the effectiveness of this intervention.
Keywords: Neuroloigcal physiotherapy, assessment, clinical reasoning, clincial decision making, education, teaching, clinical practice, physiotherapoy students, standards, thresholds, framework
Subject: Medicine thesis
Thesis type: Doctor of Philosophy
Completed: 2025
School: College of Nursing and Health Sciences
Supervisor: Associate Professor Maayken van den Berg