The public defense of Maria Elvén's doctoral thesis

Doctoral thesis and Licentiate seminars

Datum: 2019-05-24
Tid: 09.30 - 12.00
Plats: Room Beta, Västerås

Welcome to the public defense of Maria Elvén's doctoral thesis at Mälardalen University in Västerås.

Title: Clinical reasoning focused on clients’ behaviour change in physiotherapy. Development and evaluation of the Reasoning 4 Change instrument 

The faculty examiner is Professor Lena Nilsson-Wikmar, Karolinska Institutet, and the examining committee consists of associate professor Christina Gummesson, Lund University, Professor Ulf Jakobsson, Lund University och associate professor Nina Brodin, Karolinska Institutet.
Reserve: associate professor, Peter Larm, Mälardalen University
Number 289


With the recognition of the impact of lifestyle behaviours on health and the evidence of incorporating biopsychosocial and behavioural considerations in physiotherapy, there is a need to advance the clinical reasoning of physiotherapists from a traditional focus on clients’ physical functions to also include psychosocial factors and clients’ behaviours. Clinical reasoning encompasses physiotherapists’ thinking and decision-making processes in assessment, analysis and treatment and is a core competency of physiotherapists. Enabling clinical reasoning advancements requires investigations in practice and education, which in turn requires robust assessments. The overall aim of this thesis was to develop and evaluate an instrument to study physiotherapy students’ clinical reasoning focused on clients’ activity-related behaviour and behaviour change. 

In study I, the clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists (CRBC-PT) was developed based on existing research, theory and views of physiotherapists and students. In studies II and III, the items of the instrument were developed based on the CRBC-PT model and existing measures. Also, physiotherapists with expertise in behavioural medicine and students responded to the instrument for evaluation of the instrument’s measurement properties. The final web-based version of the Reasoning 4 Change instrument (R4C) demonstrated satisfactory measurement properties and included four parts, namely, Physiotherapist, Input from client, Functional behavioural analysis, and Strategies for behaviour change. In study IV, 151 final-semester students from all physiotherapy programmes in Sweden completed the R4C instrument. The findings showed that all included individual- and curriculum-level factors were associated with the students’ clinical reasoning performance in ‘Input from client’. Students’ analytical and reflective skills highly explained their performance, followed by attitudes and curriculum with behavioural medicine competencies. Only curriculum with behavioural medicine competencies was associated with the students’ performance in ‘Functional behavioural analysis’ and ‘Strategies for behaviour change’.

In conclusion, the in-depth description of clinical reasoning presented in this thesis may contribute to an expanded understanding of the complexity in reasoning processes that incorporate factors related to human behaviours, analyses of what factors motivates or hinders behaviours and interventions to support behaviour change. Such knowledge is valuable for the teaching of and learning clinical reasoning. The R4C instrument helps fill the need for well-tested instruments and can support investigations and evaluations in physiotherapy education and research. To develop students’ clinical reasoning competence, analytical and reflective skills, positive attitudes and the incorporation of behavioural medicine competencies in physiotherapy curricula should be targeted. Further attention to complex reasoning, including analysis and treatment, is warranted.



Key words: Assessment; Behaviour change; Clinical reasoning; Education; Functional behavioural analysis; Physiotherapy, Reliability; Scale development; Validity