Clinical Reasoning of Occupational Therapists during the Initial Assessment of Physically Disabled Patients

Clinical reasoning lies at the core of the occupational therapy process. Although several models of clinical thinking have been presented in the literature for use by occupational therapists, no empirical studies have been conducted to examine the process in action. This article reports a pilot study of the first component of the occupational therapy process—assessment. Ten therapists, working with patients with physical problems in medical settings, were observed and interviewed as they assessed patients and summarized their impressions. The aim of the study was to describe the reasoning process used to determine functional problems and treatment goals. A six-stage model to describe the reasoning process was derived from the data. The first stage involved a search for medical information and led to the second stage in which assessments were selected. In stages three through six, the assessment plan was implemented, client problems were defined, treatment objectives were specified, and the assessment process was evaluated. The salient features of each stage are described. Overall, the therapists found it difficult to outline the progression of their thoughts. The medical diagnosis played a key role in their thoughts as did the therapist-patient relationship. The therapists' perspective for assessment focused on musculoskeletal and self-care functions. The data were interpreted in the light of the present status of occupational therapy theory.