HirofumiHori_Clinical Reasoning “Breadth” and “Depth” of Physical Therapists in the Post-operative Management of Femoral Neck Fracture: An ICF-Based Descriptive Study_TPTA

The quality of physiotherapists’ clinical reasoning is a key determinant of patient recovery, yet objective descriptors of its multilayered nature remain scarce. Using the International Classification of Functioning, Disability and Health (ICF), we quantified two complementary indices—breadth and depth—to chart how physiotherapists (PTs) appraise a standardised postoperative femoral neck fracture case over time.

1. BREADTH AND DEPTH OF
CLINICAL REASONING IN
PHYSIOTHERAPISTS
A DESCRIPTIVE STUDY BASED
ON THE ICF
Hirofumi Hori¹*, Kanae Takahashi² ³, MitsunoriMatsushita³
¹ Department of Physical Therapy, Faculty of Nursing & Rehabilitation,
Konan Women’s University, Hyōgo, Japan
² Department of Rehabilitation, Higashi-Osaka Hospital, Osaka, Japan
³ Faculty of Informatics, Kansai University, Osaka, Japan

2. OVERVIEW
•Problem: Objective, multilayered metrics for clinical reasoning
are scarce.
•Idea: ICF lets us quantify what we capture (Breadth) and how
far we link (Depth).
•Goal: Track changes POD7 → POD30 in a standardised hip-
fracture case.
ICF=International Classification of Functioning, Disability and Health
POD=Postoperative Delirium

3. BACKGROUND
CASE REPORTS AND CLINICAL REASONING
•In Japan, case reports are not necessarily mandatory in
undergraduate or postgraduate physiotherapy education.
•Although they are required within the Registered
Physiotherapist program, only about 50% of new graduates
register with the Japanese Physical Therapy Association,
which reduces opportunities to produce case reports.
•As a result, opportunities to verbalise/articulate clinical
reasoning are gradually being lost.

4. BACKGROUND
PERSPECTIVE
Academic
•Clinical reasoning is an essential skill for ensuring the accuracy and reproducibility
of physiotherapistsʼ thinking.
Societal
•In Japan, education in clinical reasoning is insufficient and is largely left to
learning from clinical experience.
Personal
•About 50% of physiotherapists feel their own clinical reasoning is inadequate.
Research
•Objective indicators that describe the structure of clinical reasoning are scarce.
•The ICF model can provide a framework that captures the multilayered
structureof clinical reasoning.

5. RESEARCH QUESTION
Research Questions
•Can clinical reasoning ability be visualized through the
connections among ICF domains?
•Can physiotherapistsʼ level of expertisebe assessed
using the dual indices of breadthand depth?
(This presentation is coordinated with the next speaker, Takahashi.)

6. AIM
Study Approach
•Visualize the sequenceof physiotherapistsʼ reasoning
steps.
•Track how selections shift across the ICF domains̶Body
Functions → Activities → Participation̶based on case
data.
•Examine changes in reasoning on postoperative day 7
(POD7)and day 30 (POD30)for a post–femoral-neck-
fracturecase.

7. CONCEPT
BREADTH AND DEPTH
Use the ICF as the reference framework: Body Functions (b) →
Activities & Participation (d) → Environmental Factors (e).
Breadth = the number of Body Functions (b) items (i.e., the spread of
b-level problems).
Depth =the count of domains present at the same rank along b → d →
e (range 1–3).
Image: breadth = the width of the net; depth = vertical penetration.

8. PARTICIPANTS AND DATA
Physiotherapists: 22 (median clinical experience 4.5 years, range 1–
19); from three hospitals (acute-care and convalescent/rehabilitation-
specialty settings).
Case: Standardized post–femoral-neck-fracture patient, assessed at
postoperative day 7 (POD7) and day 30 (POD30).
Inputs: For each ICF domain, participants listed up to five problems
with linked interventions (free-text entries).

9. METHODS
OPERATIONALISATION& ANALYSIS
•Input per time-point: ≤5 problems + linked interventions in each ICF
domain (free text)
•Breadth = count of unique BF items (1–5)
•Depth = mean # of domains present at same rank (b–d–e, range 1–
3)
•Free text harmonisedvia 50-term ICF synonym dictionary
•Stats: Wilcoxon (paired), Mann–Whitney (experience)

10. RESULTS ①
PRIMARY OUTCOMES
OutcomePOD7
(Mean ±SD)
POD30
(Mean ±SD)Testp-valueEffect size rInterpretati
on
Breadth
(unique BF
items, 1–5)
2.73 ±1.242.14 ±1.08Wilcoxon
signed-rank0.0410.08
Significant
decrease; very
small effect
Depth
(domains
linked per
rank, 1–3)
2.45 ±0.422.69 ±0.49Wilcoxon
signed-rank0.0670.30
Non-
significant
upward trend;
small–to-
moderate
effect

11. RESULTS ②
BODY FUNCTIONS (BF)
RankPOD7 (Item, %)POD30 (Item, %)
1Reduced muscle power, 86%Muscle power, 73%
2Pain, 73% Muscle endurance, 41%
3Joint-mobility restriction, 55%Pain, 41%

12. RESULTS ③
A&P + E
RankPOD7 (Item, %)POD30 (Item, %)
1Short-distance walking, 68%Outdoor walking distance, 59%
2Standing, 55%Stair negotiation, 50%

13. RESULTS ④
SUBGROUP & QUALITY INDICATE
ComparisonGroups (n)Statisticp-valueFinding
Breadth(POD-
pooled median)
≤10 y (n=19) vs
>10 y (n=3)Mann-Whitney U0.58No difference (median 2vs 2)
Depth(POD-
pooled)
≤10 y (n=19) vs
>10 y (n=3)Mann-Whitney U1.00No difference

14. •One-month maturation = Selection
(Breadth↓) + Integration (Depth↑)
•POD (time since surgery)strongly
shapes reasoning structure
•Use Breadth×Depthas an auditable
KPIfor teams
DISCUSSION
SO WHAT?

15. CLINICAL
IMPLICATIONS & LIMITATION
•Teaching novices: target ~3 BF items + ≥1 full
b–d–e chain/case
•Plan for outdoor walking & transport early
•Limits: single standardisedcase; small n;
dictionary-based coding

16. Thank you for your attention
Contact Address
[email protected]