KanaeTakahashi_A Network Analysis of Clinical Reasoning after Femoral Transverse Fracture Surgery: A Comparison by Years of Experience_TPTA

Clinical reasoning requires organizing extensive patient information. However, Japanese physical therapist schools provide an insufficient curriculum for clinical reasoning, leading to less-experienced physical therapists struggling with information structuring. We examined the differences in clinical reasoning between less-experienced and more-experienced physical therapists to clarify how years of experience influence their reasoning capabilities.

1. ANetworkAnalysisofClinicalReasoning
afterFemoralTransverseFracture Surgery:
A Comparison by Years of Experience
KanaeTakahashi
1,2
HirofumiHori
3
MitsunoriMatsushita
1
1，Kansai University
2，Higashi-OsakaHospital
3,，KonanWomen’s University
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2. Background
Clinical reasoning
The process of identifyingthe patient's problem
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3. Background
Clinical reasoning
The process of identifyingthe patient's problem
3
However
the framework of the reasoning process is
not well-structured.

4. Background
Clinical reasoning is not well structured
Clinical reasoning changeswith
Hospitals andclinics,the therapist’s experience
4
Because

5. Background
In particular, Clinical reasoning changeswith
the therapist’s individual experience
many less-experienced physical therapists
in Japan strugglewith clinical reasoning
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6. Background → Purpose
structuring clinical reasoning is an urgent task
for providing better physical therapy.
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we make a structure and show
clinical reasoning as a network.

7. Purpose & Research Question
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Research Question1：With more experience
does clinical reasoning become more complex?
Research Question2：With more experience,
does extensive clinical reasoning?
Purpose：Network analysis clinical reasoning and
compare it by years of experience.

8. Purpose & Research Question
8
Research Question2：With more experience,
does extensive clinical reasoning?
Purpose：Network analysis clinical reasoning and
compare it by years of experience.
Research Question1：With more experience
does clinical reasoning become more complex?

9. Methods: Experiment
Number of participants: 20 people
a less-experienced group (1–2 years) 10 people
a more-experienced group (6–13 years) 10 people
Experimental method:
STEP1Participants were presented with simulated patient
data after femoral transverse fracture surgery
STEP2Participants were asked to select the necessary tests,
possible problems, and body parts.
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10. Methods:
Network analysis methods for clinical reasoning
Clinical reasoning structure was visualized using NetworkX,a Python library.
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patient →problem →body part →tests
This is the Node.
This is the Edge.
Edges connect the nodes.
the mean degree:
Average number of edges
connected to each node
Basic network

11. Methods:
Network analysis methods for clinical reasoning
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muscle
function
Walking-gait-orservation
patient
ROM(Hip extention)
Gluteus
Maximus
example
Nodes= 6
Edges= 5
the mean degree = 1.67
Average number of edges
connected to each node
MMT(Hip extention)

12. Methods:
Network analysis methods for clinical reasoning
12
muscle
function
Walking-gait-orservation
patient
ROM(Hip extention)
GMAX
example
Nodes= 6
Edges= 5
MMT(Hip extention)
Focus on!
the mean degree = 1.67
Average number of edges
connected to each node

13. Methods:
Network analysis methods for clinical reasoning
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Hypothesis
the mean degree＝The complexity of clinical reasoning
Does the number of years of experience
affect the mean degree?

14. Analysis & statistics
We calculatedthe mean numbers of nodes and edges,
the mean degree for the two groups.
The comparison between the two groups of
the mean degree was
performed using the Mann-Whitney U test.
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Analysis 1

15. Results
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the mean nodes the mean egdes
-experienced
25.8 ±17.5 106.4±115.2, 6.03±3.91
-
34.2 ±20.8 145.5±174.4 6.28 ±4.87
•The Mann-Whitney U test showed no significant difference
in k̄between groups(U = 48.0, p = 0.910, r = 0.03).
•Mean ±SD values were as followsAnalysis 1

16. Research Question1：With more experience
does clinical reasoning become more complex?
Purpose & Research Question
16
Purpose：Network analysis clinical reasoning and
compare it by years of experience.
Research Question2：With more experience,
does extensive clinical reasoning?

17. Methods:
Network analysis methods for clinical reasoning
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Analysis 2We assessed the extensive of clinical reasoning
by visualizing networks.
A less-experienced group(n=10) A more-experienced group(n=10)

18. 18A less-experienced group(n=10) A more-experienced group(n=10)
Which problems, body parts, tests
are the two groups focusing on?

19. Methods:
Network analysis methods for clinical reasoning
we investigated paths
from the problem node to the test node
that wereselected by 5 out of 10 people in each group.
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Analysis 2
lack-free paths

20. Results: Path Patterns
(A less-experienced group)
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A less-experienced group focused on
combinations of
“muscle function→hip /knee muscles→MMT.”
MMT
Muscle function
ROM
NRS
（Pain）
FIM
Hip muscle
Knee muscle
Joint mobility
Pain
Walking pattern
Muscle endurance
Joint stability

21. Results: Path Patterns
(A more-experienced group )
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a more-experienced group also considered pain-related
pathways such as
“pain sensation →hip/knee muscles →NRS/tenderness.
MMT
NRS
tenderness
ROM
FIM,BI
Muscle function
Pain
Hip muscle
Knee muscle
Joint mobility
Walking pattern

22. Conclusion
•Therewasnodifferenceinthemeandegree,andtheeffectsize
wasminimal，Suggestingthatthemeandegreedoesnot
dependonyearsofexperience.
•However, qualitative evaluation of the network showed that the
more experienced group was able to engage in broader clinical
reasoning.
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23. Clinical Significance
Networkvisualizationofclinicalreasoningstructureis
effectiveforsupportingclinicalreasoningeducation.
1.becauseitrevealsbiasesinclinicalreasoning.
2.becauseclinicalreasoningrevealstherelationshipbetween
thecombinationofproblems,bodyregions,andtests.
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24. Summary
Background: Structure of clinical reasoning is not well-developed．
Less-experienced physical therapists struggling with organizing information.
Purpose : To examine the impact of years of experience on clinical reasoning.
Methods: Clinical reasoning structure was visualized using NetworkX.
Analysis : We calculated the mean numbers of nodes and edges , the mean degree for the two
groups. the mean degree values were compared between groups using a U test.
Results: The Mann-Whitney U test showed no significant difference in the mean degree between
groups．A less-experienced group focused on the three combinations of “muscle function→hip
muscles→MMT.” In contrast, a more-experienced group also considered pain-related pathways
such as “pain sensation →hip muscles →NRS/tenderness.
Conclusion:Suggesting that the density of connections does not depend on years of experience.
Nonetheless, a more-experienced group addressed a broader range of problems-including pain-.
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