The ""Health Profile"": a didactic tool for clinical reasoning.

Introduction
Physical therapy students of the Vrije Universiteit Brussel are trained to acquire the clinical reasoning competence by using a didactic tool, called "health profile" (HP). HP is a 13-step didactic tool that helps to structure the clinical interview in order to obtain the necessary information concerning the patient's health status. It encompasses several conceptual models like the International Classification of Functioning and the importance of the patient's participation in establishing treatment goals. In this study, the usability and the clinical impact of the HP was tested in a group of physical therapists.
Methods
First, therapists were asked to read a case study and consequently answer questions relating to the patient's examination, prognosis and treatment goals. Second, subjects were informed about the HP and its conceptual models (e.g., International Classification of Functioning), followed by a workshop in which they were trained to use the HP in a case study. Third, subjects were asked to use the HP in five new patients. Fourth, the subjects were asked to read a second case study and answer the same questions as before. Fifth, subjects were questioned about their experience with the HP and their knowledge of ICF dimensions by using a semi-structured interview. The answers on the case studies were evaluated by two independent researchers. They used a checklist to assess how many items of the HP were used in the answers to the questions (max score 84). The interviews were analyzed and keywords for positive and negative comments on the HP were listed. Every comment was than assigned to a keyword. The number of reports that act in accordance with a keyword were provided as percentages of the total number of subjects.
Results
Twenty-six physical therapists were included in this study. Six of them were graduated within the last 10 years. No significant difference was found between the scores of both case studies. The interview revealed that the majority of therapists have a limited knowledge of the Dutch ICF-dimensions for body functions and structure, activity, personal factors and environmental factors. However, all therapists that graduated within the last 10 years defined these dimensions correctly and 67% of them indicated that they apply ICF into their clinical reasoning (vs 37% of the more experienced therapists of whom 11% use ICF). Therapists found that the HP is user-friendly (68%), that it contributes to a more profound description of the health status (70%) and that it is an acceptable time investment (80%). However, most therapists are convinced that HP does not influence the physical examination (85%). A small portion indicate that HP changes the way of clinical handling (27%) and that it influences treatment goals (19%).
Conclusion
In contrast to older therapist, younger therapist have better knowledge of ICF dimensions and implement them more frequently into practice. Older therapists are convinced that HP may help them to describe the patient's health, a workshop is not enough to implement the HP into practice.