Academic Journal
Προβολή σε EDS

Exploring clinical reasoning in physical and occupational therapists treating frail older adults in skilled nursing facilities: a Delphi study.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος: Exploring clinical reasoning in physical and occupational therapists treating frail older adults in skilled nursing facilities: a Delphi study.
Συγγραφείς: Bloch T; Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building 106 Carrigan Drive, Burlington, VT 05405-0160, USA., Melekis K; Department of Social Work, University of Vermont, Burlington, VT, USA., Failla M; Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building 106 Carrigan Drive, Burlington, VT 05405-0160, USA., Escorpizo R; Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building 106 Carrigan Drive, Burlington, VT 05405-0160, USA.
Πηγή: Age and ageing [Age Ageing] 2026 Sep 04; Vol. 55 (9).
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Oxford University Press Country of Publication: England NLM ID: 0375655 Publication Model: Print Cited Medium: Internet ISSN: 1468-2834 (Electronic) Linking ISSN: 00020729 NLM ISO Abbreviation: Age Ageing Subsets: MEDLINE
Imprint Name(s): Publication: Oxford : Oxford University Press
Original Publication: London, Baillière, Tindall.
Ιατρικοί όροι (MeSH): Occupational Therapists*/psychology , Physical Therapists*/psychology , Frailty*/psychology , Frailty*/diagnosis , Frailty*/rehabilitation , Frailty*/therapy , Skilled Nursing Facilities* , Frail Elderly* , Clinical Reasoning* , Occupational Therapy*, Humans ; Delphi Technique ; Aged ; Female ; Male ; Activities of Daily Living ; Consensus ; Geriatric Assessment ; Cognition ; Aged, 80 and over ; Canada ; Middle Aged
Περίληψη: Frailty is highly prevalent in skilled nursing facilities (SNFs), yet little is known about how physical and occupational therapists (PTs/OTs) apply clinical reasoning (CR) when designing and progressing EPs for frail older adults. This study used a three-round Delphi method (DM) to generate expert consensus on the reasoning strategies therapists employ in SNF practice. Licensed PTs and OTs from the USA and Canada were recruited through professional directories and completed iterative surveys focused on assessment, goal-setting and intervention adaptation. Round 1 consisted of open-ended questions analysed through thematic coding; Rounds 2 and 3 involved Likert-scale ratings of synthesised statements, with consensus defined as ≥75% agreement. Forty-four therapists participated in Round 1, with 39 completing all rounds (89% retention). Participants represented a wide range of experience levels and both professional disciplines. Five core themes reached consensus: (i) engagement in therapy, emphasising meaningful, patient-centred activities to enhance motivation; (ii) mobility and movement confidence, reflecting the importance of addressing fear of falling and psychological readiness; (iii) functional outcomes and endurance, prioritising activities aligned with real-world activities of daily living (ADLs) and stamina; (iv) pain and cognition, recognising daily fluctuations that require dynamic clinical adjustment and (v) task-specific interventions, integrating ADL-focused and dual-task activities to promote carryover and ecological validity. These findings illustrate the complexity and adaptability of therapist decision-making when treating frail older adults in SNFs. The themes highlight how PTs and OTs integrate patient goals, functional demands and fluctuating physical and cognitive status into individualised exercise planning. This study provides a foundation for developing frailty-focused education, clinical pathways and interdisciplinary guidelines to support high-quality rehabilitation in SNFs.
(© The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Contributed Indexing: Keywords: clinical reasoning; frailty; older people; physical and occupational therapy; rehabilitation; skilled nursing facilities
Entry Date(s): Date Created: 20260924 Date Completed: 20260924 Latest Revision: 20260930
Update Code: 20260930
DOI: 10.1093/ageing/afag293
PMID: 42784539
Βάση Δεδομένων: MEDLINE
FullText Text:
  Availability: 0
CustomLinks:
  – Url: https://resolver.ebsco.com/c/fiv2js/result?sid=EBSCO:cmedm&genre=article&issn=14682834&ISBN=&volume=55&issue=9&date=20260904&spage=&pages=&title=Age and ageing&atitle=Exploring%20clinical%20reasoning%20in%20physical%20and%20occupational%20therapists%20treating%20frail%20older%20adults%20in%20skilled%20nursing%20facilities%3A%20a%20Delphi%20study.&aulast=Bloch%20T&id=DOI:10.1093/ageing/afag293
    Name: Full Text Finder (for New FTF UI) (ns324271)
    Category: fullText
    Text: Full Text Finder
    MouseOverText: Full Text Finder
Header DbId: cmedm
DbLabel: MEDLINE
An: 42784539
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Exploring clinical reasoning in physical and occupational therapists treating frail older adults in skilled nursing facilities: a Delphi study.
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AU" term="%22Bloch+T%22">Bloch T</searchLink>; Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building 106 Carrigan Drive, Burlington, VT 05405-0160, USA.<br /><searchLink fieldCode="AU" term="%22Melekis+K%22">Melekis K</searchLink>; Department of Social Work, University of Vermont, Burlington, VT, USA.<br /><searchLink fieldCode="AU" term="%22Failla+M%22">Failla M</searchLink>; Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building 106 Carrigan Drive, Burlington, VT 05405-0160, USA.<br /><searchLink fieldCode="AU" term="%22Escorpizo+R%22">Escorpizo R</searchLink>; Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building 106 Carrigan Drive, Burlington, VT 05405-0160, USA.
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="JN" term="%220375655%22">Age and ageing</searchLink> [Age Ageing] 2026 Sep 04; Vol. 55 (9).
– Name: TypePub
  Label: Publication Type
  Group: TypPub
  Data: Journal Article
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: TitleSource
  Label: Journal Info
  Group: Src
  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Oxford+University+Press%22">Oxford University Press </searchLink><i>Country of Publication: </i>England <i>NLM ID: </i>0375655 <i>Publication Model: </i>Print <i>Cited Medium: </i>Internet <i>ISSN: </i>1468-2834 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2200020729%22">00020729 </searchLink><i>NLM ISO Abbreviation: </i>Age Ageing <i>Subsets: </i>MEDLINE
– Name: PublisherInfo
  Label: Imprint Name(s)
  Group: PubInfo
  Data: <i>Publication</i>: Oxford : Oxford University Press<br /><i>Original Publication</i>: London, Baillière, Tindall.
– Name: SubjectMESH
  Label: MeSH Terms
  Group: Su
  Data: <searchLink fieldCode="MM" term="%22Occupational+Therapists%22">Occupational Therapists*</searchLink>/<searchLink fieldCode="MM" term="%22Occupational+Therapists+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Physical+Therapists%22">Physical Therapists*</searchLink>/<searchLink fieldCode="MM" term="%22Physical+Therapists+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Frailty%22">Frailty*</searchLink>/<searchLink fieldCode="MM" term="%22Frailty+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Frailty%22">Frailty*</searchLink>/<searchLink fieldCode="MM" term="%22Frailty+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Frailty%22">Frailty*</searchLink>/<searchLink fieldCode="MM" term="%22Frailty+rehabilitation%22">rehabilitation</searchLink> <br /><searchLink fieldCode="MM" term="%22Frailty%22">Frailty*</searchLink>/<searchLink fieldCode="MM" term="%22Frailty+therapy%22">therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Skilled+Nursing+Facilities%22">Skilled Nursing Facilities*</searchLink> <br /><searchLink fieldCode="MM" term="%22Frail+Elderly%22">Frail Elderly*</searchLink> <br /><searchLink fieldCode="MM" term="%22Clinical+Reasoning%22">Clinical Reasoning*</searchLink> <br /><searchLink fieldCode="MM" term="%22Occupational+Therapy%22">Occupational Therapy*</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Delphi+Technique%22">Delphi Technique</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Activities+of+Daily+Living%22">Activities of Daily Living</searchLink> ; <searchLink fieldCode="MH" term="%22Consensus%22">Consensus</searchLink> ; <searchLink fieldCode="MH" term="%22Geriatric+Assessment%22">Geriatric Assessment</searchLink> ; <searchLink fieldCode="MH" term="%22Cognition%22">Cognition</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%2C+80+and+over%22">Aged, 80 and over</searchLink> ; <searchLink fieldCode="MH" term="%22Canada%22">Canada</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Frailty is highly prevalent in skilled nursing facilities (SNFs), yet little is known about how physical and occupational therapists (PTs/OTs) apply clinical reasoning (CR) when designing and progressing EPs for frail older adults. This study used a three-round Delphi method (DM) to generate expert consensus on the reasoning strategies therapists employ in SNF practice. Licensed PTs and OTs from the USA and Canada were recruited through professional directories and completed iterative surveys focused on assessment, goal-setting and intervention adaptation. Round 1 consisted of open-ended questions analysed through thematic coding; Rounds 2 and 3 involved Likert-scale ratings of synthesised statements, with consensus defined as ≥75% agreement. Forty-four therapists participated in Round 1, with 39 completing all rounds (89% retention). Participants represented a wide range of experience levels and both professional disciplines. Five core themes reached consensus: (i) engagement in therapy, emphasising meaningful, patient-centred activities to enhance motivation; (ii) mobility and movement confidence, reflecting the importance of addressing fear of falling and psychological readiness; (iii) functional outcomes and endurance, prioritising activities aligned with real-world activities of daily living (ADLs) and stamina; (iv) pain and cognition, recognising daily fluctuations that require dynamic clinical adjustment and (v) task-specific interventions, integrating ADL-focused and dual-task activities to promote carryover and ecological validity. These findings illustrate the complexity and adaptability of therapist decision-making when treating frail older adults in SNFs. The themes highlight how PTs and OTs integrate patient goals, functional demands and fluctuating physical and cognitive status into individualised exercise planning. This study provides a foundation for developing frailty-focused education, clinical pathways and interdisciplinary guidelines to support high-quality rehabilitation in SNFs.<br /> (© The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
– Name: SubjectMinor
  Label: Contributed Indexing
  Group:
  Data: <i>Keywords: </i>clinical reasoning; frailty; older people; physical and occupational therapy; rehabilitation; skilled nursing facilities
– Name: DateEntry
  Label: Entry Date(s)
  Group: Date
  Data: <i>Date Created: </i>20260924 <i>Date Completed: </i>20260924 <i>Latest Revision: </i>20260930
– Name: DateUpdate
  Label: Update Code
  Group: Date
  Data: 20260930
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1093/ageing/afag293
– Name: AN
  Label: PMID
  Group: ID
  Data: 42784539
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42784539
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1093/ageing/afag293
    Languages:
      – Code: eng
        Text: English
    Subjects:
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Delphi Technique
        Type: general
      – SubjectFull: Aged
        Type: general
      – SubjectFull: Female
        Type: general
      – SubjectFull: Male
        Type: general
      – SubjectFull: Activities of Daily Living
        Type: general
      – SubjectFull: Consensus
        Type: general
      – SubjectFull: Geriatric Assessment
        Type: general
      – SubjectFull: Cognition
        Type: general
      – SubjectFull: Aged, 80 and over
        Type: general
      – SubjectFull: Canada
        Type: general
      – SubjectFull: Middle Aged
        Type: general
      – SubjectFull: Occupational Therapists psychology
        Type: general
      – SubjectFull: Physical Therapists psychology
        Type: general
      – SubjectFull: Frailty psychology
        Type: general
      – SubjectFull: Frailty diagnosis
        Type: general
      – SubjectFull: Frailty rehabilitation
        Type: general
      – SubjectFull: Frailty therapy
        Type: general
      – SubjectFull: Skilled Nursing Facilities
        Type: general
      – SubjectFull: Frail Elderly
        Type: general
      – SubjectFull: Clinical Reasoning
        Type: general
      – SubjectFull: Occupational Therapy
        Type: general
    Titles:
      – TitleFull: Exploring clinical reasoning in physical and occupational therapists treating frail older adults in skilled nursing facilities: a Delphi study.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Bloch T
      – PersonEntity:
          Name:
            NameFull: Melekis K
      – PersonEntity:
          Name:
            NameFull: Failla M
      – PersonEntity:
          Name:
            NameFull: Escorpizo R
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 04
              M: 09
              Text: 2026 Sep 04
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1468-2834
          Numbering:
            – Type: volume
              Value: 55
            – Type: issue
              Value: 9
          Titles:
            – TitleFull: Age and ageing
              Type: main
ResultId 1