Contextual factors influencing Canadian physiotherapists’ clinical reasoning about older adult clients’ finances and economics: A qualitative descriptive study
Bibliographic record
Abstract
INTRODUCTION: While physiotherapy can be beneficial for older adults, many experience financial barriers to accessing physiotherapy services. There is limited published evidence regarding how physiotherapists consider client finances in their work. PURPOSE: This study aimed to explore Canadian physiotherapists' current practice regarding the inclusion of clients' financial or economic context in clinical reasoning and to identify possible ways to improve physiotherapy services access. METHODS: We interviewed nine physiotherapists practicing in Manitoba, Canada, using an in-depth semi-structured guide. We recorded and transcribed each interview and then analyzed transcripts thematically, building upon reflexive thematic analysis and framework approaches. RESULTS: We generated three themes through our analysis: (1) considering older adults' finances in clinical reasoning depends on contextual factors internal and external to the physiotherapists, (2) learning about clients' finances influenced physiotherapists' clinical reasoning, and (3) physiotherapists used varied approaches to address the needs of clients with limited finance. Internal factors included physiotherapists not knowing how to discuss finances with clients and physiotherapists' need to make a liveable wage. External factors included limited resources available to address the needs of clients with limited finances and physiotherapists' caseloads. CONCLUSIONS: Including older adults' finances in clinical reasoning is a complex process. There may be a need for systemic changes, such as provision of workplace processes and resources, to encourage physiotherapists to include clients' finances in clinical reasoning. The findings point to the need for educational programs for physiotherapists to ensure comfort and confidence with including finances as part of their standard practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.020 | 0.010 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".