Why all this?

As soon-to-be physical therapists, we felt the burning need to develop our own clinical reasoning skills. Working with paper case studies was a major focus in our second year courses and we came to the conclusion that it was unnecessarily difficult to make order out of the data chaos. We had our first encounter with the HOAC II during the second half of the year and started to use parts of it in our case studies. It worked! Even the small HOAC II steps we applied made a lot of sense and helped us communicate our ideas about the case in a logical and structured way.

The American Physical Therapy Association (APTA) developed Vision 2020 as their official vision statement for the future of physical therapy (APTA 2000). The vision calls for autonomous physical therapy practice that is characterised by independent, self-determined professional judgement and action. It is well-noted that clinical reasoning skills are at the heart of professional accountability and autonomy (Rothstein et al. 2003, Edwards et al. 2004, Higgs et al. 2011). Importantly for students and novice physical therapists, research has concluded that expertise in physical therapy is not necessarily based on the years of experience but rather on the development of advanced clinical decision making skills (Resnik et al. 2003, Atkinson et al. 2011).

To accommodate for the development of clinical reasoning skills, regulatory bodies and educational institutions seek solutions to implement sound clinical reasoning frameworks into their practice guidelines, curricula and continuing education programmes (de Bakker 2011, Engelbert 2011). However, the complexity and abstract nature of the subject have made such an implementation a major challenge.

Consequently, finding ways to practice case-based clinical reasoning outside the clinical settings remains a challenge for students and clinicians alike. It seems that internationally recognised clinical reasoning frameworks appear too complex and big in theory for them to deliberately employed in studies and practice routines.

This is where getPTsmart.com fits in.

For students & clinicians

With the help of getPTsmart.com students and physical therapists can engage in develping their clinical reasoning skills in a contemporary, time-independent environment that serves as a link between the classroom and clinical practice. getPTsmart.com is primarily targeted for physical therapy students in the last year of their entry level education as well as for novice physical therapists. During the development of the site, the target group is mainly represented by third year students of the European School of Physiotherapy (ESP), Amsterdam, the Netherlands.

For teachers & professors

Teachers and professors are encouraged to use getPTsmart.com in their clinical reasoning modules. The case studies or parts of them serve as self-explanatory preparatory homework material. The differences in the students’ solutions and the provided solutions will then serve as discussion points in the following class.


  • American Physical Therapy Association. Vision 2020 [online]. Alexandria: American Physical Therapy Association; 2000 [last update 4/2011; cited 2011 October 19]. URL: http://www.apta.org/Vision2020.
  • Atkinson HL, Nixon-Cave K. A tool for clinical reasoning and reflection using the International Classification of Functioning, Disability and Health (ICF) framework and patient management model. Phys Ther. 2011;91:416-30.
  • de Bakker P. Professor in Physiotherapy (Hogeschool van Amsterdam, the Netherlands). Personal communication. 18 October 2011.
  • Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen G. Clinical reasoning strategies in physical therapy. Phys Ther. 2004;84:312-35.
  • Engelbert R. Director of education in Physiotherapy (Hogeschool van Amsterdam, the Netherlands). Personal communication. 6 December 2011.
  • Higgs J, Jones M. Clinical decision making and multiple problem spaces. In: Higgs J, Jones MA, Loftus S, Christensen N. Clinical reasoning in health professions. Amsterdam: Elsevier; 2008. p. 4-19.
  • Resnik L, Jensen GM. Using clinical outcomes to explore the theory of expert practice in physical therapy. Phys Ther. 2003;83:1090-106.
  • Rothstein JM, Echternach JL, Riddle DL. The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): a guide for patient management. Phys Ther. 2003;83(5):455-70.
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