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The Clinical Reasoning That Guides Therapists in Interpreting Errors in Real-World Performance

Bottari, Carolina PhD, OT; Iliopoulos, Georgia MSc, OT; Wai Shun, Priscilla Lam MSc, OT; Dawson, Deirdre R. PhD, OT

Section Editor(s): Dijkers, Marcel P. PhD; Gordon, Wayne A. PhD

Journal of Head Trauma Rehabilitation: November/December 2014 - Volume 29 - Issue 6 - p E18–E30
doi: 10.1097/HTR.0000000000000029
Original Articles

Objectives: The objective of this study was to examine the reasoning used by clinicians when deciding whether errors observed during the performance of everyday activities were made by clients with acquired brain injury (ABI) or by healthy controls.

Methods: Ninety clinicians observed 27 short video clips of subjects (ABI, healthy controls), carrying out the Baycrest Multiple Errands Test. On the basis of their observations, they classified subjects into either an ABI or healthy control group and specified their reasons. Their reasoning was analyzed using qualitative content analysis.

Results: The majority of the coded material explaining the reasoning behind correct attributions of performance errors to people with ABI related to 3 general themes: (1) inefficient executive functioning, (2) task-related difficulty, and (3) prediction of impact on independence in everyday activities. Clinicians were most successful at identifying neurological subjects when subjects either omitted tasks or took an excessive amount of time to complete the test.

Conclusions: Correctly interpreting performance errors in real-world tests relies on clinicians' observational and clinical reasoning skills combined with their theoretical knowledge of constructs underlying the evaluation. Some clinical signs bear more weight than others when clinicians interpret performance errors to determine whether the behavior is pathological.

Occupational Therapy Program, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada (Dr Bottari and Ms Wai Shun); Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada (Dr Bottari and Mss Iliopoulos and Wai Shun); Rotman Research Unit, Baycrest, Toronto, Canada (Dr Dawson); Department of Occupational Science and Occupational Therapy, and Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, Canada (Dr Dawson); Toronto Rehabilitation Institute, Toronto, Canada (Dr Dawson).

Corresponding Author: Carolina Bottari, PhD, OT, Occupational Therapy Program, School of Rehabilitation, Faculty of Medicine, Université de Montréal, C.P. 6128 Succursale Centre-Ville, Montreal, QC H3C 3J7, Canada (

The research reported here was supported from funding for a team grant on community-based interventions for individuals with traumatic brain injury received from an interprovincial collaboration between the Ontario Neurotrauma Foundation and the Quebec Rehabilitation Research Network.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins