Questioning, analysing, and forming conclusions based on evidence and reasoning are at the heart of critical thinking. In this way, multiple perspectives are considered, possible biases are recognised, and informed decisions are made. This is a key process in many aspects of life and is especially important for healthcare professionals to improve patient care. With this goal in mind, Vall d’Hebron has led the adaptation and validation of a questionnaire to assess critical thinking among professionals working in physiotherapy, applicable across different work settings. The project was funded by the Official College of Physiotherapists of Catalonia, and was carried out in collaboration with Hospital Clínic, Hospital de Bellvitge, Hospital de la Santa Creu i Sant Pau, Hospital del Mar, and Hospital Germans Trias i Pujol, as well as the Methodology, Methods, Models and Outcomes of Health and Social Sciences research group at the University of Vic – Central University of Catalonia. The results have been published in the journal Clinical Rehabilitation.

Critical thinking makes it possible to analyse each clinical situation more reflectively and rigorously. “This translates into a greater ability to adapt treatments to each patient’s individual needs, anticipate potential risks, assess therapeutic options based on scientific evidence, and make safer, better-founded decisions. Ultimately, this improves the quality and safety of physiotherapy care”, says Beatriz Hernández Méndez, physiotherapist at the Physical Medicine and Rehabilitation Department of Vall d’Hebron University Hospital, principal investigator of the Multidisciplinary Nursing Research Group at Vall d’Hebron Research Institute (VHIR) and first author of the study.

Until now, physiotherapists had no validated tools to assess critical thinking in their clinical practice. To address this need, the research team adapted a questionnaire originally designed for nursing clinical practice so that it reflects the clinical context and terminology of physiotherapy.

In the study, the questionnaire was administered to 235 physiotherapists, 108 of whom completed it again two weeks later to check the stability of the results. “We have demonstrated its validity and reliability for the physiotherapy profession as a whole; it is not limited to a particular specialty or setting. It can be useful in hospital care, health centres, private clinics, nursing homes, or any other place where physiotherapists work”, Hernández explains. “This questionnaire represents a step forward for physiotherapy in Spain, as it provides, for the first time, a valid and reliable tool to measure a key competence in clinical decision-making”, she adds.

A questionnaire to assess four dimensions of critical thinking

The questionnaire contains 109 questions and takes around 15 minutes to complete. The questions are grouped into four dimensions that allow precise measurement of different aspects of the physiotherapist’s critical thinking:

• Personal characteristics (attitudes, beliefs, and values that act as a trigger for thinking skills)
• Intellectual or cognitive skills (knowledge related to decision-making in the professional context)
• Interpersonal and self-management skills (abilities that promote therapeutic communication)
• Technical skills (knowledge and experience in profession-specific procedures)

For example, it assesses the application of knowledge derived from scientific evidence in clinical practice, the performance of a systematic and organised assessment to identify deficits, activity limitations, participation restrictions and/or environmental barriers or facilitators for patients, as well as the safe delivery of treatments (including dosage, precautions, contraindications, etc.).

Once completed, it provides an overall score and a specific score for each dimension, classifying the level of critical thinking in clinical practice as low, moderate, or high.

The questionnaire is currently available for any interested centre to use for training or research purposes. The ultimate aim is for it to be used as a self-assessment or continuing education tool, ideally in moments of professional reflection, for example, after internal training sessions or as part of quality improvement processes in healthcare.