Abstract
Most physiotherapists would agree the need to establish effective working relationships with their patients in order to achieve successful outcomes in therapy. Collaboration, as an entity in clinical practice, has continued to increase in importance due to a changing climate of healthcare. Traditional models of physiotherapy treatment based on the medical model and delivered in acute settings are giving way to newer models of practice, such as health promotion, that are patient or client centred and increasingly located in community settings. At the same time, the notion of patient compliance with physiotherapy advice and exercises, deriving from a medical model of practice, is being superseded by the notion of collaborative decision making (or reasoning) in physiotherapy. Recent physiotherapy literature suggests that collaborative decision making is an advanced clinical skill, while also casting doubt on just how well or consistently physiotherapists are able to set goals with their patients and nurture a collaborative approach in working towards those goals. The purpose of this article is to demonstrate how clinical reasoning is an ideal vehicle by which physiotherapy practitioners can reflect on the process of collaboration with their patients in clinical practice. Three particular forms of collaboration are identified which can be traced to different assumptions about knowledge and how this knowledge is both generated and used by practitioners in clinical practice. In this paper, we argue that these different forms of collaboration each have an important role in clinical practice as they address both the diversity and underlying nature of those treatment goals that may be seen as desirable from the perspective of either practitioner or patient. In turn, these forms of collaboration assist in the development of a variety of knowledge and skills for both practitioners and patients alike.