Clinical Decision Making in Pediatric Physiotherapy: A Scoping Review.

Aims

Clinical decision making (CDM) in pediatric physiotherapy is complicated by developmental variability, family-centered care, and age-appropriate child participation. This scoping review mapped the literature to identify frameworks used to study CDM and factors influencing therapists' decisions.

Methods

Following the Arksey and O'Malley framework and PRISMA-ScR reporting checklist, PubMed, Scopus, Web of Science, and the Cochrane Library were searched without date restriction. Empirical qualitative, quantitative, or mixed-methods studies examining CDM in physiotherapy for children and adolescents (0-18 years) were included. Two reviewers independently screened records, extracted data, and synthesized findings thematically.

Results

Twenty-two studies published between 1996 and 2024 were included, concentrated in high-income settings and dominated by qualitative designs. No single framework prevailed; overlapping traditions included ICF-based, family-centered and shared decision-making, motor learning and tacit reasoning, and evidence-based practice approaches. Influencing factors clustered into five domains: clinical/child-related, professional, family/relational, contextual/service-related, and evidence/training-related. Shared decision making was widely endorsed but unevenly implemented; children's participation remained limited. No study linked CDM to patient outcomes.

Conclusions

Pediatric physiotherapy CDM is multidimensional and context-sensitive, marked by conceptual fragmentation and an evidence-practice gap. Future research should prioritize integrative pediatric-specific frameworks, children's voices, outcome-linked studies, and evidence from diverse cultural contexts.