Table 2 Themes and associated list of biases identified within the data
Theme | Possible sources of bias |
|---|---|
Variability in diagnostic processes and lack of standardised practice | |
Differences in diagnoses and diagnostic processes | Insufficient knowledge regarding classification systems which limited discussion regarding use of research to justify decisions in clinical practice |
Diagnostic process occurs over a long period of time | Diagnostic processes involved a wide range of tests and rehabilitation methods. Physiotherapy was often perceived to be the correct starting place for patients to try ‘a few treatment sessions before [they] started considering those other investigations’ There was a desire to see if they could enact change within the patient during a physiotherapy appointment, indicting there was a perceived role for physiotherapy |
Diagnostic test choices influenced by factors beyond objective markers associated with the patient injury | Time, access and cost were perceived as barriers to additional diagnostic tests which may be beneficial to patients Barriers used to justify prioritising physiotherapist-based tests and assessments as standard practice instead of technology-based tests Prioritised the information collected from the physiotherapist over that using technological means Participants with higher levels of activity, more likely to have referrals for technology-based objective testing in a shorter time frame Tied in with this was an example where despite having similar levels of activity between male and female vignettes, the male vignette was only offered onward referral (gender bias) |
Planning for prognosis is influenced by a number of factors | Diagnostic processes and decisions regarding management influenced by previous clinical experience and knowledge whether the treatment was likely to be effective Psychosocial influences were generally perceived to be only relevant for the female vignettes in a negative way |
Knowledge and attitudes towards novel technologies for facilitating assessment and clinical decision making | |
Trust in staff relationships General distrust of individuals or modes of medicine used outside of the department | Evident in discussions regarding medical professionals outside of their department in relation to the patient vignettes The physiotherapists in the focus groups described additional checks which they would undertake due to them not trusting other professionals’ practices and abilities |
Trust in staff relationships Unity within the department | Very few disagreements within the departments. Verbally confirmed and structurally apparent in the construction of the group discussions Evidence of a medical hierarchy within the group and practice |
Lack of knowledge and rejection of 3D motion capture | Lack of knowledge limiting participants using technology which could facilitate decision making General trend for the participants to not pursue the use of any technology unless it was perceived as necessary Perception that having additional information or data will not benefit the diagnostic process if cannot be understood or usefully integrated into the current practice |